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Acute Patellar Tendon Repair

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Knee Arthroscopy and Knee Preservation Surgery

Abstract

Rupture of the patellar tendon is an infrequent knee extensor mechanism injury. It tends to occur during activities when a violent eccentric contraction of the quadriceps occurs during a flexed knee posture. Patellar tendon ruptures may also occur during less strenuous activity in individuals whose tendons are weakened by systemic illness or who has had the administration of local steroids or systemic use of certain medications (i.e., steroids or fluoroquinolones). Patellar tendon ruptures can therefore represent a spectrum of disease from acute traumatic rupture to rupture due to the final stages of a degenerative tendinopathy that occurs with repetitive microtrauma or systemic processes. The diagnosis of an acute patellar tendon rupture can often be made based on a careful physical exam and evaluating the patellar height on lateral radiographs. Magnetic resonance imaging is useful to rule out concomitant injuries, which is more likely to occur among young individuals with higher energy injury mechanisms. Surgical repair soon after the injury is recommended to achieve optimal results. This is usually accomplished by accurate approximation of the ruptured tendon ends and repair of the torn extensor retinacula if present. In addition to primary tendon repair, augmentation methods to reduce strain on the primary repair and permit early range of motion can be considered. A rehabilitation program that emphasizes early range of motion, protected weight bearing, and quadriceps engagement can improve the patient outcomes of individuals recovering from patellar tendon repairs. Return to activity following acute patellar tendon repairs is favorable with a general high return to work and return to sport after acute primary patellar tendon repairs.

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References

  1. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39(12):1338–44.

    Article  PubMed  Google Scholar 

  2. Chen KK, Chan JJ, Ranson W, Debellis N, Huang HH, Vulcano E, et al. Epidemiology of acute extensor mechanism injuries in collegiate-level athletes in the United States. Sports Health. 2022;14(2):262–72.

    Article  PubMed  Google Scholar 

  3. Lyons JG, Mian HM, Via GG, Brueggeman DA, Krishnamurthy AB. Trends and epidemiology of knee extensor mechanism injuries presenting to United States emergency departments from 2001 to 2020. Phys Sportsmed. 2022:1–10.

    Google Scholar 

  4. Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am. 1981;63(6):932–7.

    Article  CAS  PubMed  Google Scholar 

  5. Garner MR, Gausden E, Berkes MB, Nguyen JT, Lorich DG. Extensor mechanism injuries of the knee: demographic characteristics and comorbidities from a review of 726 patient records. J Bone Joint Surg Am. 2015;97(19):1592–6.

    Article  PubMed  Google Scholar 

  6. Ali Yousef MA, Rosenfeld S. Acute traumatic rupture of the patellar tendon in pediatric population: case series and review of the literature. Injury. 2017;48(11):2515–21.

    Article  PubMed  Google Scholar 

  7. el-Khoury GY, Wira RL, Berbaum KS, Pope TL, Monu JU. MR imaging of patellar tendinitis. Radiology. 1992;184(3):849–54.

    Article  CAS  PubMed  Google Scholar 

  8. Yoo JH, Yi SR, Kim JH. The geometry of patella and patellar tendon measured on knee MRI. Surg Radiol Anat. 2007;29(8):623–8.

    Article  PubMed  Google Scholar 

  9. Ganokroj P, Polklaew T, Lertwanich P. Determination of patellar tendon length for anterior cruciate ligament reconstruction using an anteroposterior knee radiograph. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2018;16:1–7.

    PubMed  PubMed Central  Google Scholar 

  10. McAllister DR, Bergfeld JA, Parker RD, Grooff PN, Valdevit AD. A comparison of preoperative imaging techniques for predicting patellar tendon graft length before cruciate ligament reconstruction. Am J Sports Med. 2001;29(4):461–5.

    Article  CAS  PubMed  Google Scholar 

  11. Wiesinger HP, Seynnes OR, Kösters A, Müller E, Rieder F. Mechanical and material tendon properties in patients with proximal patellar tendinopathy. Front Physiol. 2020;11:704.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pearson SJ, Hussain SR. Region-specific tendon properties and patellar tendinopathy: a wider understanding. Sports Med. 2014;44(8):1101–12.

    Article  PubMed  Google Scholar 

  13. Gilmore JH, Clayton-Smith ZJ, Aguilar M, Pneumaticos SG, Giannoudis PV. Reconstruction techniques and clinical results of patellar tendon ruptures: evidence today. Knee. 2015;22(3):148–55.

