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Case Reports
. 2025 Jun:131:111376.
doi: 10.1016/j.ijscr.2025.111376. Epub 2025 Apr 25.

Simultaneous rupture of the anterior cruciate ligament and patellar tendon: report of a case and review of the literature

Mansi Zied  1 , Ben Salah Jihed  2 , Guedhami Hedhili  2 , Souid Abderrahmen  3 , Jlalia Zied  4 , Soui Slah  5
Affiliations
Case Reports

Simultaneous rupture of the anterior cruciate ligament and patellar tendon: report of a case and review of the literature

Mansi Zied et al. Int J Surg Case Rep. 2025 Jun.

Abstract

Introduction and importance: Simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare and complex injury, often resulting from high-energy trauma. This dual injury presents significant challenges in diagnosis and treatment.

Case presentation: This is a 29-year-old patient who sustained simultaneous ruptures of the ACL and patellar tendon following right knee trauma. A single-stage surgical treatment was performed, which involved ACL ligament reconstruction using a tendon graft from the contralateral knee and an end-to-end suture of the patellar tendon reinforced with a figure-8 plasty from the ipsilateral knee. The functional results were good: 140 degrees of flexion and full extension with stable support. Clinical evaluation included IKDC, Lysholm, and KOOS scores. The patient returned to work after three months.

Discussion: Such combined injuries are rare, and their diagnosis often requires thorough clinical assessment and imaging, especially MRI. Treatment protocols remain debated, with differing opinions on one-stage versus two-stage surgeries. However, early diagnosis and repair of the patellar tendon have been shown to provide the best outcomes. Our proposed technique aims for optimal functional results, emphasizing early intervention, precise repair, and personalized rehabilitation: analgesic physiotherapy, active extension and strengthening work.

Conclusion: In conclusion, suspicion of simultaneous ACL and patellar tendon rupture should arise in high velocity acute knee trauma with ligamentous laxity and significant hemarthrosis. Prompt diagnosis is the key of management. While a well-established treatment protocol is lacking, the general consensus is that prompt intervention is crucial for the patellar tendon.

Keywords: Anterior cruciate ligament (ACL); Ligamentoplasty; Patellar tendon; Rupture.

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Conflict of interest statement

Declaration of competing interest The authors confirm that they have no conflicts of interest associated with this publication. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
MRI: complete rupture of the patellar tendon and anterior cruciate ligament.
Fig. 2
Fig. 2
End-to-end sutures with PDS2 and Harvesting of the semitendinosus and gracilis tendons.
Fig. 3
Fig. 3
Repair of the patellar tendon reinforcement with a DIDT graft from the ipsilateral knee, passed through a transverse trans-patellar tunnel and secured at the external tibial tuberosity with an interference screw, forming a figure-8 pattern.
Fig. 4
Fig. 4
3-month follow-up; full active extension, and flexion at 130°.
See this image and copyright information in PMC

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