title: Recurrent patellar tendon rupture in a patient after intramedullary nailing of the tibia: reconstruction using an Achilles tendon allograft.
abstract: Various complications after intramedullary (IM) nailing of the tibia have been reported, the most common of which are anterior knee pain and symptoms similar to patella tendonitis. Complete rupture of the patellar tendon after IM nailing of the tibia has been reported on 2 occasions, in conjunction with predisposing patient factors, such as systemic disease or a proud tibial nail. Patellar tendon ruptures are disabling injuries that can be technically difficult to repair because of the poor quality of remaining tendon tissue, quadriceps muscle atrophy and/or contracture, and scar-tissue formation. Many methods have described the surgical reconstruction of the knee extensor mechanism, which is most commonly performed after total knee arthroplasty. We report the successful surgical and clinical outcome of patellar tendon reconstruction using an Achilles tendon allograft in a patient subject to late and recurrent ruptures after IM nailing of the tibia through a mid-patellar tendon-splitting approach. Seven months after tendon reconstruction, the patient exhibited full knee flexion, an extension lag of 10º, 4/5 quadriceps strength, and return to her baseline ambulatory status.
authors.affiliation: Orthopaedic Surgery Specialists, Burbank, CA. djagow88@yahoo.com.
authors.forename: Devin M
authors.initials: DM
authors.lastname: Jagow
authors.forename: Branden J
authors.initials: BJ
authors.lastname: Garcia
authors.forename: Stephan V
authors.initials: SV
authors.lastname: Yacoubian
authors.forename: Shahan V
authors.initials: SV
authors.lastname: Yacoubian
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D000328:Adult; D064591:Allografts; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006801:Humans; D017847:Patellar Ligament / Q000293:injuries / Q000601:surgery*; D020127:Recovery of Function; D012008:Recurrence; D012421:Rupture; D013708:Tendon Injuries / Q000209:etiology / Q000601:surgery*; D013977:Tibia / Q000601:surgery; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome