Ezeokoli Ekene U, Sutton Daniel, Shybut Theodore B
Oakland University William Beaumont School of Medicine, Royal Oak, USA.
Department of Orthopedic Surgery and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.
Video J Sports Med. 2022 Oct 20;2(5):26350254221119217. doi: 10.1177/26350254221119217. eCollection 2022 Sep-Oct.
Patellar tendon ruptures are the third-most common injury involving the knee extensor mechanism. They typically occur in men under 40 years old as a result of eccentric quadriceps contraction while the knee is flexed and the foot is planted. The optimal treatment is surgical repair within 2 weeks of injury to prevent scar formation, degeneration, and loss of tendon excursion.
Operative management is generally indicated for patellar tendon ruptures. In this case, a physically active, healthy 24-year-old man presented with acute pain, extensor lag, and patella alta related to a basketball injury. He was diagnosed with acute patellar tendon rupture/extensor mechanism disruption and indicated for surgery.
We describe a technique for primary patellar tendon repair which uses both knot-based and knotless suture anchor fixation. Using a pulley effect, sutures in the inferior patellar anchors are used to reduce and repair the patellar tendon back to its bony origin. Patellar anchor-based tapes and a suprapatellar traction suture are affixed with knotless anchors to the proximal tibia to reinforce the repair. Anchor-based suture limbs are used to repair the medial and lateral retinacula.
The senior authors' experience with this technique has been excellent restoration of extensor mechanism function, with rehabilitation permitting early range of motion and no major complications or failures. This patient returned to unassisted activities of daily living between 8 and 12 weeks and had returned to gym workouts and recreational sports at 12 months.
DISCUSSION/CONCLUSION: Biomechanical studies have demonstrated that compared with transosseous repair, suture anchor repair decreases gap formation and improves ultimate load to failure. Advantages of suture anchor repair include smaller incision, less tissue dissection, shorter operative time, and improved repair biomechanics. Our technique follows a principle of tendon repair using a high number of suture and tape limbs to span the repair. In addition, this technique incorporates a "double row" of suture anchors and spans the primary repair with a suture and tape "internal brace."The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
髌腱断裂是涉及膝关节伸肌机制的第三常见损伤。它们通常发生在40岁以下男性身上，是由于膝关节屈曲且足部着地时股四头肌离心收缩所致。最佳治疗方法是在受伤后2周内进行手术修复，以防止瘢痕形成、退变和肌腱活动度丧失。
髌腱断裂一般需要手术治疗。在本病例中，一名24岁身体健康、热爱运动的男性因篮球运动损伤出现急性疼痛、伸肌滞后和髌骨高位。他被诊断为急性髌腱断裂/伸肌机制破坏，并被建议进行手术。
我们描述了一种一期髌腱修复技术，该技术使用基于结和无结的缝线锚钉固定。利用滑轮效应，髌下锚钉中的缝线用于将髌腱复位并修复至其骨附着点。基于髌腱锚钉的胶带和髌上牵引缝线通过无结锚钉固定于胫骨近端，以加强修复。基于锚钉的缝线肢体用于修复内外侧支持带。
资深作者使用该技术的经验表明，伸肌机制功能得到了极佳恢复，康复允许早期活动范围，且无重大并发症或失败情况。该患者在8至12周之间恢复了独立的日常生活活动，并在12个月时恢复了健身房锻炼和娱乐性运动。
讨论/结论：生物力学研究表明，与经骨修复相比，缝线锚钉修复减少了间隙形成并提高了最终破坏载荷。缝线锚钉修复的优点包括切口更小、组织分离更少、手术时间更短以及修复生物力学改善。我们的技术遵循使用大量缝线和胶带肢体跨越修复部位的肌腱修复原则。此外，该技术采用了“双排”缝线锚钉，并通过缝线和胶带“内部支撑”跨越一期修复部位。作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿发表包含患者发布声明或其他书面批准形式。
