Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: Series of 25 patients

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Original article

Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: Series of 25 patients

K. Belhaj

^a,

*, H. El Hyaoui

^b

, A. Tahir

^c

, S. Meftah

^a

, L. Mahir

^a

, A. Rafaoui

^b

, F. Lmidmani

^a

, M. Arsi

^b

, M. Rahmi

^b

, M. Rafai

^b

, A. Garch

^b

, M. Fadili

^c

, M. Nechad

^c

, A. El Fatimi

^a

aDepartmentofphysicalmedicineandrehabilitation,IbnRochduniversityhospital,Casablanca,Morocco

bDepartmentoforthopedicsandtraumatology(P32),IbnRochduniversityhospital,Casablanca,Morocco

cDepartmentoforthopedicsandtraumatology(P4),IbnRochduniversityhospital,Casablanca,Morocco

1. Introduction

Isolatedpatellartendonrupture(PTR)isanuncommoninjury requiringimmediaterepairtore-establishkneeextensorcontinu- ityandallowearlymotion[1].Thepeakincidenceoccursespecially inpatientsyoungerthan40years[2].Thetraumamechanismof PTR can be indirect or direct [3]. Direct trauma, repetitive microtraumaanddegenerationaretheprincipalcausesresulting inviolenteccentriccontractiononaﬂexedkneeinhealthypeople, commonlyseeninyoungathletesinvolvedinjumpingsports[1,4–

6]. Spontaneous rupture is common in patients with systemic collagendisordersorthosereceivingsteroidinjections[7,8].Pre- disposingrisk factorsinclude microtrauma,degenerative tendi- nopathy,localcorticosteroidinjections,andotherrheumatologic, metabolic,or immunologic conditions[8–10]. Multiple surgical

techniqueshavebeendescribed forreconstructing theextensor mechanismoftheknee[11–16].

AlthoughmanagementofPTRisnowwellcodiﬁed,theresults ofsurgeryhavebeenrarelyassessed[17,18]becauseoftherarityof theconditionandthereforeresultslackstatisticalpower.

Weaimedtoevaluateclinicaloutcomesaftersurgicalrepairof PTR and compare the evolution of 2 rupture types (acute and chronic)afterthesamerehabilitationprotocol.

2. Materialsandmethods

2.1. Studydesignandparticipants

WeperformedaprospectivecohortstudyofpatientswithPTR treatedbetweenJanuary2006andJanuary2014inthedepartment oftraumasurgery,IbnRochduniversityhospital,Casablanca.All participantsprovidedwritteninformedconsentandtheresearch protocol was approvedby theEthics in Research with Human ARTICLE INFO

Articlehistory:

Received4January2016 Accepted3October2016

Keywords:

Patellartendonrupture Chronicrupture Acuterupture Outcome Rehabilitation

ABSTRACT

Objective:Weaimedtoevaluatetheclinicaloutcomesaftersurgicalrepairofpatellartendonrupture (PTR)andcomparetheevolutionof2typesofrupture(acuteandchronic)afterthesamerehabilitation protocol.

Methods:ThiswasaprospectivecohortstudyofpatientswithPTRtreatedbetweenJanuary2006and January2014inthedepartmentoftraumasurgery,IbnRochduniversityhospital,Casablanca.

Results:Weevaluated25patients(21men)afteramedianfollow-upof75months(range29–120).The meanagewas34.78.59years.Overall,17patientshadacuteruptureand8chronicrupture.Fifteen healthyvolunteers(13men)wererecruitedasacontrolgroup.MeanKneeSocietyScore(KSS)kneescorewas significantlyhigherafterthanbeforesurgery(82.2812.297vs20.647.6;P<0.0001)aswasKSSfunction score(88.4017.483vs23.408.98;P<0.0001).Painmeasuredonavisualanalogscalewassignificantly lowerafterthanbeforesurgery(1.961.24vs6.601.26;P<0.0001).ROMandKSSkneeandfunction scoresweresignificantlylowerontheoperatedthannon-operatedsideaftersurgery.ForbothtypesofPTR, onlykneeextensormusclestrengthwassignificantlylowerontheoperatedthannon-operatedsideandas comparedwithhealthyvolunteerknees.

Conclusions:SurgicalrepairofPTRwithreinforcementandanearlyrehabilitationprogramdemonstrate goodresultsafteralongfollow-up.However,chronicPTRmayneedlongeroradifferentrehabilitation protocoloftheknee-extensorapparatus.

