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手术技术：在先前用于前交叉韧带重建而采集的肌腱中修复髌腱断裂

Surgical Technique: Repair of Patella Tendon Rupture in a Previously Harvested Tendon for an Anterior Cruciate Ligament Reconstruction.

作者信息

Lissy Micah, Patel Urvi J

机构信息

Department of Orthopaedics, United Health Services Sports Medicine, Vestal, New York, USA.

Department of Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, New York, USA.

出版信息

J Orthop Case Rep. 2019;9(4):34-40. doi: 10.13107/jocr.2019.v09.i04.1468.

DOI:10.13107/jocr.2019.v09.i04.1468
PMID:32405484
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7210899/
Abstract

BACKGROUND

A rare cause of patellar tendon (PT) ruptures is complications after bone-PT-bone (BPTB) graft harvest for anterior cruciate ligament (ACL) reconstruction. The atypical tear pattern in these patients can be technically challenging to address.

DESCRIPTION OF TECHNIQUE

A Krackow suture fixation of the medial, tibial based PT was fixed with a knotless suture anchor to the patella. A Krackow suture fixation of the lateral, patella based PT was fixed with a knotless suture anchor to the tibia. Fiber Tape was used for an Internal Brace.

PATIENT AND METHODS

We retrospectively reviewed a single patient with a proximal-medial and distal-lateral PT rupture following BPTB graft harvest for an ACL reconstruction. The described repair technique was used to repair the PT rupture. Follow-up was 6-months. Range of motion (ROM), functional outcome scores, and patient-reported outcomes were assessed and recorded.

RESULTS

Six-months postoperatively, the patient has regained full knee extension and flexion to 130 degrees. The patient has good quadriceps strength, and manual muscle testing shows no deficits in the operative leg. The patient is able to perform all of her activities of daily living and is discharged from physical therapy.

CONCLUSION

We describe a novel technique that effectively repairs the atypical PT rupture pattern seen after ACL reconstruction using BPTB autograft. This technique allows for aggressive post-operative rehabilitation in ROM and strengthening.

LEVEL OF EVIDENCE

Level V.

摘要

背景

髌腱（PT）断裂的一种罕见原因是在取自体骨-髌腱-骨（BPTB）移植物用于前交叉韧带（ACL）重建后出现的并发症。这些患者的非典型撕裂模式在技术上处理起来具有挑战性。

技术描述

采用Krackow缝合法将基于胫骨内侧的PT固定，通过无结缝线锚钉固定于髌骨。采用Krackow缝合法将基于髌骨外侧的PT固定，通过无结缝线锚钉固定于胫骨。使用纤维带进行内部支撑。

患者与方法

我们回顾性分析了1例在取自体BPTB移植物用于ACL重建后出现近端内侧和远端外侧PT断裂的患者。采用上述修复技术修复PT断裂。随访6个月。评估并记录活动范围（ROM）、功能结果评分和患者报告的结果。

结果

术后6个月，患者膝关节已恢复完全伸直，屈曲可达130度。患者股四头肌力量良好，手术侧下肢手动肌力测试无缺陷。患者能够进行所有日常生活活动，已结束物理治疗。

结论

我们描述了一种新技术，可有效修复在使用BPTB自体移植物进行ACL重建后出现的非典型PT断裂模式。该技术允许在ROM和强化方面进行积极的术后康复。

证据级别

V级。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/1b9f1af7e5d4/JOCR-9-34-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/13417cb8664c/JOCR-9-34-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/63ee639462e1/JOCR-9-34-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/92914f33e435/JOCR-9-34-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/87ed549d7028/JOCR-9-34-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/9a8a205f1168/JOCR-9-34-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/136ae78050ff/JOCR-9-34-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/c13370217412/JOCR-9-34-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/2245fc9710e4/JOCR-9-34-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/1b9f1af7e5d4/JOCR-9-34-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/13417cb8664c/JOCR-9-34-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/63ee639462e1/JOCR-9-34-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/92914f33e435/JOCR-9-34-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/87ed549d7028/JOCR-9-34-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/9a8a205f1168/JOCR-9-34-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/136ae78050ff/JOCR-9-34-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/c13370217412/JOCR-9-34-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/2245fc9710e4/JOCR-9-34-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5081/7210899/1b9f1af7e5d4/JOCR-9-34-g009.jpg

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