Limits...
Neglected Patellar Tendon Rupture With Massive Proximal Patellar Migration Treated With Patellar Transport and Staged Allograft Reconstruction

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Several methods had been reported to relocate the proximally migrated patella distally to its anatomic location, including preoperative traction, intraoperative traction, quadricepsplasty, and external fixation... Over the course of 2 years, the patient developed progressive scarring of the quadriceps tendon on the left side and had an extensor lag of 25°... He was operated upon successfully with open quadricepsplasty and was able to again achieve full extension... In their case report of 2 cases, the final ROM was 0° to 90° and 0° to 120°, with no extensor lag... Synthetic materials have also been used with satisfactory results... In cases with severe quadriceps tendon contracture and fixed proximal patellar migration, numerous techniques have been reported to adequately mobilize the patella and relocate it distally to its anatomic position and to reconstruct the patellar tendon; however, there is no widely accepted method... Levin used a Dacron graft to replace the tendon followed by cast immobilization for 6 weeks... Casey and Tietjens reported on 4 cases where they successfully used direct repair augmented by cerclage... The use of external fixation has been reported for patients with severe quadriceps contractures and fixed elevated patella... Isiklar et al reported on 2 patients with chronic patellar tendon ruptures due to failed primary repairs in which the authors used ring and wire external fixation, applying the distraction principles of Ilizarov preoperatively to mobilize the patella distally and postoperatively to protect the reconstruction while maintaining ROM and full weightbearing... In their case report, Isiklar et al reported on successful use of external fixation to treat 2 patients with chronic patellar tendon ruptures with failed primary repair, presenting 3.5 years and 8 months after the initial injury, the final ROM achieved was 0° to 130° in 1 patient and 0° to 110° in the second patient, with no extensor lag, normal Insall-Salvati ratio, and 5 out of 5 quadriceps strength in both patients... Those results were most similar to the results we achieved... The wires were pulled axially through a small wire site at the skin minimizing skin trauma... Despite the high rate of complications encountered, specifically the pin tract infection in the first patient and deep vein thrombosis in the second patient, those complications were managed conservatively and appropriately without the need to reoperate and without any effect on the final outcome of the procedure.

No MeSH data available.


Postoperative (A) frontal and (B) lateral plain radiographs at the end of distraction showing improved patellar height of the left knee. Note the oblique distal pull on the 2 olive wires creating a resultant vector in the distal direction (arrows).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
getmorefigures.php?uid=PMC5120681&req=5

fig8-2325967116672175: Postoperative (A) frontal and (B) lateral plain radiographs at the end of distraction showing improved patellar height of the left knee. Note the oblique distal pull on the 2 olive wires creating a resultant vector in the distal direction (arrows).

Mentions: A 180-mm ring was applied to the distal femur orthogonal to the femoral axis and secured with two 6-mm half pins. Next, 2 oblique olive wires were placed through the patella in a proximal to distal direction. The 2 wires were 30° off a vertical line and created a vector that was a vertical line in a proximal to distal direction. The wires were cut off the ends of the olives, and the olives were seated at the proximal medial and proximal lateral poles of the patella. The wires were attached to slotted Ilizarov rods, and a mechanism to axially pull the olive wires was created off the femoral ring. The direction was oblique to avoid the future knee incision, and the resultant vector was straight distal. Knee ROM was checked and was from full extension to 90° of flexion. Finally, the position of the frame and the wires was checked under fluoroscopy. The adjustments were started on the first postoperative day with a target of 1-mm distraction per day divided into 4 adjustments. The patient was followed up with every 2 weeks with plain radiographs of the left knee to follow the progression of distal transport of the patella (Figure 8). The target was to pull the patella distally 5 cm. We used the Insall-Salvati ratio14 for assessment of patellar height to follow the progression of distal patellar transport, and the goal was to achieve a ratio of 1.


Neglected Patellar Tendon Rupture With Massive Proximal Patellar Migration Treated With Patellar Transport and Staged Allograft Reconstruction
Postoperative (A) frontal and (B) lateral plain radiographs at the end of distraction showing improved patellar height of the left knee. Note the oblique distal pull on the 2 olive wires creating a resultant vector in the distal direction (arrows).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC5120681&req=5

fig8-2325967116672175: Postoperative (A) frontal and (B) lateral plain radiographs at the end of distraction showing improved patellar height of the left knee. Note the oblique distal pull on the 2 olive wires creating a resultant vector in the distal direction (arrows).
Mentions: A 180-mm ring was applied to the distal femur orthogonal to the femoral axis and secured with two 6-mm half pins. Next, 2 oblique olive wires were placed through the patella in a proximal to distal direction. The 2 wires were 30° off a vertical line and created a vector that was a vertical line in a proximal to distal direction. The wires were cut off the ends of the olives, and the olives were seated at the proximal medial and proximal lateral poles of the patella. The wires were attached to slotted Ilizarov rods, and a mechanism to axially pull the olive wires was created off the femoral ring. The direction was oblique to avoid the future knee incision, and the resultant vector was straight distal. Knee ROM was checked and was from full extension to 90° of flexion. Finally, the position of the frame and the wires was checked under fluoroscopy. The adjustments were started on the first postoperative day with a target of 1-mm distraction per day divided into 4 adjustments. The patient was followed up with every 2 weeks with plain radiographs of the left knee to follow the progression of distal transport of the patella (Figure 8). The target was to pull the patella distally 5 cm. We used the Insall-Salvati ratio14 for assessment of patellar height to follow the progression of distal patellar transport, and the goal was to achieve a ratio of 1.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Several methods had been reported to relocate the proximally migrated patella distally to its anatomic location, including preoperative traction, intraoperative traction, quadricepsplasty, and external fixation... Over the course of 2 years, the patient developed progressive scarring of the quadriceps tendon on the left side and had an extensor lag of 25°... He was operated upon successfully with open quadricepsplasty and was able to again achieve full extension... In their case report of 2 cases, the final ROM was 0° to 90° and 0° to 120°, with no extensor lag... Synthetic materials have also been used with satisfactory results... In cases with severe quadriceps tendon contracture and fixed proximal patellar migration, numerous techniques have been reported to adequately mobilize the patella and relocate it distally to its anatomic position and to reconstruct the patellar tendon; however, there is no widely accepted method... Levin used a Dacron graft to replace the tendon followed by cast immobilization for 6 weeks... Casey and Tietjens reported on 4 cases where they successfully used direct repair augmented by cerclage... The use of external fixation has been reported for patients with severe quadriceps contractures and fixed elevated patella... Isiklar et al reported on 2 patients with chronic patellar tendon ruptures due to failed primary repairs in which the authors used ring and wire external fixation, applying the distraction principles of Ilizarov preoperatively to mobilize the patella distally and postoperatively to protect the reconstruction while maintaining ROM and full weightbearing... In their case report, Isiklar et al reported on successful use of external fixation to treat 2 patients with chronic patellar tendon ruptures with failed primary repair, presenting 3.5 years and 8 months after the initial injury, the final ROM achieved was 0° to 130° in 1 patient and 0° to 110° in the second patient, with no extensor lag, normal Insall-Salvati ratio, and 5 out of 5 quadriceps strength in both patients... Those results were most similar to the results we achieved... The wires were pulled axially through a small wire site at the skin minimizing skin trauma... Despite the high rate of complications encountered, specifically the pin tract infection in the first patient and deep vein thrombosis in the second patient, those complications were managed conservatively and appropriately without the need to reoperate and without any effect on the final outcome of the procedure.

No MeSH data available.