ß2016ElsevierMassonSAS.Allrightsreserved.

* Correspondingauthor.

E-mailaddress:[email protected](K.Belhaj).

Availableonlineat

ScienceDirect

www.sciencedirect.com

http://dx.doi.org/10.1016/j.rehab.2016.10.003

1877-0657/ß2016ElsevierMassonSAS.Allrightsreserved.

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Beings Committee of the institution. The principal inclusion criteria were age18 years, unilateral and complete PTR, undergoingprimarysurgicaltreatmentwiththesameprocedure andpostoperativerehabilitationprotocol.Theprincipalexclusion criteriawerefollow-up<1 year,bilateralrupture, and patients withanterior knee surgeryor associatedinjury of theextensor mechanismoftheknee.

Patientsweredividedinto2groupsbasedontimeofdiagnosis andtreatment:acutePTR(diagnosisandrepairoccurring6weeks fromtimeofinjury)andchronicorneglectedPTR(diagnosisand repairoccurring>6weeksfromtimeofinjury)[16].

Preoperativediagnosiswasestablishedbyphysicalexamina- tion including an evaluation of movement with use of a goniometer and evaluation of muscle strength, to reveal an inabilityto extend theknee joint or maintaina straight knee againstgravity[19].KneeSocietyScore(KSS)[20]andpainscored onavisualanalogscale(VAS)weredetermined.HighKSSscore indicatedbettercondition.PreoperativeX-rayswerereviewedto calculatethe patellarheight indexwith the Caton-Deschamps index(CDI)[21].PatientswithchronicruptureunderwentMRIto assessthetendonconditions.

Weincludedasacontrolgroup15adultvolunteerswithoutany kneepathologywhounderwentisokineticevaluationoftheknee musclestrength.

2.2. Operativetechnique

Six(24%)patientspresentedafull-bodyacutetear:therewas nodistancebetweentherupturetendonextremities,andend-to- end suture was performed with thick resorbable suture. Eight (32%)patientspresentedafull-bodychronictear,andrestoration of patellar tendon length involved use of hamstring tendons [17,22].Eleven(44%)patientspresentedaproximalavulsion:the tendon was anchored to the bone by 2 thick, non-resorbable sutures via 2 parallel bone tunnels to the proximal pole of thepatella.

Repairwasprotectedbyareinforcementframeinallcasesby using metal wire (McLaughlin cerclage). The wire was passed throughthepatellaandthetibialtuberosityandwastightenedin about 608 knee ﬂexion [23]. The surgeries wereperformed by several surgeons. After 6 weeks, the McLaughlin cerclage was removedandfreemobilizationwasallowed[23].

2.3. Postoperativerehabilitationprotocol

Allpatientsunderwentthesamerehabilitationprotocolbased onthefollowing5phases[24]:

phase1:theﬁrstweekaftersurgery.Thelimbwasimmobilized in a cylindercastwithfull weight-bearing. On postoperative day1or2,patientsstartedpassivekneemotion,withrangeof motion(ROM)from08to308,andisometricexercisesafterthe castwasremovedundertheguidanceofa physicaltherapist.

Passiveﬂexionwaslimitedto608;

phase2:2to6weeksaftersurgery.Patientsweredischarged homeandcontinuedfullweight-bearingwithaclosedcylinder castforafurther4weeks.Passivekneemotionwaslimitedto 908ROMwithoutactivekneeextension;

phase3:6to12weeksaftersurgery.Arehabilitationprogram withisometricexercisesandgentleactiveprogressiveextension withoutresistance wasstarted toregain quadricepsstrength andgaitstability.Flexionupto908wasallowed;

phase 4: 12 to 16 weeks after surgery. Full knee ROM with progressivestep-upstairswasallowed.Patients hadtoavoid anyforcefuleccentriccontractionsand exercisesthat created movementcompensations;

phase5:16to24weeksaftersurgery.Impactcontrolexercises beginning2feetto2feet,progressingfrom1foottotheother and then1foottothesamefoot.Movementcontrolexercise beganwithlowvelocity,singleplaneactivitiesandprogressed to higher velocity. Jumping and sports activities were not alloweduntil6monthsaftersurgeryandareturnofnearfull musclestrengthasassessedbythesurgeon.

