Spoliti Marco, Giai Via Alessio, Padulo Johnny, Oliva Francesco, Del Buono Angelo, Maffulli Nicola
Department of Orthopaedics and Traumatology, San Camillo-Forlanini Hospital, Piazza C. Forlanini 1, Rome, Italy.
Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata", School of Medicine, Viale Oxford 81, 00133, Rome, Italy.
Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3183-3190. doi: 10.1007/s00167-014-3448-9. Epub 2014 Nov 26.
Patellar tendon rupture is a serious complication of total knee arthroplasty (TKA). Its reconstruction in patients with chronic ruptures is technically demanding. This article reports the results of surgical reconstruction of neglected patellar tendon rupture in TKA using autologous hamstring tendons.
Nine TKA patients (six women and three men) (mean age at index surgery 68 years) with chronic patellar tendon tears underwent reconstruction with ipsilateral hamstrings tendon, leaving the distal insertion in situ. The clinical diagnosis was supported by imaging (anterior-posterior and 30° flexion lateral radiographs). Insall-Salvati index, range of motion, and leg extension test were recorded preoperatively and at last follow-up. The modified Cincinnati rating system and the Kujala score were administered. The patients sustained the patellar tendon tear an average of 8 weeks before the procedure.
At final follow-up of 4 years (range 2-8 years), the median of extension lag was 5° (range 0°-15°; DS = 5). The median of post-operative Insall-Salvati index was 1.4 (range 1.3-1.8; SD = 0.15; p = 0.002) compared to the preoperative index of 1.7 (range 1.5-2.2; SD = 0.23). The mean modified Cincinnati and Kujala scores significantly increased compared with the preoperative ones (p < 0.01). At final follow-up, all patients were able to walk without brace or aids, and they were satisfied with the procedure.
Based on our retrospective study of nine patients, reconstruction of neglected patellar tendon rupture in TKA with autologous hamstring tendons is feasible and safe, and provides good functional recovery.
Case series, Level IV.
髌腱断裂是全膝关节置换术(TKA)的一种严重并发症。对慢性髌腱断裂患者进行重建手术技术要求较高。本文报告了采用自体腘绳肌腱对TKA中被忽视的髌腱断裂进行手术重建的结果。
9例(6例女性,3例男性)慢性髌腱撕裂的TKA患者接受了同侧腘绳肌腱重建,保留远端止点原位不动。临床诊断通过影像学检查(前后位和30°屈曲侧位X线片)得到支持。术前和末次随访时记录Insall-Salvati指数、活动范围和伸膝试验情况。采用改良的辛辛那提评分系统和库亚拉评分。患者在手术前平均髌腱撕裂8周。
在4年(范围2 - 8年)的最终随访中,伸直滞后的中位数为5°(范围0° - 15°;DS = 5)。术后Insall-Salvati指数中位数为1.4(范围1.3 - 1.8;SD = 0.15;p = 0.002),而术前指数为1.7(范围1.5 - 2.2;SD = 0.23)。与术前相比,改良的辛辛那提和库亚拉平均评分显著提高(p < 0.01)。在最终随访时,所有患者都能够不用支具或辅助器具行走,并且对手术满意。
基于我们对9例患者的回顾性研究,采用自体腘绳肌腱对TKA中被忽视的髌腱断裂进行重建是可行且安全的,并能实现良好的功能恢复。
病例系列,IV级。