Patellar Tendon Rupture 12 Years after ACL Reconstruction with BPTB Autograft

Abstract

We present a case of a 33-year-old male with a history of anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft and prior ipsilateral hamstring harvest, who presented with a complete patella tendon rupture (PTR) 12 years after ACLR. The patient underwent a successful patellar tendon (PT) repair augmented with Achilles tendon allograft and cerclage with nonabsorbable suture tape. PTR after ACLR with BPTB autograft is rare, particularly in patients over a decade out from the index procedure, but can occur. This case report highlights a novel technique for PT repair following BTB ACLR in a hamstring deficient knee.

Figure 1

(a) Preoperative AP view of bilateral knees demonstrating bilateral bipartite patella and right knee ACL reconstruction. (b) Preoperative lateral view of the right knee demonstrating patella alta with a Caton-Deschamps ratio of 1.86 in the setting of prior ACL reconstruction.

Figure 2

Intraoperative fluoroscopic image demonstrating correction of the patella alta.

Figure 3

Intraoperative image of soft tissue Achilles allograft used to reinforce patellar tendon repair.

Figure 4

(a, b) Postoperative AP radiograph at 10 months of the right (operative) knee and contralateral left knee for comparison. (c, d) Postoperative lateral radiograph at 10 months of the right (operative) knee with a C-D ratio of 1.1 compared to the contralateral left knee with a C-D ratio of 1.0.