2.4. Follow-upandevaluation

Patientswerereviewedat6weeks,3and6monthsand1year aftersurgery.Follow-up examinationincludedpatient’shistory, assessment of risk factors, clinical examination of both knees, X-ray, KSS, and medical outcomes study 36-item short form (SF-36)[20,25].Pain(ona0-10VAS)andsatisfaction(ratedfrom 1to4,dissatisﬁedtoverysatisﬁed)wereevaluated.X-raywasused toassesspatellarheightbytheCaton-DeschampsIndex(CDI)[21].

Knee musclestrengthwasevaluatedisokinetically at6 months aftersurgery.

2.5. Isokinetictesting 2.5.1. Equipment

ThetestsinvolveduseofaCYBEXnormisokineticdynamome- tersystemtomeasureisokineticjointtorqueofkneeﬂexionand extension in concentric mode. The system was driven by the Human assessment computer (HUMAC)software for Windows.

Thedynamometerwasrecalibratedaccordingtothemanufactu- rer’sspeciﬁcations.

2.5.2. Positioningofparticipants

Theoperatedandnon-operatedsidesweretested.Participants were seated properly by a physical therapist on the CYBEX dynamometerandleanedagainstabackrestinclinedat168from verticalandwiththeseatinclined68fromhorizontal.Theaxisof thedynamometerwasalignedwiththeﬂexion-extensionaxisof theknee.Thetrunk,waist,distalthighandlegweresecuredwith strapstostabilizethebodyandminimizemusclecompensation.

All measurements incorporated a gravity-correctionprocedure.

Duringthetest,testersgaveverbalfeedbackasneededtomaintain properpositioning.

2.5.3. Exerciseprotocol

Only conventional concentric isokinetic tests were used becauseeccentricmovements weredangerous.Before thetests andtobecomefamiliarwithit,patientsperformeda5-minwarm- uponabikeand3repetitionsatbothspeeds(608/sand1208/s), oneamaximalcontraction.Theprotocolconsistedof5repetitions at608/sfollowedby10repetitionsat1208/switha1-minrecovery allowedbetweenbothseries.A3-minrestwasallowedbetween testingoneachside.Thenon-operatedsidewastestedﬁrstandthe orderofspeedwasfromslower tofaster, assuggested[26].All evaluationtestswereconductedbythesamephysicaltherapist whofollowedthesameprocedure.Thestrengthparameters(peak torque)wereevaluatedat608/s(mediumspeed).Thesespeedsare recommendedbyCYBEXandcorrelatewellwithjointvelocities duringfunctionaltasks.

The same isokinetic exercise protocol was used for both patientsandvolunteers.

2.5.4. Datacollection

Maximumorpeaktorque(Newtons/meter)wascalculatedby measuring the highest concentric torque for ﬂexion and extension movements noted at 608/s angular speeds. Only values that had good reproducibility were analyzed. Good reproducibility of the measure required an identical torque

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curve for 3 complete and successive ﬂexion–extension move- mentsfor eachtest[27].

2.6. Statisticalanalysis

The normalityof the data distribution was assessed by the Shapiro-Wilktestandskewnesskurtosisz-values.Demographic dataaresummarizedbymeanSDandnumber(%).TheWilcoxon signed-ranktestwasusedtocompareKSSkneeandfunctionscores andVASscoresbeforeandaftersurgeryandbetweentheoperated andnon-operatedsidesaftersurgery.TheMann-WhitneyU-testwas usedtocomparescoresbetweenacuteandchronicruptureandto comparekneemusclestrengthbetweenoperatedkneesandhealthy kneesofvolunteers.Multipleregressionanalysiswithforced-entry selectionwasusedtodetermineriskfactorsofabsoluteKSSkneeand function changes. Data were analyzed by using SPSS 20.0.

P<0.05wasconsideredstatisticallysigniﬁcant.

3. Results

Weevaluated25patients(21men)withamedianfollow-upof 75months(range29–120).Themeanagewas34.78.59years (median36years[interquartilerange11]).Themeantimetosurgical interventionwas32.13weeks.Characteristicsofpatientsare in Table1.Overall,17patientshadacuteruptureand8chronicrupture.

We included 15 healthy volunteers (13 men) (mean age 31.87.14years).Patientsandhealthyvolunteersdidnotdifferin ageorsex.

Forthe operatedside,meanKSSkneescorewas signiﬁcantly higher after than before surgery (82.2812.297 vs 20.647.6;

P<0.0001)aswasKSSfunctionscore(88.4017.483vs23.408.98;

P<0.0001).Meanpainscorewassigniﬁcantlylowerafterthanbefore surgery(1.961.24vs6.601.26,P<0.0001).

