Aguirre RVH, Hernández TM, Valero GFS

Language: Spanish
References: 10
Page: 150-154
PDF size: 210.57 Kb.

ABSTRACT

Introduction: Simultaneous lesions of the patellar tendon (TP), anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are rare, and they are related to high-energy mechanisms, generally associated with chondral lesions, meniscal tears or bone fractures. The objective of this study is to present a clinical case, the surgical approach in two steps, and to provide other management options. Case report: We discuss the diagnostic strategy in a 42-year-old male with a high-energy trauma, the surgical technique and the clinical outcome. The case was solved in two surgical steps. First, a reconstruction of the TP, reinforcement with en allograft and reinsertion of the LCM with anchors were performed. Then, eight weeks later, the surgery consisted of an ACL reconstruction and meniscal repair by arthroscopy. Discussion: The patient’s age was above the average (29.9 years) of the reported case series. The mechanism of injury did not correspond to a sports-related event (77.41% in athletes). In contrast with the current literature, in this case we present a lesion of the TP associated with an LCM injury (67.74%), which has been reported previously as rare. We opted for a treatment in two steps according to the complexity of the lesions.

REFERENCES

1. Marx RG, Parker RD, Matawa MJ, Sekiya JK. Cruciate and collateral ligament injuries. American Academy of Orthopaedic Surgeons. Comprehensive Orthopaedic Review, Section 11: Knee, Chapter 109; 1113-1129.

2. Skendzel JG, Sekiya JK, Wojtys EM. Diagnosis and management of the multiligament-injured knee. J Orthop Sports Phys Ther. 2012; 42 (3): 234-242. doi: 10.2519/jospt.2012.3678.

3. Cucchi D, Aliprandi A, Nocerino E, Randelli P. Early combined arthroscopic treatment for simultaneous ruptures of the patellar tendon and the anterior cruciate ligament leads to good radiological results and patient satisfaction. Knee Surg Sports Traumatol Arthrosc. 2018; 26 (4): 1164-1173. doi: 10.1007/s00167-017-4562-2.

4. Futch LA, Garth WP, Folsom GJ, Ogard WK. Acute rupture of the anterior cruciate ligament and patellar tendon in a collegiate athlete. Arthroscopy. 2007; 23 (1): 112.e1-112.e4. doi: 10.1016/j.arthro.2005.07.030.

5. Koukoulias NE, Koumis P, Papadopoulos A, Kyparlis D, Papastergiou SG. Acute, simultaneous tear of patellar tendon and ACL: possible mechanism of injury and rationality of the two-stage surgical treatment. BMJ Case Rep. 2011; 2011: bcr0520114178. doi: 10.1136/bcr.05.2011.4178.

6. Gülabi D, Erdem M, Bulut G, Sağlam F. Neglected patellar tendon rupture with anterior cruciate ligament rupture and medial collateral ligament partial rupture. Acta Orthop Traumatol Turc. 2014; 48 (2): 231-235. doi: 10.3944/AOTT.2014.3149.

7. Wissman RD, Vonfischer N, Kempf K. Acute concomitant anterior cruciate ligament and patellar tendon tears in a non-dislocated knee. J Clin Imaging Sci. 2012; 2: 3. Published online 2012 Feb 18. doi: 10.4103/2156-7514.93035. PMCID: PMC3307214.

8. Costa-Paz M, Muscolo DL, Makino A, Ayerza MA. Simultaneous acute rupture of the patellar tendon and the anterior cruciate ligament. Arthroscopy. 2005; 21 (9): 1143.e1-1143.e4. doi: 10.1016/j.arthro.2005.05.028.

9. Chiang AS, Shin SS, Jazrawi LM, Rose DJ. Simultaneous ipsilateral ruptures of the anterior cruciate ligament and patellar tendon: a case report. Bull Hosp Jt Dis. 2005; 62 (3-4): 134-136.

10. Levakos Y, Sherman MF, Shelbourne KD, Trakru S, Bonamo JR. Simultaneous rupture of the anterior cruciate ligament and the patellar tendon. Six case reports. Am J Sports Med. 1996; 24 (4): 498-503. doi:10.1177/036354659602400415.