Zied Mansi, Jihed Ben Salah, Hedhili Guedhami, Abderrahmen Souid, Zied Jlalia, Slah Soui
Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia.
Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia.
Int J Surg Case Rep. 2025 Jun;131:111376. doi: 10.1016/j.ijscr.2025.111376. Epub 2025 Apr 25.
Simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare and complex injury, often resulting from high-energy trauma. This dual injury presents significant challenges in diagnosis and treatment.
This is a 29-year-old patient who sustained simultaneous ruptures of the ACL and patellar tendon following right knee trauma. A single-stage surgical treatment was performed, which involved ACL ligament reconstruction using a tendon graft from the contralateral knee and an end-to-end suture of the patellar tendon reinforced with a figure-8 plasty from the ipsilateral knee. The functional results were good: 140 degrees of flexion and full extension with stable support. Clinical evaluation included IKDC, Lysholm, and KOOS scores. The patient returned to work after three months.
Such combined injuries are rare, and their diagnosis often requires thorough clinical assessment and imaging, especially MRI. Treatment protocols remain debated, with differing opinions on one-stage versus two-stage surgeries. However, early diagnosis and repair of the patellar tendon have been shown to provide the best outcomes. Our proposed technique aims for optimal functional results, emphasizing early intervention, precise repair, and personalized rehabilitation: analgesic physiotherapy, active extension and strengthening work.
In conclusion, suspicion of simultaneous ACL and patellar tendon rupture should arise in high velocity acute knee trauma with ligamentous laxity and significant hemarthrosis. Prompt diagnosis is the key of management. While a well-established treatment protocol is lacking, the general consensus is that prompt intervention is crucial for the patellar tendon.
前交叉韧带（ACL）和髌腱同时断裂是一种罕见且复杂的损伤，通常由高能创伤导致。这种双重损伤在诊断和治疗方面带来了重大挑战。
这是一名29岁的患者，右膝外伤后出现ACL和髌腱同时断裂。进行了一期手术治疗，包括使用对侧膝关节的肌腱移植物重建ACL韧带，以及对髌腱进行端端缝合，并采用同侧膝关节的8字成形术进行加强。功能结果良好：屈曲140度且完全伸直，支撑稳定。临床评估包括IKDC、Lysholm和KOOS评分。患者三个月后重返工作岗位。
这种联合损伤很少见，其诊断通常需要全面的临床评估和影像学检查，尤其是MRI。治疗方案仍存在争议，对于一期手术还是二期手术存在不同意见。然而，已证明早期诊断和修复髌腱可提供最佳结果。我们提出的技术旨在实现最佳功能结果，强调早期干预、精确修复和个性化康复：止痛物理治疗、主动伸展和强化训练。
总之，在伴有韧带松弛和明显关节积血的高速急性膝关节创伤中，应怀疑ACL和髌腱同时断裂。及时诊断是治疗的关键。虽然缺乏成熟的治疗方案，但普遍共识是对髌腱进行及时干预至关重要。