ROM, KSS knee and function scores signiﬁcantly differed between the operated and non-operated sides after surgery (Table 2). Acute and chronic rupture groups did not differ in preoperativeKSSkneeandfunctionscores,absolutechangeinKSS knee score, satisfaction, or SF-36 PCS or MCS scores, but postoperative KSSknee and function scores, absolutechange in KSS function, preoperative and postoperative pain score, and postoperativeROMweregreaterwithacutethanchronicrupture (Table 3). Clinicalexaminationshowed no patellaralta,with no recurrenceduringfollow-up.

Intermsofisokineticexerciseaftersurgery,thekneeextensor musclesweresigniﬁcantlystrongerwithacutethanchronicrupture (mean 156.5329.93 vs 102.6329.76N/m; P<0.01) as were knee ﬂexor muscles (mean 102.2423.49 vs 64.7522.66N/m;

P<0.01) (Table 4). For both types of PTR, only knee extensor muscle strength was signiﬁcantly lower on the operated than

non-operatedside(Table2)andwaslowerforpatientthanvolunteer knees(Table5).

Onmultipleregressionanalysisandwiththereducedsimple size,only2riskfactorswereevaluated:typeofrupture(acuteand chronic) andassociated diseases (diabetesmellitus, rheumatoid arthritis,andsystemiclupuserythematosus).Onlytypeofrupture predictedtheabsolutechangeinKSSfunctionscore.Becauseofthe smallsimplesize,thismodelexplainedonly25.6%oftheabsolute changeinKSSfunctionscore(R²=0.256andadjustedR²=0.188).

We found no collinearity within our data (variance inﬂation factor<10).ChronicrupturepredictedlowchangeinKSSfunction.

4. Discussion

Here,weevaluatedclinicaloutcomesaftersurgicalrepairofPTR andcomparedtheevolutionofacuteandchronicruptureafterthe samerehabilitationprotocol.Inour25patients,themeanKSSknee scorewassignificantlyhigherafterthanbeforesurgery,aswasKSS functionscore.However,painwassignificantlylowerafterthan beforesurgery.ForbothtypesofPTR,onlykneeextensormuscle strength was significantly lower on the operated than non- operated side and as compared with healthy volunteer knees.

SurgicalrepairofPTRwithreinforcementandanearlyrehabilita- tion program demonstrate good results aftera long follow-up.

However,chronicPTRmayneedlongeroradifferentrehabilitation protocoloftheknee-extensorapparatus.

PTRoccursinpatientsyoungerthan40yearsasaresultofan indirecttrauma[1,2].Our patientswereyoungerthan40 years, andasreportedintheliterature,PTRoccurredmostofteninmales, withapeakincidenceinthethirdandfourthdecades[2].

ManytreatmentshavebeenproposedforPTRdependingonthe severityoftherupture.Partialruptureistreatedbyimmobilization

Table1

Characteristicsof25patientswithpatellartendonrupture.

Age(years) 34.728.59

Gender,male 21(84)

Typeofrupture

Acute 17(68)

Chronic 8(32)

Mechanismofrupture

Traumatic 20(80)

Spontaneous 5(20)

Clinicalcharacteristics

Diabetesmellitus 3(12)

Rheumatoidarthritis 3(12)

Systemiclupuserythematosus 2(8)

Noassociateddiseases 17(68)

Caton-Deschampsindex 1.100.168

Dataareno.(%)ormeanSD.

Table2

Scoresforoperatedandnon-operatedsidefor25patientsaftersurgery.

Scores Operatedside Non-operatedside P-value

KSS

Knee 82.2812.297 90.006.191 <0.001

Function 88.4017.483 97.207.916 0.005

ROM 111.4015.780 121.406.696 0.001

Peaktorque(N/m)

Extensormuscle 139.2838.911 157.0428.253 <0.001 Flexormuscle 90.2428.914 96.9230.243 0.051 DataaremeanSD.KSS:KneeSocietyScore;ROM:rangeofmotion;N/m:Newtons/

meter.

Table3

Scoresfortheoperatedsidebyacuteandchronicrupture.

