Ismailidis Petros, Kernen Rolf, Egloff Christian, Nüesch Corina, Mündermann Annegret, Müller Sebastian Andreas
Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
Case Rep Orthop. 2020 Feb 4;2020:5793948. doi: 10.1155/2020/5793948. eCollection 2020.
Simultaneous ipsilateral patellar tendon (PT) and anterior cruciate ligament (ACL) tear is a rare injury. Associated meniscal and ligamentous injuries are common but frequently initially missed. In contrast, to date, there is no report of associated fractures. We report on a 40-year-old female Caucasian patient presenting with a ski injury resulting in simultaneous ipsilateral patellar tendon and ACL tear combined with a tibia plateau fracture and a medial and lateral meniscus lesion. ORIF of the tibia as well as one-stage primary reconstruction of the PT and ACL and suturing of the menisci was conducted. The final follow-up was 2 years postoperatively. Lower extremity kinematic, kinetic, and muscle activity measurements were conducted. Although the clinical result was excellent, altered joint kinematics went along with large side-to-side difference in hip and knee joint moments during midstance and terminal stance. During weight acceptance, vastus medialis and hamstring muscles showed greater relative activity in the injured than the uninjured side. This case demonstrates the possibility of excellent early and midterm results with a one-stage approach and suitable rehabilitation scheme. Biomechanical measurements could further help evaluate the outcome of the treatments and implications for the development of potential secondary damage.
同侧髌腱（PT）和前交叉韧带（ACL）同时撕裂是一种罕见的损伤。相关的半月板和韧带损伤很常见，但最初常被漏诊。相比之下，迄今为止，尚无相关骨折的报道。我们报告一例40岁的白种女性患者，因滑雪受伤导致同侧髌腱和ACL同时撕裂，并伴有胫骨平台骨折以及内侧和外侧半月板损伤。对胫骨进行切开复位内固定（ORIF），同时对髌腱和ACL进行一期初次重建以及对半月板进行缝合。最后一次随访是在术后2年。进行了下肢运动学、动力学和肌肉活动测量。尽管临床结果极佳，但在支撑中期和末期，关节运动学改变伴随着髋关节和膝关节力矩的较大左右差异。在负重时，患侧股内侧肌和腘绳肌的相对活动比未受伤侧更大。该病例表明，采用一期手术方法和合适的康复方案可获得优异的早期和中期结果。生物力学测量可进一步帮助评估治疗效果以及对潜在继发性损伤发展的影响。
