Buchupalli Bharath Reddy1 , Asadi Madhusudhana2 , Avalapati Narendra3
INTRODUCTION: Neglected rupture of the patellar tendon is a rare disabling injury that is technically difficult to manage. Many different surgical techniques have been described for reconstruction of the disrupted extensor mechanism of the knee. In this study we describe an improved technique for the reconstruction of patellar tendon using semitendinosus and gracilis tendon grafts preserving their tibial insertion distally and Ethibond suture augmentation instead of stainless steel wire having the added advantage of no further operative intervention needed for removal.
MATERIALS AND METHODS: The study included 9 patients (7 male & 2 female) with mean age of 40.2 years (+/- 2 SD) presented with pain, instability, difficulty in carrying out Activities of Daily Living (ADL) associated with neglected patellar tendon injury. The time since injury ranged from 3months to 2years. All the patients had loss of active extension, extensor lag between 300 to 500 with an average of 41.10 (+/- 2 SD) and severe functional limitation of ADL. All the patients underwent patellar tendon reconstruction using semitendinosus and gracilis tendon grafts. The functional outcome was assessed using Lysholm Knee Score, Visual Analogue Score (VAS) and IKDC scoring system.
RESULTS: Post-operatively with an average follow-up of 19 months (+/- 2 SD) all the patients had decreased amount of pain, stable knee with active extension of knee without any extension lag with flexion up to 1100 (900 -1250 ). Out of 9 patients 7 had good and two had fair functional outcome with improvement in ADL with the IKDC score of 83.5 (+/- SD), Lysholm Knee Score 90.8 (+/- SD) and no/little pain on Visual Analogue Scale.
CONCLUSION: The results of our study shows that the use of ipsilateral semitendinosus and gracilis tendon grafts preserving their insertions on tibia distally for reconstruction of neglected patellar tendon ruptures along with Ethibond suture augmentation provides good knee stability and functional improvement in ADL without need for allograft or prosthetic material. The use of Ethibond suture instead of stainless steel wire has added advantage of no further operative intervention needed for its removal.