Scores Acuterupture

(n=17)

Chronicrupture (n=8)

P-value

PreoperativeKSS

Knee 21.187.67 19.507.84 0.598

Function 21.769.83 26.885.94 0.225

PostoperativeKSS

Knee 86.599.01 73.1313.85 0.014

Function 92.9413.58 78.7521.67 0.023

AbsolutechangeinKSS

Knee 65.4111.08 53.6218.27 0.102

Function 71.1811.93 51.8722.98 0.032

PostoperativeROM 119.717.99 93.7513.56 0.0002

Satisfaction(1-4) 3.590.79 3.001.07 0.102

Pain,VAS(0-10)

Preoperative 7.120.99 5.501.07 0.003

Postoperative 1.651.11 2.631.30 0.029

SF-36PCS 53.3710.44 38.0413.73 0.14

SF-36MCS 44.338.13 42.467.41 0.521

DataaremeanSD.VAS:visualanalogscale;SF-36:medicaloutcomesstudy36-item shortform;PCS:physicalcomponentsummary;MCS:mentalcomponentsummary.

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until the tendon has totally healed, with rehabilitation for 3 months. Complete rupture requires surgical intervention [28,31,32]. There are several surgical techniques for repair of acuteandchronicorneglectedruptureofthepatellartendon,and comparisons between methods have not yet been examined becauseoftherarityoftheinjury[13,33–35].Somesurgeonshave usedmetalwirestoreinforcerepairsafterreconstructionbythe distal release of the quadriceps or by positioning the tibial tuberosityintheproximaldirection[13].Othershavedescribed differenttypesofreconstructionwhenthegapistoolarge[13–

15,36].Forthisstudy,thehamstringtendonswerepreferablewith chronicrupture.

WefoundpainandKSSkneeandfunctionscoreswithgoodand signiﬁcant improvement after surgery as well as good patient satisfaction.Otherstudies,notprospective,haveshownthesame resultsbutwithsmallsamplesizesand[13,37].

ROMandKSSkneeandfunctionsigniﬁcantlydifferedbetween theoperated andnon-operated sides.Extensormusclestrength wassigniﬁcantlylowerfortheoperatedthannon-operatedside.

Thissituationcanbeexplainedbypostoperativeimmobilization.

Mostsurgeonsroutinelyprescribe6weeksofimmobilizationina cylindercast,withgenerallygoodresults[2,22,38,39].However, someauthors havereported acceptableresultswithearlyROM exerciseswithoutstrictimmobilizationinacast[3,11,22].

EarlysurgicaltreatmentofthePTRwithin1monthiseffective formostpatients[2,4,5,11,29,30,38].SiweckandRaofoundbetter outcomesinpatientsreceivingtreatmentwithin2weeksofthe injury[2].Inourstudy,preoperativepainwashighwithacutePTR, butbothKSSandpainscoresweremoreimprovedaftersurgery thanwithchronicPTR.Also, ROM wassigniﬁcantlylower with chronicthanacutePTR.Thisresultcanbeexplainedbyquadriceps contracture and retraction, ﬁbrous adhesions, and the same surgicalprocedureforbothtypesofPTR.

Many risk factorsfor PTRhave been cited in theliterature:

steroidinjections,‘‘jumper’s’’knee,previousmajorkneesurgery, and medical conditions resulting in weak collagen content (rheumatoidarthritis,diabetis mellitus,etc.)[9,10].Onmultiple regression,ourﬁndingsdidnotmatchthoseintheliterature.

The main strengthof thestudywasthe longfollow-up, the prospectivedesign,andtheisokineticcontrolgroup.Limitations

involvetherelativelysmallsamplesize,whichwasacceptablein lightofthelowprevalenceofthispathologyandtheseriesinthe literature. Another limitation was the surgery performed by several surgeons, but the procedure was standardized in our center.

5. Conclusion

PTRisusuallycomplete.Long-termfollow-upresultsindicate excellentfunctionwithearlyrepair.Immediatesurgicalrepairis thetreatmentofchoiceforPTRbecauseitaffectsthekneeROM, function, and muscle strength. Surgical repair of the rupture with reinforcementandearly rehabilitationdemonstrate good results after long follow-up. However, chronic PTR may need longeroradifferentrehabilitationprotocoloftheknee-extensor apparatus.

Disclosureofinterest

Theauthorsdeclarethattheyhavenocompetinginterest.

References

[1]BhargavaSP,HynesMC,DowellJK.Traumaticpatellatendonrupture:early mobilisationfollowingsurgicalrepair.Injury2004;35:76–9.

