# Simultaneous rupture of the anterior cruciate ligament and patellar tendon: report of a case and review of the literature

## TL;DR

A rare case of simultaneous ACL and patellar tendon rupture is reported, highlighting the challenges in diagnosis and the effectiveness of a single-stage surgical treatment.

## Contribution

A case report and review proposing a single-stage surgical technique for combined ACL and patellar tendon rupture.

## Key findings

- Single-stage surgery using tendon graft and suture provided good functional results with 140 degrees of flexion and full extension.
- Early diagnosis and repair of the patellar tendon are crucial for optimal outcomes.
- MRI is essential for diagnosing such rare combined injuries.

## Abstract

Simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare and complex injury, often resulting from high-energy trauma. This dual injury presents significant challenges in diagnosis and treatment.

This is a 29-year-old patient who sustained simultaneous ruptures of the ACL and patellar tendon following right knee trauma. A single-stage surgical treatment was performed, which involved ACL ligament reconstruction using a tendon graft from the contralateral knee and an end-to-end suture of the patellar tendon reinforced with a figure-8 plasty from the ipsilateral knee. The functional results were good: 140 degrees of flexion and full extension with stable support. Clinical evaluation included IKDC, Lysholm, and KOOS scores. The patient returned to work after three months.

Such combined injuries are rare, and their diagnosis often requires thorough clinical assessment and imaging, especially MRI. Treatment protocols remain debated, with differing opinions on one-stage versus two-stage surgeries. However, early diagnosis and repair of the patellar tendon have been shown to provide the best outcomes. Our proposed technique aims for optimal functional results, emphasizing early intervention, precise repair, and personalized rehabilitation: analgesic physiotherapy, active extension and strengthening work.

In conclusion, suspicion of simultaneous ACL and patellar tendon rupture should arise in high velocity acute knee trauma with ligamentous laxity and significant hemarthrosis. Prompt diagnosis is the key of management. While a well-established treatment protocol is lacking, the general consensus is that prompt intervention is crucial for the patellar tendon.

•Simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare and complex injury•Such combined injuries are rare, and their diagnosis often requires thorough clinical assessment and imaging, especially MRI•Reconstruction of chronic patellar tendon ruptures using the ipsilateral semitendinosus tendon mimicking the native tendon, appears to be an anatomical method

Simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare and complex injury

Such combined injuries are rare, and their diagnosis often requires thorough clinical assessment and imaging, especially MRI

Reconstruction of chronic patellar tendon ruptures using the ipsilateral semitendinosus tendon mimicking the native tendon, appears to be an anatomical method