    Article  PubMed  Google Scholar 

  14. Soldado F, Reina F, Yuguero M, Rodríguez-Baeza A. Clinical anatomy of the arterial supply of the human patellar ligament. Surg Radiol Anat. 2002;24(3–4):177–82.

    CAS  PubMed  Google Scholar 

  15. Bennett K, Vincent T, Sakthi-Velavan S. The patellar ligament: a comprehensive review. Clin Anat. 2022;35(1):52–64.

    Article  PubMed  Google Scholar 

  16. Hadjicostas PT, Soucacos PN, Berger I, Koleganova N, Paessler HH. Comparative analysis of the morphologic structure of quadriceps and patellar tendon: a descriptive laboratory study. Arthroscopy. 2007;23(7):744–50. Epub 2007 Jul 20

    Article  PubMed  Google Scholar 

  17. Camarda L, D’Arienzo A, Morello S, Guarneri M, Balistreri F, D’Arienzo M. Bilateral ruptures of the extensor mechanism of the knee: a systematic review. J Orthop. 2017;14(4):445–53.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rosa B, Campos P, Barros A, Karmali S, Gonçalves R. Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone-induced tendinopathy. Clin Case Rep. 2016;4(7):678–81.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Van Glabbeek F, De Groof E, Boghemans J. Bilateral patellar tendon rupture: case report and literature review. J Trauma. 1992;33(5):790–2.

    Article  PubMed  Google Scholar 

  20. Webb LX, Toby EB. Bilateral rupture of the patella tendon in an otherwise healthy male patient following minor trauma. J Trauma. 1986;26(11):1045–8.

    Article  CAS  PubMed  Google Scholar 

  21. McKinney B, Cherney S, Penna J. Intra-articular knee injuries in patients with knee extensor mechanism ruptures. Knee Surg Sports Traumatol Arthrosc. 2008;16(7):633–8.

    Article  PubMed  Google Scholar 

  22. Davies SG, Baudouin CJ, King JB, Perry JD. Ultrasound, computed tomography and magnetic resonance imaging in patellar tendinitis. Clin Radiol. 1991;43(1):52–6.

    Article  CAS  PubMed  Google Scholar 

  23. Steele R, Hayden SR, Ward N, Macias M. Patellar tendon rupture bedside diagnosis. J Emerg Med. 2021;60(3):384–6.

    Article  PubMed  Google Scholar 

  24. Turner EHG, Akoh CC, Hetzel SJ, Markhardt BK, Spiker AM. Do intra-articular knee injuries detected by preoperative MRI affect the clinical management of extensor mechanism ruptures? OTA Int. 2021;4(4):e149.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ibounig T, Simons TA. Etiology, diagnosis and treatment of tendinous knee extensor mechanism injuries. Scand J Surg. 2016;105(2):67–72.

    Article  CAS  PubMed  Google Scholar 

  26. Ramseier LE, Werner CM, Heinzelmann M. Quadriceps and patellar tendon rupture. Injury. 2006;37(6):516–9.

    Article  CAS  PubMed  Google Scholar 

  27. Belhaj K, El Hyaoui H, Tahir A, Meftah S, Mahir L, Rafaoui A, et al. Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: series of 25 patients. Ann Phys Rehabil Med. 2017;60(4):244–8.

    Article  CAS  PubMed  Google Scholar 

  28. Matava MJ. Patellar tendon ruptures. J Am Acad Orthop Surg. 1996;4(6):287–96.

    Article  CAS  PubMed  Google Scholar 

  29. Ettinger M, Dratzidis A, Hurschler C, Brand S, Calliess T, Krettek C, et al. Biomechanical properties of suture anchor repair compared with transosseous sutures in patellar tendon ruptures: a cadaveric study. Am J Sports Med. 2013;41(11):2540–4.

    Article  PubMed  Google Scholar 

  30. Lanzi JT, Felix J, Tucker CJ, Cameron KL, Rogers J, Owens BD, et al. Comparison of the suture anchor and Transosseous techniques for patellar tendon repair: a biomechanical study. Am J Sports Med. 2016;44(8):2076–80.

    Article  PubMed  Google Scholar 

  31. Ode GE, Piasecki DP, Habet NA, Peindl RD. Cortical button fixation: a better patellar tendon repair? Am J Sports Med. 2016;44(10):2622–8.

    Article  PubMed  Google Scholar 

  32. Gould HP, Weiner DA, Tomaszewski PM, Parks BG, Abbasi P, Fillar AL. High-strength suture tape augmentation improves cyclic gap formation in Transosseous patellar tendon repair: a biomechanical study. Arthrosc Sports Med Rehabil. 2020;2(5):e469–e73.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mihalko WM, Vance M, Fineberg MJ. Patellar tendon repair with hamstring autograft: a cadaveric analysis. Clin Biomech (Bristol, Avon). 2010;25(4):348–51.