[2]SiweckCW,RaoJP.Rupturesoftheextensormechanismofthekneejoint.J BoneJointSurg1981;63:932–7.

[3]Lindy PB,Boynton MB, Fadale PD.Repair of patellar tendon disruptions withouthardware.JOrthopTrauma1994;9:238–43.

[4]KellyDW,CarterVW,JobeFW,KerlanRK.Patellarandquadricepstendon ruptures–jumper’sknee.AmJSportsMed1984;12:374–5.

[5]LobenhofferP,ThermannH.Quadricepsandpatellartendonruptures.Ortho- pade2000;29:228–343.

[6]KannusP,JozsaL.Histopathologicalchangesprecedingspontaneousrupture of a tendon.A controlled studyof 891 patients.J Bone Joint Surg Am 1991;73:1507–25.

[7]MorganJ,McCartyD.Tendonrupturesinpatientswithsystemiclupusery- thematosus.ArthritisRheum1974;17:1033.

[8]ChenSK,LuCC,ChouPH,GuoLY,WuWL.Patellartendonrupturesinweight liftersafterlocalsteroidinjections.ArchOrthopTraumaSurg2009;129:

369–72.

[9]BonamoJJ,KrinikRM,SpornAA.Ruptureofthepatellarligamentafteruseof thecentralthirdforanteriorcruciatereconstruction:areportoftwocases.J BoneJointSurg1984;66:1294–7.

[10]RosenbergJM,WhitakerJH.Bilateralinfrapatellartendonruptureinapatient withjumpersknee.AmJSportsMed1991;19:94–5.

[11]LevyM,GoldsteinJ,RosnerM.Amethodofrepairforquadricepstendonor patellarligament(tendon)ruptureswithoutcastimmobilization.Preliminary report.ClinOrthop1987;218:297–301.

[12]BurnettRS,BergerRA,PaproskyWG,DellaValleCJ,JacobsJJ,RosenbergAG.

Extensormechanismallograftreconstructionaftertotalkneearthroplasty.A comparisonoftwotechniques.JBoneJointSurgAm2004;86A:2694–9.

[13]CaseyJrMT,TietjensBR.Neglectedrupturesofthepatellartendon.Acase seriesoffourpatients.AmJSportsMed2001;29:457–60.

[14]CrossettLS,SinhaRK,SechriestVF,RubashHE.Reconstructionofaruptured patellartendonwithachillestendonallograftfollowingtotalkneearthro- plasty.JBoneJointSurgAm2002;84A:1354–61.

[15]Prada SA,Grifﬁn FM,NelsonCL, Garvin KL.Allograft reconstruction for extensormechanismruptureaftertotalkneearthroplasty:4.8-yearfollow- up.Orthopedics2003;26:1205–8.

Table4

Datafromthemainrelatedliteratureandthepresentseries.

References No.of

patients

Follow-up (years)

Flexion Extension Patellarheight

MarderandTimmerman(1999)[28] 12 2.6 Mean58deﬁcit/healthyside Noextensiondeﬁcit MeanISI1.090.68

Kastenetal.(2001)[29] 29 8.1 1328 Noextensiondeﬁcit 55%with>10%ISI

Differencefromhealthy side

Bhargavaetal.(2004)[1] 11 2.2 1378 Noextensiondeﬁcit MedianISI1(range0.95–1.1)

Westetal.(2008)[24] 34 4 – – Nopatellaaltaorinferaat6months

Chenetal.(2009)[8] 7 2.2 – – MeanISI0.96

Roudetetal.(2014) 23 9.3 78%withﬂexionidenticalto

healthyside

Noextensiondeﬁcit MeanCDI0.910.13(range0.57–1.29 at7.1months)

Presentseries(2015) 25 6.25 1118 Noextensiondeﬁcit MeanCDI1.100.168

ISI:Insall-Salvatiindex;CDI:Caton-Deschampsindex.

Table5

Comparisonofmusclekneestrengthbetweenpatientsandvolunteers.

Patients (operatedknees) (n=25)

Volunteers (healthyknees) (n=15)

P-value

Age 34.728.59 31.807.14 0.174

Peaktorque(N/m)

Extensormuscle 139.2838.911 173.7339.028 0.002

Flexormuscle 90.2428.914 85.1736.545 0.576

DataaremeanSD.

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[16]WiegandN,NaumovI,VamhidyL,WartaV,ThanP.Reconstructionofthe patellartendonusingaY-shapedﬂapfoldedbackfromthevastuslateralis fascia.Knee2013;20:139–43.

