Summary

This novel surgical technique for patellar tendon reconstruction with triple graft cerclage in the patient with a neglected injury provide a valuable option for treating chronic or neglected injury, offering a potential for excellent functional recovery and avoid risk of iatrogenic patella fracture complication.

Abstract

Background

Neglected patellar tendon injuries are rare but present significant challenges due to fibrotic scarring, native tendon degeneration and quadricep muscle atrophy. This study describes a novel surgical technique for patellar tendon reconstruction in a patient with a neglected patellar tendon injury using the triple autograft cerclage.

Case Presentation: A 56-year-old female presented with a neglected patellar tendon injury for 1-year post- wide excision the tumor at her right knee. The patient was unable to extend her knee actively, felt off and on pain and could not walk for a long distance. X-ray showed the superior migration of the patella. MRI revealed the completely rupture of the patellar tendon at the patellar attachment with high riding patella and buckling quadriceps tendon. The patellar tendon was reconstructed using the gracillis, semitendinosus and peroneus longus autograft to cerclage over superior border of the patellar without creating the transpatellar tunnel to avoid the iatrogenic patellar fracture or cartilage penetration. The grafts were fixed with the suspensory device after passing through the horizontal osseous tunnel at the tibial tubercle.

Conclusion

This demonstrates a successful outcome using a novel surgical technique for patellar tendon reconstruction in a patient with a neglected injury. This technique may provide a valuable option for managing similar cases, offering a potential for excellent functional recovery with no iatrogenic patellar complications.