Review Article

Extensor Mechanism Reconstruction for Chronic Patellar Tendon Tears

Authors: Addison Cimino, MD, Kevin C. Wall, MD, MPH, Joseph Elphingstone, MD, Kyle Paul, BS, Alexandra M. Arguello, MD, Aaron Casp, MD, Eugene Brabston, MD, Brent Ponce, MD, Amit Momaya, MD

Abstract

Objectives: Reconstruction for a chronic patellar tendon rupture in a native knee is an uncommon surgical procedure. Although there have been case series investigating patient-reported outcomes, there is no systematic review of these studies to date. The purpose of this review is to synthesize the literature on this procedure to better understand its outcomes, complications, and surgical technique options.

Methods: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies that reported outcomes and techniques of patellar tendon reconstruction for chronic disruption in native knees. Searches were conducted through MEDLINE using PubMed, Cochrane Database of Systematic Reviews, and clinicaltrials.gov.

Results: Ten studies with 103 patients and 105 knees were included. Results for nonnative (arthroplasty) knees were excluded. The mean patient age was 40.3 years, and the mean postsurgical follow-up time was 53.8 months. Of the 105 knees, 75% received a hamstring tendon graft, whereas 13% received a bone-tendon-bone graft and 7% received a whole extensor mechanism allograft. The mean preoperative range of motion was 113.8°, which improved to 126.0° postoperatively. The mean preoperative Lysholm score was 58.6, which improved to 86.0 postoperatively; 100% of patients returned to their normal work activities and 76% returned to their prior level of physical activity. There were no major complications reported in any of the included studies.

Conclusions: Chronic patellar tendon disruption in a native knee is an uncommon injury that can result in significant limitations for patients. Although more research is needed to better elucidate which graft is best, outcomes after patellar tendon reconstruction for chronic tears appear to be satisfactory with current techniques.
Posted in: Rheumatology and Orthopedics26

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Pengas IP, Assiotis A, Khan W, et al. Adult native knee extensor mechanism ruptures. Injury 2016;47:2065–2070.
 
2. Saragaglia D, Pison A, Rubens-Duval B. Acute and old ruptures of the extensor apparatus of the knee in adults (excluding knee replacement). Orthop Traumatol Surg Res 2013;99(1 suppl):S67–S76.
 
3. Abdou YE. Reconstruction of a chronic patellar tendon rupture with semitendinosus autograft. Arch Orthop Trauma Surg 2014;134:1717–1721.
 
4. Sundararajan S, Srikanth K, Rajasekaran S. Neglected patellar tendon ruptures—a simple modified reconstruction using hamstrings tendon graft. Int Orthop 2013;37:2159–2164.
 
5. Temponi EF, Camelo N, Tuteja S, et al. Reconstruction of chronic patellar tendon rupture with contralateral bone-tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc 2017;25:2468–2473.
 
6. Matava MJ. Patellar tendon ruptures. J Am Acad Orthop Surg 1996;4: 287–296.
 
7. Yablon CM, Pai D, Dong Q, et al. Magnetic resonance imaging of the extensor mechanism. Magn Reson Imaging Clin N Am 2014;22:601–620.
 
8. Ibounig T, Simons TA. Etiology, diagnosis and treatment of tendinous knee extensor mechanism injuries. Scand J Surg 2016;105:67–72.
 
9. Gilmore JH, Clayton-Smith ZJ, Aguilar M, et al. Reconstruction techniques and clinical results of patellar tendon ruptures: evidence today. Knee 2015; 22:148–155.
 
10. Jabalameli M, Bagherifard A, Hadi H, et al. Surgical treatment of chronic patellar tendon rupture: a case series study. Trauma Mon 2018;23:e59259.
 
11. Shau D, Patton R, Patel S, et al. Synthetic mesh vs. allograft extensor mechanism reconstruction in total knee arthroplasty—a systematic review of the literature and meta-analysis. Knee 2018;25:2–7.
 
12. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700.
 
13. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003;73:712–716.
 
14. Belhaj K, El Hyaoui H, Tahir 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;60:244–248.
 
15. Kovačev N, Antić J, Gvozdenović N, et al. Patellar tendon rupture: treatment results. Med Pregl 2015;68:22–28.
 
16. Jain JK, Vidyasagar JV, Chabra R. Percutaneous reconstruction of patellar tendon using semitendinosus tendon in chronic patellar tendon injury— case series and outcome. Knee 2014;21:726–730.
 
17. Maffulli N, Del Buono A, Loppini M, et al. Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures: average 5.8-year followup. J Bone Joint Surg Am 2013;95:e1231–e1236.
 
18. Fiquet C, White N, Gaillard R, et al. Partial extensor mechanism allograft reconstruction for chronic patellar tendon disruption shows superior outcomes in native knees when compared to same technique following total arthroplasty. Int Orthop 2018;42:2591–2599.
 
19. Valianatos P, Papadakou E, Erginoussakis D, et al. Treatment of chronic patellar tendon rupture with hamstrings tendon autograft. J Knee Surg 2020;33:792–797.
 
20. Bek D, Demiralp B, Komurcu M, et al. Neglected patellar tendon rupture: a case of reconstruction without quadriceps lengthening. J Orthop Traumatol 2008;9:39–42.
 
21. Cadambi A, Engh GA. Use of a semitendinosus tendon autogenous graft for rupture of the patellar ligament after total knee arthroplasty. A report of seven cases. J Bone Joint Surg Am 1992;74:974–979.
 
22. Mandelbaum BR, Bartolozzi A, Carney B. A systematic approach to reconstruction of neglected tears of the patellar tendon. A case report. Clin Orthop Relat Res 1988;(235):268–271.
 
23. Haskel JD, Fried JW, Hurley ET, 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;29:2695–2700.
 
24. Lee D, Stinner D, Mir H. Quadriceps and patellar tendon ruptures. J Knee Surg 2013;26:301–308.
 
25. Healy WL, Della Valle CJ, Iorio R, et al. Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clin Orthop Relat Res 2013;471:215–220.
 
26. Lamberti A, Balato G, Summa PP, et al. Surgical options for chronic patellar tendon rupture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018;26:1429–1435.