[17]SaragagliaD,PisonA,Rubens-DuvalB.Acuteandoldrupturesoftheextensor apparatusofthekneeinadults(excludingkneereplacement).OrthopTrau- matolSurgRes2013;99:S67–76.

[18]LeeD,StinnerD,MirH.Quadricepsandpatellartendonruptures.JKneeSurg 2013;26:301–8.

[19]ClaudeE,NicholsMD.Patellartendoninjuries.ClinSportMed1992;11.

[20]InsallJN,DorrLD,ScottRD,ScottWN.RationaleoftheKneesocietyclinical ratingsystem.ClinOrthop1989;248:13–4.

[21]CatonJ.Methodofmeasuringtheheightofthepatella.ActaOrthopBelg 1989;55:385–6.

[22]LarsonRV, Simonian PT.Semitendinosusaugmentation of acutepatellar tendonrepairwithimmediatemobilization.AmJSportsMed1995;23:82–6.

[23]MiskewDBW,PearsonRL,PankovichAM.Mersilenestripsutureinrepairof disruptionsofthequadricepsandpatellartendons.JTrauma1980;20:867–72.

[24]WestJL,KeeneJS,KaplanLD. Earlymotionafterquadricepsandpatellar tendonrepairs: outcomeswith singlesuture augmentation.AmJSports Med2008;36:316–23.

[25]WareJrJE,SherbourneCD.TheMOS36-itemShort-Formhealthsurvey(SF- 36).I.Conceptualframeworkanditemselection.MedCare1992;30:473–83.

[26]WilhiteMR,CohenER,WilhiteSC.Reliability ofconcentricandeccentric measurementsofquadricepsperformanceusingtheKin-Comdynamometer:

theeffectoftestingorderforthreedifferentspeeds.JOrthopSportsPhysTher 1992;15:175–82.

[27]OstemigLR.Isokineticdynamometry:implicationsformuscletestingand rehabilitation.ExertSportSciRev1986;14:45–80.

[28]MarderRA,TimmermanLA.Primaryrepairofpatellartendonrupturewithout augmentation.AmJSportsMed1999;27:304–7.

[29]KastenP,ScheweB,MaurerF,GoslingT,KrettekC,WeiseK.Ruptureofthe patellartendon:areviewof68casesandaretrospectivestudyof29ruptures comparing two methods of augmentation. Arch Orthop Trauma Surg 2001;121:578–82.

[30]RoudetA,BoudissaM,ChaussardC,Rubens-DuvalB, SaragagliaD.Acute traumaticpatellartendonrupture:earlyandlateresultsofsurgicaltreatment of38cases.OrthopTraumatolSurgRes2015;101:307–11.

[31]GreisPE,HolmstromMC,LahavA.Surgicaltreatmentoptionsforpatella tendonrupture,partI:acute.Orthopedics2005;28:672–9.

[32]GreisPE,LahavA,Holmstrom MC.Surgicaltreatmentoptionsforpatella tendonrupture,partII:chronic.Orthopedics2005;28:765–9.

[33]ChagarB,BoussougaM,LazrakKH,TaobaneH.Neglectedspontaneousbilat- eralruptureofthepatellartendon:acasereport.RevChirOrthopReparAppar Mot2003;89:733–7.

[34]ShepardGJ, ChristodoulouL,HegabAI.Neglectedruptureofthepatellar tendon.ArchOrthopTraumaSurg1999;119:241–2.

[35]TakebeK,HirohataK.Oldruptureofthepatellartendon.Acasereport.Clin OrthopRelatRes1985;196:253–5.

[36]BarrackRL,LyonsT.Proximaltibia-extensormechanismcompositeallograft forrevisionTKAwithchronicpatellartendonrupture.ActaOrthopScand 2000;71:419–21.

[37]ChenB,LiR,ZhangS.Reconstructionandrestorationofneglectedpatellar tendon using semitendinosusand gracilistendons with preserved distal insertions:twocasereports.Knee2012;19:508–12.

[38]HsuKY,WangKC,HoWP,HsuRW.Traumaticpatellartendonruptures:a follow-upstudyofprimaryrepairandaneutralizationwire.JTrauma1994;

36:658–60.

[39]KuechleDK,StuartMJ.Isolatedruptureofthepatellartendoninathletes.AmJ SportsMed1994;22:692–5.