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A Modified Surgical Technique of Patellar Tendon Reconstruction in Total Knee Arthroplasty Using Achilles Tendon Allograft.

ABSTRACT: Patellar tendon disruption is one of the most dreaded complications after total knee arthroplasty (TKA) impacting joint function and implant longevity. Management of this condition remains controversial, and no one treatment has provided consistent clinical success. Here we propose a modified technique from the standard Achilles allograft procedure to reconstruct a ruptured patellar tendon after TKA. A fresh-frozen Achilles tendon allograft with attached calcaneal bone graft was used. Our technique offers the advantage of a more stable graft fixation by relying on both quadriceps tendon and transosseous patellar fixation and bone-to-bone allograft fixation to the tibial tuberosity. The patient regained full extension and discontinued walking aids postoperatively. Careful attention to graft preparation, tensioning, stable graft fixation, and postoperative rehabilitation led to encouraging results in this complex problem.

SUBMITTER: Poon G

PROVIDER: S-EPMC8789511 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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A Modified Surgical Technique of Patellar Tendon Reconstruction in Total Knee Arthroplasty Using Achilles Tendon Allograft.

Poon Glenys G Moo Ing How IH Poon Kein Boon KB

Arthroplasty today 20220120

Patellar tendon disruption is one of the most dreaded complications after total knee arthroplasty (TKA) impacting joint function and implant longevity. Management of this condition remains controversial, and no one treatment has provided consistent clinical success. Here we propose a modified technique from the standard Achilles allograft procedure to reconstruct a ruptured patellar tendon after TKA. A fresh-frozen Achilles tendon allograft with attached calcaneal bone graft was used. Our techni ...[more]

PMID: 35106354

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Patellar tendon reconstruction using an Achilles tendon-bone block allograft for periprosthetic joint infection accompanied by patellar tendon disruption after total knee arthroplasty: a case report.

Project description:BackgroundAs a complication of total knee arthroplasty (TKA), patella tendon disruption has been scarcely reported. Moreover, combined periprosthetic joint infection with patellar tendon disruption is even rare. This is a case report on successful treatment of a recurred periprosthetic joint infection accompanying the patellar tendon disruption after revision of TKA.Case descriptionA 63-year-old woman presented with pain and exudate in the right knee. she had a history of two-stage revision TKA at another hospital for periprosthetic joint infection of right knee. With repeated incision and debridement, Achromobacter xylosoxidan was identified in samples collected from deep tissue. Therefore, two-stage revision TKA was performed. Intra-operatively, a complete defect of the patellar tendon was observed. Re-revision TKA was performed as a routine of two-stage revision of TKA for periprosthetic joint infection. Reconstruction of the patellar tendon defect was performed using an Achilles tendon-bone block allograft. Stability of allograft was confirmed at 30 degrees of flexion, and excellent implant placement was confirmed by postoperative radiographs. At the final follow-up 3 years after surgery, evidence of infectious sign was absent, and the range of flexion up to 120 degrees was recovered without extension lag. Normal locomotive gait was restored, and recreational activities previously performed were possible without discomfort.ConclusionsProper reconstruction of extensor mechanism was achieved by patellar wrapping technique using an Achilles tendon-bone block allograft.

| S-EPMC10170282 | biostudies-literature

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Project description:Preoperative planning is a fundamental element in total knee arthroplasty (TKA). A previous surgery that must be recognized and identified preoperatively is the Hauser procedure, a posteromedialization of the tibial tubercle for recurrent patellar instability. Here, we describe 2 case reports in patients with previous Hauser surgeries. The first TKA surgery was complicated from a standard medial peripatellar approach resulting in complete transection of the patellar tendon during standard arthrotomy. The tendon was repaired, and the arthroplasty was aborted. For the second case, correct preoperative identification of the Hauser procedure was performed. The second TKA surgery was performed using a lateral peripatellar arthrotomy with excellent exposure, resulting in a successful operation. Here, we highlight the importance of an accurate history, physical and radiographic examination, and the recommendation of an alternative TKA approach to help avoid the serious intraoperative complication of a patellar tendon laceration.

