Woodard David R, Richards Jarod A, Daniel Adam, Smith Patrick A
Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, U.S.A.
Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A.
Arthrosc Tech. 2024 May 18;13(9):103036. doi: 10.1016/j.eats.2024.103036. eCollection 2024 Sep.
Chronic patellar tendinosis is an overuse pathology affecting both adolescents and adults who participate in jumping sports. It often can be managed with nonoperative modalities. Chronic patellar tendinosis is associated with degenerative changes to the proximal, posterior patellar tendon. Operative treatments include open or arthroscopic debridement of the pathologic tissue. When a debridement is performed, the resulting defect forms a void at the posterior segment of the proximal patellar tendon. The authors assert this defect should be addressed in elite athletes with a graft as opposed to tendon debridement alone to prevent recurrence and maximize tendon strength. Described herein is the senior author's preferred technique for open patellar tendon debridement and allograft reinforcement with suture tape augmentation for chronic patellar tendinosis. This technique creates both a tension band construct with allograft to offload the tendon proximally and an InternalBrace construct longitudinally for patellar tendon load sharing.
慢性髌腱病是一种过度使用性病变,影响参与跳跃运动的青少年和成年人。它通常可以通过非手术方式进行治疗。慢性髌腱病与髌腱近端、后部的退行性改变有关。手术治疗包括对病变组织进行开放或关节镜下清创。当进行清创时,所形成的缺损在髌腱近端后部形成一个空隙。作者认为,对于精英运动员,应使用移植物来处理这个缺损,而不是仅进行肌腱清创,以防止复发并使肌腱强度最大化。本文描述的是资深作者治疗慢性髌腱病的开放性髌腱清创及用缝线带增强同种异体移植物的首选技术。该技术既利用同种异体移植物构建张力带结构以减轻髌腱近端的负荷,又纵向构建内部支撑结构以实现髌腱负荷分担。