Falconiero R P, Pallis M P
Department of Orthopaedics, Graduate Hospital, Philadelphia, Pennsylvania, USA.
Arthroscopy. 1996 Oct;12(5):623-6. doi: 10.1016/s0749-8063(96)90204-2.
Chronic ruptures of the patellar tendon fortunately are an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by quadriceps muscle contracture and a great deal of scar tissue formation. We report the case of a repair of a chronic patellar tendon rupture. The patient's right patellar tendon was reconstructed approximately 10 months after the injury using quadricepsplasty and an Achilles tendon allograft with a suprapatellar wire for tension release. Four weeks postoperatively, he had attained 60 degrees of flexion and full active extension. At 8 weeks, the suprapatellar wire was removed allowing the distribution of stresses on the reconstructed patellar tendon. At 6 months, the patient had 130 degrees of flexion and full extension, but showed a persistent 40% deficit in right quad strength. The technique accomplished the preoperative goals of restoring quadriceps function, restoring the anatomic position of the patella, and allowing early mobilization after surgery. Although the use of a suprapatellar wire to reduce tension on the reconstructed tendon required a second operation for removal, it allowed early mobilization and better healing of the repair.
幸运的是，髌腱慢性断裂并不常见。这些断裂通常难以修复，因为它们一般伴有股四头肌挛缩和大量瘢痕组织形成。我们报告一例慢性髌腱断裂修复病例。患者右髌腱在受伤约10个月后采用股四头肌成形术和带髌上钢丝的跟腱同种异体移植进行重建，以释放张力。术后4周，他已达到60度屈曲和完全主动伸直。8周时，取出髌上钢丝，使重建髌腱上的应力得以分布。6个月时，患者有130度屈曲和完全伸直，但右股四头肌力量持续存在40%的缺损。该技术实现了术前恢复股四头肌功能、恢复髌骨解剖位置以及允许术后早期活动的目标。尽管使用髌上钢丝来减轻重建肌腱上的张力需要二次手术取出，但它允许早期活动并使修复愈合得更好。