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Quadriceps Tendon Reconstruction With Achilles Tendon Bone Block Allograft.

Project description:Chronic quadriceps tendon ruptures are relatively uncommon albeit debilitating injuries to the knee extensor mechanism. Previous literature demonstrates worse reported outcomes with delayed surgical intervention, and no gold-standard technique currently exists for managing chronic quadriceps tendon ruptures. The goal of this technique is to provide orthopaedic surgeons an additional option that may provide a greater mechanical load to failure and greater allograft acceptance for cases with large tendon gapping or poor tissue quality that may not be viable to other lengthening techniques. We describe the repair of a chronic quadriceps tendon rupture using an Achilles tendon bone block allograft.

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Superior Capsular Reconstruction with Achilles Tendon Allograft.

Project description:Superior capsular reconstruction (SCR) has become an increasingly popular choice in the treatment of massive, irreparable rotator cuff tears, pseudoparalysis, and in cases in which revision of previous rotator cuff repair is indicated. The SCR procedure is intended to restore the superior stabilizing forces of a deficient rotator cuff. This technique is accomplished by substituting an autograft or allograft between the superior glenoid and the greater tuberosity of the humerus, thus keeping the humeral head centered in the glenoid during shoulder forward flexion and abduction. Since its advent, numerous techniques have been described for this procedure. A fascia lata autograft was initially described; however, many surgeons in the United States have advocated for the use of a humeral dermal allograft. Yet, biomechanical studies have demonstrated elongation and thinning of this material. Thus, the Achilles tendon allograft may be an attractive choice for SCR, given its previous success with ligamentous and tendinous reconstructions. In this article, we present our technique of SCR using an Achilles tendon allograft.

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Patellar Tendon Reconstruction for a Chronic Extensor Mechanism Deficit Using an Achilles Tendon Allograft With Hamstring Autograft and Suture Augmentation.

Project description:Patellar tendon ruptures are the third most common injury to the extensor mechanism. These injuries are debilitating to the patient, and delays in treatment can present a challenge to the treating surgeon. Chronic patellar tendon injuries are rare and are more difficult to manage given proximal patellar retraction, scarring, and atrophy of surrounding tissues. There is no consensus on the optimal approach for treatment, and numerous reconstruction techniques have been described using a variety of graft choices and fixation methods. We describe our surgical technique for a 3-fold reconstruction of a chronic patellar tendon rupture using an Achilles tendon allograft augmented with a vascularized ipsilateral hamstring tendon autograft and additional FiberTape augmentation. The aim of this procedure is to restore patellar height and prevent extensor lag.

| S-EPMC7189117 | biostudies-literature

Surgical Technique: Jumper's Knee-Arthroscopic Treatment of Chronic Tendinosis of the Patellar Tendon.

Project description:Chronic patellar tendinosis (jumper's knee) is a common problem among athletes. Conservative treatment is successful in most of the cases including, among others, the use of nonsteroidal anti-inflammatory drugs, local cryotherapy, eccentric muscle training, limitation of sports activity, and local infiltration. In approximately 10% of conservatively treated patients, conservative treatment fails and surgery is required. Different open and arthroscopic surgical techniques have been described in the literature. The presented all-arthroscopic surgical technique for the treatment of chronic patellar tendinosis includes debridement of soft tissue at the lower patellar pole and resection of the bony lower patellar pole. It leads to excellent clinical results comparable to described open treatment and provides the benefits of a minimally invasive and safe procedure with a faster recovery and return to sporting activities after surgery. An additional bony resection in case of a prominent lower patellar pole does not lead to a significant extension of the operation time and may avoid a relapse or treatment failure in selective cases. Therefore, arthroscopic treatment such as the presented technique may be the preferred method for surgical treatment of chronic patellar tendinosis.

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A Crossed Screw Patellar Reconstruction Technique for the Treatment of the Severely Deficient Scaphoid Shaped Patella in Total Knee Arthroplasty.

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