Ipsilateral Patellar Tendon Reconstruction Using Quadriceps Tendon-Patella Bone Autograft for Simultaneous Rupture of the Patellar Tendon, Anterior Cruciate Ligament, and Medial Collateral Ligament: A Case Report

TL;DR

A rare case of simultaneous knee injuries was treated with a two-stage surgical approach using autografts, resulting in successful recovery and no complications.

Contribution

A novel two-stage surgical method using quadriceps tendon-patella bone autograft for complex knee trauma is presented.

Findings

Successful reconstruction of patellar tendon using QTB autograft led to full knee extension and 135° flexion.

No postoperative complications such as retear or infection were observed.

ACL reconstruction using semitendinosus tendon was successfully performed in the second stage.

Abstract

Simultaneous rupture of the patellar tendon (PT), anterior cruciate ligament (ACL), and medial collateral ligament is a relatively rare type of trauma. We present a two-stage treatment for this type of trauma.

A 47-year-old male who fell from a height of 2 m. The ruptured part of the PT was in poor condition and required strong fixation; therefore, we reconstructed the tendon using quadriceps tendon-patellar bone (QTB) autograft as the first stage of the procedure. After nine months, ACL reconstruction using the semitendinosus tendon (ST) was performed as the second stage. Eighteen months after the first operation, the range of motion (ROM) was 0° of knee extension without any extension lag and 135° of flexion. Radiographs revealed that bone graft incorporation was achieved with an Insall-Salvati ratio of 1.11. The Lachman test and pivot-shift test were negative. There were no postoperative complications, including retear, loss of ROM, or infection.

The use of QTB autografts for the rupture of the PT has several advantages. First, the enthesis can be reconstructed with healthy tissue, and the PT length can be maintained. Second, autografts can be expected to be incorporated. Third, the ST can be preserved for ACL reconstruction without invading the contralateral leg.

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