Epidemiology
Usually occurs in young people
- often previous history of tendonitis ± steroid injections
Location
Usually at level of inferior pole of patella
- less common at tibial tubercle
- mid-substance ruptures rare
Clinical
Severe pain
Palpable defect
Extensor deficit / unable to SLR
Xray
Patella alta / high riding patella
Distal Pole Patella Fracture
MRI
In chronic cases may only detect that tendon not attaching to distal pole patella
Acute Management
Requires operative repair
Technique
Problem
- avoid baja caused by overtightening patella tendon
- drape patient in such a way so as to palpate other PT
- compare patella heights at end of case
1. Tendon torn off patella
Multiple Bunnell / Krackow Sutures to Patella Tendon
- 2 non absorbable
- drill holes through patella ( 3 - 4)
- pass sutures and tie
- can augment with box fibrewire
Can reinforce with box wire loop
- large gauge wire 18G
- drill hole in tibial tuberosity
- transverse drill hole in patella
- pass in square and tie
- protects patella tendon
- problem is will break / irritate / need removal
- only do if concerned re repair
Test repair at end of case
- should be able to do some limited ROM
2. Avulsion from tibial tuberosity
Repair with suture anchors
3. Midtendon rupture
May need augmentation with hamstring tendon
Augmentation
1. Semitendinosus autograft
- leave semitendinosus attached distally
- pass through distal pole patella
- reattach to tibia on lateral side
2. Patella tendon Allograft
3. Lars Ligament
Chronic Rupture
Reconstruction
Case: Reconstruction with tendoachilles allograft, bone block in tibia
Case: Reconstruction with Hamstring Autograft (if patella relatively low) or Tibialis Posterior
https://www.vumedi.com/video/patella-tendon-reconstruction-with-allogra…
