Semitendinosus and Gracilis Autograft for Neglected Patellar Tendon Rupture: A Surgical Reconstruction

Surya Adisthanaya; Putu Astawa; I Gusti Ngurah Wien Aryana; Febyan

doi:10.3889/oamjms.2022.9177

Authors

Surya Adisthanaya Department of Orthopaedic and Traumatology, Faculty of Medicine, Udayana University, Sanglah Public General Hospital, Bali, Indonesia
Putu Astawa Department of Orthopaedic and Traumatology, Faculty of Medicine, Udayana University, Sanglah Public General Hospital, Bali, Indonesia
I Gusti Ngurah Wien Aryana Department of Orthopaedic and Traumatology, Faculty of Medicine, Udayana University, Sanglah Public General Hospital, Bali, Indonesia
Febyan Department of Orthopaedic and Traumatology, Bhayangkara Denpasar Hospital, Bali, Indonesia https://orcid.org/0000-0001-9055-0361

DOI:

https://doi.org/10.3889/oamjms.2022.9177

Keywords:

Patellar tendon, Semitendinosus, Gracilis, Autograft, Reconstruction

Abstract

BACKGROUND: Neglected patellar tendon rupture is an extremely rare case among orthopedic injuries that severely compromises the function of the extensor mechanism of the knee. Therefore, a prompt and accurate diagnosis of a ruptured patellar tendon are a key to efficacious management, because a treatment delay is often associated with unsatisfactory functional outcomes.

CASE PRESENTATION: We report the case of an adult male patient with traumatic patellar tendon rupture after 9 months of a motorcycle accident. The patient underwent reconstruction surgery using semitendinosus and gracilis tendon augmentation. This procedure restores the anatomical position of the patella and prevents extensor lag. At a 3-month follow-up, a full recovery of the structure and function of the extensor mechanism was perceived. The patient could return to normal daily activities following rehabilitation protocol.

CONCLUSION: Semitendinosus and gracilis tendon autograft is the technique of choice to be applied in the surgical reconstruction of neglected patellar tendon rupture.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Mihalko WM, Vance M, Fineberg MJ. Patellar tendon repair with hamstring autograft: A cadaveric analysis. Clin Biomech (Bristol, Avon). 2010;25(4):34851. https://doi.org/10.1016/j.clinbiomech.2010.01.003 PMid:20133030 DOI: https://doi.org/10.1016/j.clinbiomech.2010.01.003

Milankov MZ, Miljkovic N, Stankovic M. Reconstruction of chronic patellar tendon rupture with contralateral BTB autograft: A case report. Knee Surg Sports Traumatol Arthrosc. 2007;15(2):1445-8. https://doi.org/10.1007/s00167-007-0365-1 PMid:17579835 DOI: https://doi.org/10.1007/s00167-007-0365-1

Sundararajan SR, Srikanth KP, Rajasekaran S. Neglected patellar tendon ruptures: A simple modified reconstruction using hamstrings tendon graft. Int Orthop. 2013;37(11):2159-64. https://doi.org/10.1007/s00264-013-2112-1 PMid:24081511 DOI: https://doi.org/10.1007/s00264-013-2112-1

Harato K, Kobayashi S, Udagawa K, Iwama Y, Masumoto K, Enomoto H, et al. Surgical technique to bring down the patellar height and to reconstruct the tendon for chronic patellar tendon rupture. Arthrosc Tech. 2017;6(5):1897-901. https://doi.org/10.1016/j.eats.2017.07.015 PMid:29430392 DOI: https://doi.org/10.1016/j.eats.2017.07.015

Talia AJ, Tran P. Bilateral patellar tendon reconstruction using LARS ligaments: Case report and review of the literature. BMC Musculoskelet Disord. 2016;17(1):302. https://doi.org/10.1186/s12891-016-1161-1 DOI: https://doi.org/10.1186/s12891-016-1161-1

Greis PE, Holmstrom MC, Lahav A. Surgical treatment options for patella tendon rupture, Part I: Acute. Orthopedics. 2005;28(7):680-1. https://doi.org/10.3928/0147-7447-20050701-15 PMid:16119282 DOI: https://doi.org/10.3928/0147-7447-20050701-15

Van der Zwaal P, Van Arkel ER. Recurrent patellar tendon rupture: Reconstruction using ipsilateral gracilis and semitendinosus tendon autografts. Injury Extra. 2007;38(9):3203. https://doi.org/10.1016/j.injury.2006.12.018 DOI: https://doi.org/10.1016/j.injury.2006.12.018

