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Surgical options for chronic patellar tendon rupture in total knee arthroplasty

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare mid-term results of three different reconstructive techniques for chronic patellar tendon disruption after total knee arthroplasty (TKA). Several surgical techniques have been proposed, but to date it is still unclear which is the best solution. The hypothesis was that allografts provide better functional results than autografts in restoring a correct joint function.

Methods

Twenty-one reconstructions were performed in twenty-one patients (three groups of seven patients) with chronic patellar tendon lesion following TKA. Group I underwent reconstruction with an Achilles tendon allograft with a calcaneal block, Group II with an autograft of the quadriceps tendon reinforced by the semitendinosus tendon and Group III with a full extensor mechanism allograft consisting of the tibial tubercle, patellar tendon, patella, and quadriceps tendon. Preoperatively and at each follow-up, the value of the extensor lag and the Knee Score (KS) were recorded.

Results

The mean extensor lag decreased from 50° ± 19.4° to 3° ± 1.6°. The KSS improved from 44.7 ± 20.5 to 78.9 ± 13.6 points. The comparison between the groups showed statistically significant differences in the mean postoperative KS between Groups I (average score of 87.7 ± 14.3 points) and II (average score of 70 ± 4.1 points), but not between Groups I and III (average score of 78.9 ± 14.6 points) or between Groups II and III. Differences in the postoperative extensor lag were not significant between the three groups.

Conclusions

The present study may serve surgeons in choosing the best reconstructive strategy for a chronic patellar tendon lesion in TKA. According to the reported results, an Achilles tendon allograft should be considered the gold standard repair. The autograft technique is suitable when the host tissue is competent, particularly when dealing with younger patients or post-infection. A full extensor mechanism allograft may represent a reliable solution when the defect involves the patellar bone or the quadriceps tendon.

Level of evidence

IV.

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Abbreviations

TKA:

Total knee arthroplasty

EMA:

Extensor mechanism allograft

ATA:

Achilles tendon allograft

QSA:

Quadriceps tendon and semitendinosus autograft

KS:

Knee Score

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Author’s contribution

AL participated in the design of the study, collected clinical data, and drafted the manuscript. GB participated in the design of the study and performed the statistical analysis. PPS participated in performing surgery, followed up the patients, and recorded Knee Score. AR performed surgery and participated in the study design and coordination. AV participated in performing surgery, followed up the patients, and recorded Knee Score. AB performed surgery, conceived the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. IFCA, Istituto Fiorentino di Cura e Assistenza, Via del Pergolino 4, 50139, Florence, Italy

    Alfredo Lamberti, Giovanni Balato, Pier Paolo Summa & Andrea Baldini

  2. Medanta Bone and Joint Institute, Medanta- The Medicity, Gurgaon, Haryana, India

    Ashok Rajgopal & Attique Vasdev

Authors
  1. Alfredo Lamberti
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  2. Giovanni Balato
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  3. Pier Paolo Summa
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  4. Ashok Rajgopal
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  5. Attique Vasdev
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  6. Andrea Baldini
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Corresponding author

Correspondence to Alfredo Lamberti.

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Conflict of interest

The authors declare that they have no conflict of interests.

Funding

This study received no funding.

Ethical approval

The internal Institutional Review Board of the IFCA Institute of Florence, met on 13 October 2015, declares that the project titled “Surgical Options for Chronic Patellar Tendon Rupture in Total Knee Arthroplasty” submitted by Dr. Andrea Baldini et al. is compliant with the Helsinki Declaration and ethically correct. Therefore, its execution is allowed (ID 166bis/13-10-2015).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Lamberti, A., Balato, G., Summa, P.P. et al. Surgical options for chronic patellar tendon rupture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26, 1429–1435 (2018). https://doi.org/10.1007/s00167-016-4370-0

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  • DOI: https://doi.org/10.1007/s00167-016-4370-0

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