title: Surgical repair of chronic patellar tendon rupture in total knee replacement with ipsilateral hamstring tendons.
abstract: OBJECTIVE
  Patellar tendon rupture is a serious complication of total knee arthroplasty (TKA). Its reconstruction in patients with chronic ruptures is technically demanding. This article reports the results of surgical reconstruction of neglected patellar tendon rupture in TKA using autologous hamstring tendons.
  
  
  METHODS
  Nine TKA patients (six women and three men) (mean age at index surgery 68 years) with chronic patellar tendon tears underwent reconstruction with ipsilateral hamstrings tendon, leaving the distal insertion in situ. The clinical diagnosis was supported by imaging (anterior-posterior and 30° flexion lateral radiographs). Insall-Salvati index, range of motion, and leg extension test were recorded preoperatively and at last follow-up. The modified Cincinnati rating system and the Kujala score were administered. The patients sustained the patellar tendon tear an average of 8 weeks before the procedure.
  
  
  RESULTS
  At final follow-up of 4 years (range 2-8 years), the median of extension lag was 5° (range 0°-15°; DS = 5). The median of post-operative Insall-Salvati index was 1.4 (range 1.3-1.8; SD = 0.15; p = 0.002) compared to the preoperative index of 1.7 (range 1.5-2.2; SD = 0.23). The mean modified Cincinnati and Kujala scores significantly increased compared with the preoperative ones (p < 0.01). At final follow-up, all patients were able to walk without brace or aids, and they were satisfied with the procedure.
  
  
  CONCLUSIONS
  Based on our retrospective study of nine patients, reconstruction of neglected patellar tendon rupture in TKA with autologous hamstring tendons is feasible and safe, and provides good functional recovery.
  
  
  METHODS
  Case series, Level IV.
authors.affiliation: Department of Orthopaedics and Traumatology, San Camillo-Forlanini Hospital, Piazza C. Forlanini 1, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Spoliti
authors.affiliation: Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata", School of Medicine, Viale Oxford 81, 00133, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Giai Via
authors.affiliation: University e-Campus, Novedrate, Italy.|Tunisian Research Laboratory 'Sports Performance Optimization', National Center of Medicine and Science in Sport, Tunis, Tunisia.
authors.forename: Johnny
authors.initials: J
authors.lastname: Padulo
authors.affiliation: Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata", School of Medicine, Viale Oxford 81, 00133, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Oliva
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital Antonio Cardarelli, Contrada Tappino, Campobasso, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Del Buono
authors.affiliation: Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy. n.maffulli@qmul.ac.uk.|Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK. n.maffulli@qmul.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D000070632:Hamstring Tendons / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000293:injuries* / Q000601:surgery*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012421:Rupture; D013709:Tendon Transfer
keywords: Chronic rupture; Extensor mechanism insufficiency; Hamstring tendon autograft reconstruction; Patellar tendon rupture; Total knee arthroplasty