Petersen Wolf, Al Mustafa Hasan, Häner Martin, Braun Karl
Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland.
Oper Orthop Traumatol. 2025 Apr;37(2):150-158. doi: 10.1007/s00064-024-00859-5. Epub 2024 Aug 22.
Reconstruction of a patellar tendon defect in the event of a chronic rupture.
Chronic rupture of the patellar tendon due to delayed diagnosis or failure of primary refixation with a dehiscence that does not allow for anatomical refixation without patellar tendon shortening.
Infection.
Approximately 15 cm long incision from the tibial tuberosity to the patella. Depicting the rupture. Debridement of the tendon and insertion. Suture in the quadriceps tendon and distalization of the patella. If sufficient distalization of the patella is not possible, optionally perform a VY-plasty of the quadriceps tendon. Measuring the dehiscence. Securing the height of the patella by applying a patellotibial cerclage (strong suture cord). Extension of an existing tendon stump using a Z-plasty. Creation of 2 bone tunnels (diameter approx. 5 mm) in the patella and the tibial tuberosity. Insertion of an autologous or allogeneic semitendinosus tendon transplant and securing it by knotting the retaining threads in front of the tibial tuberosity.
Six weeks of partial weight-bearing with 10 kg of body weight in a straight, removable splint. Range of movement: weeks 1-4 E/F 0-0-60°, weeks 5-6 E/F 0-0-90°.
Seven patients who underwent this surgery as described above had a minimum follow-up of 2 years. Secondary lengthening of the quadriceps tendon had to be performed twice due to excessive retraction. All patients were able to perform active extension postoperatively. The Lysholm score rose from 49.3 to 83.2 points. No further rupture was detectable in the final ultrasound examination.
在慢性髌腱断裂时重建髌腱缺损。
因诊断延迟或初次固定失败导致髌腱慢性断裂，且存在裂开，若不缩短髌腱则无法进行解剖复位。
感染。
从胫骨结节至髌骨做一条约15厘米长的切口。显露断裂处。清理肌腱及附着点。缝合股四头肌肌腱并使髌骨远移。若髌骨无法充分远移，可选择对股四头肌肌腱进行V-Y成形术。测量裂开处。通过应用髌胫环扎术（粗缝线）固定髌骨高度。使用Z成形术延长现有的肌腱残端。在髌骨和胫骨结节处制作2个骨隧道（直径约5毫米）。插入自体或异体半腱肌肌腱移植体，并在胫骨结节前方将固定线打结以固定。
六周部分负重，体重10千克，佩戴直的可拆卸夹板。活动范围：第1 - 4周伸直/屈曲0 - 0 - 60°，第5 - 6周伸直/屈曲0 - 0 - 90°。
七名接受上述手术的患者进行了至少2年的随访。因过度回缩，股四头肌肌腱不得不二次延长两次。所有患者术后均能主动伸直。Lysholm评分从49.3分升至83.2分。末次超声检查未发现再次断裂。
