McNally P D, Marcelli E A
University of Medicine and Dentistry of New Jersey, Kennedy Memorial Hospitals, Stratford, USA.
Arthroscopy. 1998 Apr;14(3):340-4. doi: 10.1016/s0749-8063(98)70154-9.
Chronic ruptures of the patellar tendon are uncommon injuries. They are technically difficult to repair because of scar formation, poor quality of the remaining tendon, and quadriceps muscle atrophy and contracture. We report the reconstruction of a chronic patellar tendon rupture with an interesting complication, a tibial stress fracture. The reconstruction was performed 3 months after the injury using an Achilles tendon-bone allograft and reinforcing suprapatellar wire. At 2 weeks postoperatively, the patient had attained full extension and 90 degrees of flexion. Ten months after the index procedure, the patient had range of motion 0 degrees to 120 degrees and was diagnosed with a healing tibial stress fracture. At 17 months postoperatively, the patient had attained full extension, 120 degrees of flexion, and 85% quadriceps strength. The preoperative goals of attaining full range of motion, improving quadriceps strength, obtaining anatomic patellar alignment, and restoring function were obtained despite the complication of a tibial stress fracture. Although this reconstructive procedure is technically demanding, with potential complications, the functional results obtained can be excellent.
髌腱慢性断裂是一种罕见的损伤。由于瘢痕形成、剩余肌腱质量差以及股四头肌萎缩和挛缩，其修复在技术上具有挑战性。我们报告了一例慢性髌腱断裂的重建病例，该病例出现了一种有趣的并发症——胫骨应力性骨折。损伤后3个月，采用跟腱-骨同种异体移植物和髌上加强钢丝进行重建。术后2周，患者已达到完全伸直和90度屈曲。在初次手术后10个月，患者的活动范围为0度至120度，并被诊断为胫骨应力性骨折愈合。术后17个月，患者达到完全伸直、120度屈曲，股四头肌力量恢复至85%。尽管出现了胫骨应力性骨折这一并发症，但术前实现全关节活动范围、增强股四头肌力量、获得髌骨解剖对线以及恢复功能的目标均已达成。虽然这种重建手术技术要求高且存在潜在并发症，但获得的功能结果可能非常出色。
