Detaillierte Beitrags-Information
| Beitragstitel | Chronic patellar tendon rupture on a native knee: reconstruction with an Achilles tendon allograft with a calcaneal block. A case report. |
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| Beitragscode | P055 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Introduction Chronic ruptures of the patellar tendon have important consequences on the daily life of patients, considering the lack of the extension function and thus the difficulty to walk. Several techniques have been described for the reconstruction, with allo- or autograft and yet no consensus has been reached for the solution that works best. We describe the case of a reconstruction with an Achilles tendon allograft for a chronic rupture that happened two years ago. Case report A 60-year-old man consulted for a chronic rupture of his left patellar tendon after a fall with direct reception on the knee. He has been admitted in another hospital where they recommended surgery that the patient refused. In the meantime he was hospitalised several times in a psychiatric hospital for alcoholic withdrawals in a context of personality disorder. Finally, he decided to support a surgical intervention because of his difficulty to walk while having to remind constantly to keep the knee in extension. During the physical examination we were able to palpate the femoral condyles as well as the intercondylar spaces through a gap while the patient was flexing. The patella was mobilized and it was possible to lower it. The patient was able to walk slowly with the knee kept in extension. After discussing the case with colleagues, we decided for the reconstruction with an Achilles tendon allograft with the calcaneal block. The latter has been inserted in a cavity previously prepared under the tibial tuberosity and fixed with a 3.5mm screw. Then, after having estimated the optimal height of the patella, we introduced a cerclage through it distally to the tibial tuberosity. We then fixed the graft on the quadricipital tendon and around the patella with Orthocord suture in such a way to cover the patella. For postoperative care, we prescribed a knee extension brace for walking and authorized the early progressive mobilization during physiotherapy. At 3 months followup, the patient was able to flex at 90° with a total extension and the quadriceps muscle strength estimated at 4. Conclusion Chronic patellar tendon ruptures remains controversial. It is essential to consider every option depending on the knee being native or not, and the different types of grafts. If an allograft does not convince some surgeons, in particular due to the risks of infection and its availability, it still is an excellent option with a good cover of important tendon defects. |