title: Late reconstruction of the patellar tendon in rheumatoid arthritis using bone-patellar tendon-bone allograft.
abstract: BACKGROUND
  chronic patellar tendon rupture is rare and its incidence and prevalence are unknown. Furthermore, the data about late reconstruction of the patellar tendon in rheumatoid arthritis is limited. Such condition, if not managed properly, can substantially affect the patient's activities of daily living.
  
  
  METHODS
  We report a case of chronic patellar tendon rupture in a 49 years old lady who has been suffering from rheumatoid arthritis for over 20 years. She presented with an inability to extend the right knee which started suddenly a year and a half ago without any history of trauma. She underwent reconstruction of the patellar tendon using a massive BTB allograft. Three years after surgery, the patient had an active range of motion between -20 and 120° and was walking normally without any external support.
  
  
  CONCLUSIONS
  When the primary repair of the patellar tendon is not possible, it is necessary to either repair with autologous augmentation or use a graft to reconstruct the tendon. We believe autografts may not be suitable in the presence of rheumatoid arthritis since the disease is associated with excessive levels of collagenase that could contribute to the degeneration of the tendons.
  
  
  CONCLUSIONS
  Late patellar tendon reconstruction in rheumatoid arthritis is a challenging procedure, and we believe it is best performed using an allograft to achieve the desired outcome.
authors.affiliation: Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia; University Hospital of Valladolid, Valladolid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Palencia
authors.affiliation: Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Electronic address: alfayezsaud@gmail.com.
authors.forename: Saud M
authors.initials: SM
authors.lastname: Alfayez
authors.affiliation: Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Alshammri
authors.affiliation: Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia.
authors.forename: Hani S
authors.initials: HS
authors.lastname: Serhan
authors.affiliation: Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia.
authors.forename: Firas
authors.initials: F
authors.lastname: Serro
authors.affiliation: Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdulaziz Z
authors.initials: AZ
authors.lastname: Alomar
keywords: Allograft; Case report; Late reconstruction; Patellar tendon; Rheumatoid arthritis