Reconstruction of Acute Patellar Tendon Rupture after Patellectomy

Abstract

Acute rupture of the knee extensor mechanism after patellectomy is extremely rare. We present the case of a patient with acute patellar tendon rupture who had undergone patellectomy 53 years before. Twelve days after the injury, the ruptured patellar tendon was repaired with end-to-end suture. Postoperatively, we splinted the knee for 6 weeks but permitted the patient to walk without limiting weight bearing at 1 week postoperatively. At one-year follow-up, the patient is able to move his knee almost full range of motion and the Lysholm knee score is 81. The patient is satisfied with the outcome. This is the first report to treat acute rupture of the patellar tendon in a patient who had undergone patellectomy. Although careful rehabilitation is required, end-to-end suture might be an adequate surgical procedure for acute rupture of the knee extensor mechanism after patellectomy.

Figure 1

Plain radiographic anteroposterior view (a) and lateral view (b) of the left knee showing the absence of a patella and the presence of a small heterotopic calcification (white arrow) at the distal side of the quadriceps tendon.

Figure 2

Ultrasound examination showed a loose patellar tendon (within red circle) (a) compared with the contralateral side (b). The right is the cranial side, and the patella can be seen on the far right in (b).

Figure 3

T2-weighted magnetic resonance imaging showed a loose patellar tendon (red arrow) and subcutaneous edema (white arrow) (a) and tendon disruption (red arrow) (b) at the proximal side of the patellar tendon.

Figure 4

Intraoperative photographs. The top is cranial and the bottom is caudal. The patellar tendon and patellar retinaculum were completely ruptured. Hematoma filled the rupture site (a). We performed end-to-end suture with two Krackow locking stitches and figure-of-eight sutures (b).