Surgical Technique: Repair of Patella Tendon Rupture in a Previously Harvested Tendon for an Anterior Cruciate Ligament Reconstruction

Abstract

Background: A rare cause of patellar tendon (PT) ruptures is complications after bone-PT-bone (BPTB) graft harvest for anterior cruciate ligament (ACL) reconstruction. The atypical tear pattern in these patients can be technically challenging to address.

Description of technique: A Krackow suture fixation of the medial, tibial based PT was fixed with a knotless suture anchor to the patella. A Krackow suture fixation of the lateral, patella based PT was fixed with a knotless suture anchor to the tibia. Fiber Tape was used for an Internal Brace.

Patient and methods: We retrospectively reviewed a single patient with a proximal-medial and distal-lateral PT rupture following BPTB graft harvest for an ACL reconstruction. The described repair technique was used to repair the PT rupture. Follow-up was 6-months. Range of motion (ROM), functional outcome scores, and patient-reported outcomes were assessed and recorded.

Results: Six-months postoperatively, the patient has regained full knee extension and flexion to 130 degrees. The patient has good quadriceps strength, and manual muscle testing shows no deficits in the operative leg. The patient is able to perform all of her activities of daily living and is discharged from physical therapy.

Conclusion: We describe a novel technique that effectively repairs the atypical PT rupture pattern seen after ACL reconstruction using BPTB autograft. This technique allows for aggressive post-operative rehabilitation in ROM and strengthening.

Level of evidence: Level V.

Keywords: Patellar tendon rupture; anterior cruciate ligament harvest; repair technique.

Figure 1

Pre-operative posteroanterior (a) and lateral (b) radiographs showing patella alta before repair of a proximal medial, distal-lateral Z-type patellar tendon rupture after bonepatellar tendon-bone autograft harvest for anterior cruciate ligament reconstruction.

Figure 2

(a and b) Pre-operative magnetic resonance imaging showing significant patellar tendon remnant on the tibia medially and a larger remnant on the patella laterally.

Figure 3

Intraoperative view: (a) Proximal medial remnant of the patellar tendon attached to the tibia (b) distal-lateral remnant of the patellar tendon attached to the patella.

Figure 4

a) The proximal-medial and distal-lateral patellar tendon remnants prepared with Krackow stitch using Suture Tape, with the proximal medial remnant accommodating two Krackow flat braided sutures, and the distal-lateral remnant accommodating one Krackow flat braided suture. (b) The four suture limbs on the medial aspect of the tibialbased patellar tendon remnant were passed through a knotless suture anchor that was preloaded with Fiber Tape.

Figure 5

Intraoperative view: In preparation for repair, the proximal medial patellar tendon remnant was retracted, and the inferior pole of the patella was prepared with a bleeding bone bed for healing.

Figure 6

Intraoperative view: (a) Showing two anchors in the patella proximally, two anchors in the tibia distally, and Fiber Tape limbs from the proximal medial and lateral aspects of the patella to the distal suture anchors laterally and medially on the tibia, respectively. (b) Care was taken not to over constrain the tendon after repair, with preservation of some laxity through the final Internal Brace construct.

Figure 7

Intraoperative view showing repair of the paratenon, juxtaposed to the bursal tissue on its anterior and posterior surfaces over the patellar tendon reconstruction to potentiate regeneration of the tendon tissue within the defect.

Figure 8

(a and b) Post-operative images of the patient performing active straight leg raise.

Figure 9

(a-c) Post-operative images of patient performing active range of motion at the knee.