title: Open Patellar Tendon Tenotomy and Debridement Combined with Suture-bridging Double-row Technique for Severe Patellar Tendinopathy.
abstract: OBJECTIVE
  To create a new surgical procedure for chronic severe patellar tendinopathy and to evaluate its clinical efficacy.
  
  
  METHODS
  In this retrospective study, the data of 12 patients with severe patellar tendinopathy in 14 knees who had undergone surgical treatment at Beijing Chao-Yang Hospital between 1 March 2009 and 1 August 2013 were analyzed. Inclusion criteria included severe patellar tendinopathy (Phase III), conservative therapy for more than 6 months, American Society of Anesthesiology status Grade I-II, and body mass index <30. Patients with severe osteoporosis, complete tendon disruption (Phase IV) and those who were unable to cooperate were excluded. There were 8 men (10 knees) and 4 women (4 knees) cases. The patients' ages ranged from 38 to 54 years (mean, 45.3 years). All surgeries had been performed by the same physician. Surgical treatment comprised incising open patellar midline tenotomy, complete debridement and suture-bridging double-row fixation. Isotonic and kinetic chain exercises were implemented after the second post-operative week. A gradual increase to full weight-bearing was allowed after the third post-operative week and a gradual return to unrestricted use of the leg after the eighth post-operative week. Preoperative and postoperative visual analogue scale (VAS) scores and Lysholm knee scores were obtained from the medical records or at recent postoperative follow-up visits and the results compared using Student's two-tailed paired t-test.
  
  
  RESULTS
  VAS scores decreased by a mean of 6.7 points (range, 1.1-7.8 points) during follow-up (minimum duration 14 months; range, 14-44 months) and Lysholm scores increased from 55.7 ± 6.5 points to 90.4 ± 6.2 points. Three cases (4 knees) achieved excellent outcomes (≥95 points) and 9 cases (10 knees) good outcomes (range, 86-94 points). No intraoperative or postoperative complications occurred. There were significant differences between preoperative and postoperative VAS and Lysholm scores (P < 0.01).
  
  
  CONCLUSIONS
  All study patients achieved good or excellent outcomes. No patellar tendon rupture or suture fixation failure occurred during follow-up. Suture-bridging double-row fixation is a simple and reliable method that not only improves patients' clinical symptoms, but also restores knee joint function.
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Tie-Bing
authors.initials: TB
authors.lastname: Qu
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Shi-Xiang
authors.initials: SX
authors.lastname: Ren
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Wen
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: De-Si
authors.initials: DS
authors.lastname: Ma
authors.affiliation: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Lin
authors.affiliation: International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing, China.|Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Kung
authors.initials: CK
authors.lastname: Cheng
mesh_terms: D000328:Adult; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D052256:Tendinopathy / Q000601:surgery*; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Patellar tendinopathy; Surgery; Suture anchor; Treatment