Phillips K, Costantino TG. Diagnosis of patellar tendon rupture by emergency ultrasound. J Emerg Med. 2014;47(2):204-6. https://doi.org/10.1016/j.jemermed.2014.02.012 PMid:24746910 DOI: https://doi.org/10.1016/j.jemermed.2014.02.012

Black JC, Ricci WM, Gardner MJ, McAndrew CM, Agarwalla A, Wojahn RD, et al. Novel augmentation technique for patellar tendon repair improves strength and decreases gap formation: A cadaveric study. Clin Orthop Relat Res. 2016;474(12):2611-18. https://doi.org/10.1007/s11999-016-5009-7 PMid:27492687 DOI: https://doi.org/10.1007/s11999-016-5009-7

Lewis PB, Rue JP, Bach BR. Chronic patellar tendon rupture: Surgical reconstruction technique using 2 Achilles tendon allografts. J Knee Surg. 2008;21(2):130-35. https://doi.org/10.1055/s-0030-1247807 PMid:18500064 DOI: https://doi.org/10.1055/s-0030-1247807

Chen B, Li R, Zhang S. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: Two case report. Knee. 2012;19(4):508-12. https://doi.org/10.1016/j.knee.2011.07.007 PMid:21835626 DOI: https://doi.org/10.1016/j.knee.2011.07.007

Labib SA, Wilczynski MC, Sweitzer BA. Two-layer repair of a chronique patellar tendon rupture: A novel technique and literature review. Am J Orthop (Belle Mead NJ). 2010;39(6):277-82. PMid:20631926

Naim S, Gougoulias N, Griffiths D. Patellar tendon reconstruction using LARS ligament: Surgical technique and case report. Strateg Trauma Limb Reconstr. 2011;6(1):39-41. https://doi.org/10.1007/s11751-010-0101-0 PMid:21589681 DOI: https://doi.org/10.1007/s11751-010-0101-0

Ikpeme AI, Ikpeme AA, Abang IE, Amah PO, Achaka AM. Neglected ruptures of the patellar tendon: Repair options in a resource poor setting. Int J Case Rep Image. 2012;3(12):6-10. https://doi.org/0.5348/ijcri-2012-12-228-CS-2

Hamner DL, Brown CH, Steiner ME, Hecker AT, Hayes WC. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am. 1999;81(4):549-57. https://doi.org/10.2106/00004623-199904000-00013 PMid:10225801 DOI: https://doi.org/10.2106/00004623-199904000-00013

Abdel-Aziz A, Zaky Abdelrazek BH, Waly MR, Abdel-Aziz MA, El Din Sheriff MM. Technique for fixation of semitendinosus to the patellar in patellar tendon reconstruction. Arthrosc Tech. 2020;9(12):1943-49. https://doi.org/10.1016/j.eats.2020.08.034 PMid:33381404 DOI: https://doi.org/10.1016/j.eats.2020.08.034

Jarvela T, Halonen P, Jarvela K, Moilanen T. Reconstruction of ruptured patellar tendon after total knee arthroplasty: A case report and a description of an alternative fixation method. Knee. 2005;12(2):139-43. https://doi.org/10.1016/j.knee.2004.05.005 PMid:15749450 DOI: https://doi.org/10.1016/j.knee.2004.05.005

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. https://doi.org/10.1016/j.knee.2014.10.007 PMid:25819155 DOI: https://doi.org/10.1016/j.knee.2014.10.007

Nguene-Nyemb AG, Huten D, Ropars M. Chronic patellar tendon rupture reconstruction with a semitendinosus autograft. Orthop Traumatol Surg Res. 2011;97(4):447-50. https://doi.org/10.1016/j.otsr.2011.01.015 PMid:21596640 DOI: https://doi.org/10.1016/j.otsr.2011.01.015

Greiwe RM, Saifi C, Ahmad CS, Gardner TR. Anatomy and biomechanics of patellar instability. Oper Tech Sports Med. 2010;18(2):62-7. https://doi.org/10.1053/j.otsm.2009.12.014 DOI: https://doi.org/10.1053/j.otsm.2009.12.014

Sanaboyina A, Rao VM. Patellar tendon reconstruction with ipsilateral free semi-tendinosus and gracilis autograft for neglected patellar tendon rupture. J Orthop Allied Sci. 2015;3(1):40-3. https://doi.org/10.4103/2319-2585.155927 DOI: https://doi.org/10.4103/2319-2585.155927

Moretti L, Vicenti G, Abate A. Patellar tendon rerupture in a footballer: Our personal surgical technique and review of the literature. Injury. 2014;45:452-56. https://doi.org/10.1016/j.injury.2013.10.043 PMid:24314874 DOI: https://doi.org/10.1016/j.injury.2013.10.043