Abstract
We describe a new method for reconstructing the patellar tendon following combined injury to the patellar tendon and anterior cruciate ligament (ACL).
Combined injuries to the patellar tendon and the ACL represent a rare and potentially serious injury pattern. The injury to the patellar tendon can often go undiagnosed at primary presentation. Reconstructive options for the patellar tendon are described but can be technically difficult, particularly if ipsilateral hamstring has been used for anterior cruciate ligament reconstruction. Evidence suggests combined injuries generally lead to poor long term outcome.
We describe a case of a 26 year old male who presented with a reconstructed ACL and a patellar tendon deficient knee. Diagnosis was confirmed on Magnetic Resonance Imaging (MRI). Ipsilateral hamstrings had been used as donor for ACL reconstruction. An Achilles tendon allograft with distal bone block was used in combination with contralateral semitendinosus and gracilis autograft to reconstruct the three bundles of the patellar tendon. The patient experienced no postoperative complications and was followed up radiologically and clinically. Computer Topography imaging performed at 6 months post-operatively showed union of the bony Achilles tendon block. MRI performed 1 year post-operatively showed good incorporation of the tendinous grafts and no evidence of degeneration or tearing. Oxford knee score at 6 months post-operatively was 31/48. One year post-operatively full pre-injury activity level had been achieved.
We believe this method to provide adequate strength and integrity, enabling early rehabilitation following this rare injury. It has also been shown to give a good functional outcome.
Correspondence should be addressed to: BASK c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
