Larson R V, Simonian P T
University of Washington, Department of Orthopaedic Surgery, Seattle.
Am J Sports Med. 1995 Jan-Feb;23(1):82-6. doi: 10.1177/036354659502300114.
We report four cases of acute midsubstance rupture of the patellar tendon that were treated with primary surgical repair along with semitendinosus autograft augmentation. The goal of this treatment was to allow immediate mobilization of the knee with a single operative procedure. We also demonstrate a technique for determining patellar position intraoperatively. Patients were tested for functional performance at an average final followup of 40 months (range, 20 to 66) including hamstring and quadriceps muscle strength evaluation, completion of a functional questionnaire, functional test performance, range of motion assessment, and patellar tendon length measurement. In evaluating the results, all cases were essentially identical to the nonoperated side, except one knee that had multiple associated ligament injuries. The multitude of injuries to this knee are likely the cause of the discrepancy. Immediate midsubstance patellar tendon repair with semitendinosus augmentation allowed immediate mobilization, which decreased the recovery period and improved the outcome of rehabilitation. Furthermore, a second surgery for hardware removal was not needed. These two factors--early and improved rehabilitation and the decreased chance of a second surgery--affect the cost of treatment of this injury. All isolated patellar tendon injuries in the study had excellent function at followup. For these reasons, we recommend this procedure for acute patellar tendon ruptures.
我们报告了4例髌腱急性中部断裂患者，均采用一期手术修复并联合半腱肌自体移植加强治疗。该治疗的目的是通过单一手术操作使膝关节立即活动。我们还展示了一种术中确定髌骨位置的技术。在平均40个月（范围20至66个月）的最终随访中对患者进行功能评估，包括绳肌和股四头肌肌力评估、完成功能问卷、功能测试表现、活动范围评估以及髌腱长度测量。在评估结果时，除1例膝关节合并多处韧带损伤外，所有病例与未手术侧基本相同。该膝关节的多处损伤可能是差异的原因。采用半腱肌加强的髌腱中部急性修复可使膝关节立即活动，这缩短了恢复期并改善了康复效果。此外，无需二次手术取出内固定物。早期且改善的康复以及二次手术几率降低这两个因素影响了该损伤的治疗费用。研究中所有单纯髌腱损伤在随访时功能均良好。基于这些原因，我们推荐该手术用于治疗急性髌腱断裂。
