Kinoshita Eiji, Kondo Naoki, Tanifuji Osamu, Kakutani Rika, Hao Nariaki, Kawashima Hiroyuki
Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Division of Orthopedic Surgery, Saiseikai Niigata Kenoh Kikan Hospital, Sanjo, Niigata, Japan.
Mod Rheumatol Case Rep. 2025 Jul 25;9(2). doi: 10.1093/mrcr/rxae074.
Patellar tendon rupture is a severe complication following total knee arthroplasty (TKA). We encountered a case of rheumatoid arthritis with an incomplete rupture of the patellar tendon post-TKA. An 84-year-old woman was diagnosed with an incomplete rupture of the right patellar tendon 3 months post-TKA of her right knee. The patient exhibited a 45° extension lag 6 months post-TKA, necessitating reconstruction surgery. Intraoperative findings revealed incomplete rupture of the patellar tendon that was stretched out, diagnosed as incomplete patellar tendon rupture. Due to knee valgus instability (passive knee valgus showed 20°), the thickness of the tibial insert was adjusted from 11 to 15 mm, resulting in improved valgus instability. The scarring region of the patellar tendon was resected to 10 mm in length, and the tendon was repaired using an ultra-high molecular weight polyethylene cable (Nesplon cable) and Krackow suture. The repair was secured by making an 8-figure pattern with the cable. After the reconstruction surgery, the knee was immobilised at 0° extension for 3 weeks, followed by the initiation of range-of-motion exercises. Three months later, the extension lag was reduced to -15°, and the patient could walk without orthosis and reported neither instability nor surgical site infection at 8 months after the surgery. In conclusion, this case is notable due to the rarity of incomplete (stretched out) patellar tendon rupture post-TKA and demonstrates the effectiveness of Nesplon cable with Krackow suture in reconstruction surgery.
髌腱断裂是全膝关节置换术（TKA）后的一种严重并发症。我们遇到了一例类风湿性关节炎患者，在TKA后发生了髌腱不完全断裂。一名84岁女性在右膝TKA术后3个月被诊断为右髌腱不完全断裂。该患者在TKA术后6个月出现45°伸直滞后，需要进行重建手术。术中发现髌腱不完全断裂且被拉长，诊断为髌腱不完全断裂。由于膝关节外翻不稳定（被动膝关节外翻显示为20°），将胫骨假体垫片的厚度从11毫米调整至15毫米，从而改善了外翻不稳定情况。髌腱的瘢痕区域被切除至10毫米长，并用超高分子量聚乙烯缆线（Nesplon缆线）和Krackow缝合法修复肌腱。通过用缆线制作8字缝合法来固定修复。重建手术后，膝关节在伸直0°位固定3周，随后开始进行活动度锻炼。3个月后，伸直滞后减少至-15°，患者无需矫形器即可行走，且在术后8个月时既无不稳定情况也无手术部位感染。总之，该病例因TKA后髌腱不完全（拉长）断裂罕见而值得关注，并证明了Nesplon缆线与Krackow缝合法在重建手术中的有效性。