    Article  PubMed  Google Scholar 

  34. Ravalin RV, Mazzocca AD, Grady-Benson JC, Nissen CW, Adams DJ. Biomechanical comparison of patellar tendon repairs in a cadaver model: an evaluation of gap formation at the repair site with cyclic loading. Am J Sports Med. 2002;30(4):469–73.

    Article  PubMed  Google Scholar 

  35. West JL, Keene JS, Kaplan LD. Early motion after quadriceps and patellar tendon repairs: outcomes with single-suture augmentation. Am J Sports Med. 2008;36(2):316–23.

    Article  PubMed  Google Scholar 

  36. Van der Bracht H, Verdonk R, Stuyts B. Augmentation of a patellar tendon repair with an autologous semitendinosus graft. Acta Orthop Belg. 2009;75(3):417–9.

    PubMed  Google Scholar 

  37. El-Desouky II, Mohamed MM, Al Assassi M. Primary repair of ruptured patellar tendon augmented by semitendinosus. J Knee Surg. 2014;27(3):207–13.

    PubMed  Google Scholar 

  38. Ensminger WP, McIff T, Vopat B, Mullen S, Schroeppel JP. Mechanical comparison of high-strength tape suture versus high-strength round suture. Arthrosc Sports Med Rehabil. 2021;3(5):e1525–e34.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Rose MT, Caldwell PE, Vizzi S, Pearson SE. Distal patellar tendon SpeedBridge repair. Arthrosc Tech. 2020;10(1):e9–e13.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Arrigoni P, Brady PC, Burkhart SS. The double-pulley technique for double-row rotator cuff repair. Arthroscopy. 2007;23(6):e1–4.

    Article  Google Scholar 

  41. Fukuda A, Nakazora S, Nishimura A, Kato K. Repair of acute patellar tendon rupture using an internal Brace technique. Case Rep Orthop. 2021;2021:1086625.

    PubMed  PubMed Central  Google Scholar 

  42. Nakashima H, Takahara Y, Uchida Y, Kato H, Itani S, Iwasaki Y. Patellar tendon repair with suture tape augmentation for proximal patellar tendon rupture. Arthrosc Tech. 2022;11(2):e115–e9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Larson RV, Simonian PT. Semitendinosus augmentation of acute patellar tendon repair with immediate mobilization. Am J Sports Med. 1995;23(1):82–6.

    Article  CAS  PubMed  Google Scholar 

  44. Beranger JS, Kajetanek C, Bayoud W, Pascal-Mousselard H, Khiami F. Return to sport after early surgical repair of acute patellar tendon ruptures. Orthop Traumatol Surg Res. 2020;106(3):503–7.

    Article  PubMed  Google Scholar 

  45. Haskel JD, Fried JW, Hurley E, Mojica ES, Alaia MJ, Strauss EJ, et al. High rates of return to play and work follow knee extensor tendon ruptures but low rate of return to pre-injury level of play. Knee Surg Sports Traumatol Arthrosc. 2021;29(8):2695–700.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Division of Sports Medicine, University of Missouri – Columbia, Missouri Orthopaedic Institute, Thompson Laboratory of Regenerative Orthopaedics, Columbia, MO, USA

    Richard Ma

Authors
  1. Richard Ma
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Correspondence to Richard Ma .

Editor information

Editors and Affiliations

  1. Sports Medicine Clinic, Stanford University, Redwood City, CA, USA

    Seth L. Sherman

  2. Orthopaedics, Midwest Orthopaedics at Rush, Chicago, IL, USA

    Jorge Chahla

  3. Complex Knee and Sports Medicine Surgeon, Twin Cities Orthopedics, Edina, MN, USA

    Robert F. LaPrade

  4. Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA

    Scott A. Rodeo

Section Editor information

  1. University of Colorado, Denver, USA

    Rachel Frank

  2. University of Missouri, Columbia, MO, USA

    Clayton W. Nuelle

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Ma, R. (2024). Acute Patellar Tendon Repair. In: Sherman, S.L., Chahla, J., LaPrade, R.F., Rodeo, S.A. (eds) Knee Arthroscopy and Knee Preservation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-29430-3_18

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  • DOI: https://doi.org/10.1007/978-3-031-29430-3_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-29429-7

  • Online ISBN: 978-3-031-29430-3

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