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Abstract
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Introduction:Acute traumatic patellar and quadricipital tendon lacerations may occur with a transverse anterior knee wound, going straight down to the tendon. To expose the entire patella for transosseous tunnel repair, the surgeon has to extend the wound longitudinally over the patella, creating a skin flap that may present healing issues and induce anterior knee pain due to the scar tissue in the prepatellar bursa. Based on a clinical case, we present a less invasive technique that avoids the need to extend the traumatic wound, thus potentially decreasing skin healing complications and anterior knee pain occurrence as well as operating time.Methods:We present the case of a 23 year-old patient, transfered with a deep, transverse anterior knee wound made by a snowboard. Physical examination showed a complete patellar tendon section. He was taken to the operating theater for wound exploration and repair of the patellar tendon. In order to avoid longitudinal extension of the traumatic wound to expose the patella for transosseous tunnel repair, the following technique was applied: The technique is based on the use of a 2.4 mm straight passing needle, used in anterior cruciate ligament reconstruction, that is used as a drill and a suture passer at the same time, making it possible to drill the transosseous tunnels in the patella without having to expose its entire surface. The sutures are passed through the patellar tunnels using only the traumatic wound and the knots are tied through a small incision at the opposite pole of the patella. No skin flaps need to be raised and the patellar bursa is left untouched.Results:With a standard postoperative rehabilitation protocole, the use of this technique allowed full recovery of range of motion at three months and muscle strength at six months postoperative. There is no anterior knee pain and the cosmetic result is better, since only the traumatic wound was used to repair the patellar tendon. There were no wound healing issues and no wound adhesion with the underlying tissues. In our experience, the technique is no more difficult than the standard technique and there is practically no learning curve, making it ideal in open ruptures with a transverse wound.Conclusions:We propose this technique in cases of open acute patellar or quadricipital tendon ruptures. It allows for a decrease in surgical trauma, can potentially decrease skin healing complications, anterior knee pain and accelerate rehabilitation.
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