Objective: To investigate the effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon rupture and defects.
Methods: The clinical data of 11 patients with chronic patellar tendon rupture and defects admitted between January 2015 and August 2018 were retrospectively analyzed. The patient were treated with inverted U-shaped reconstruction technique using hamstring autografts, in which 2 bone tunnels were created at the level of 1/2 and lower 3/4 of the patella, and 1 bone tunnel was created beneath the tibial tuberosity. There were 8 males and 3 females with an average age of 30.1 years (range, 10-61 years). The average interval from the primary injury to the operation was 9.5 months (range, 2-36 months). According to Yousef classification, there were 7 cases of type A2, 3 cases of type B2, and 1 case of type C2. The length of the patella tendon defect was measured when the patella was reducted intraoperatively with an average of 4.5 cm (range, 2.7-7.1 cm). Subjective function scores [including International Knee Documentation Committee (IKDC) subjective score, Tegner activity level, and Lysholm score] were evaluated before operation and at last follow-up. The loss of knee extension, Caton index, and thigh circumference difference at 15 cm above the patella between bilateral limbs were also measured.
Results: All patients were followed up 24-66 months (mean, 34.2 months). All incisions were primary healing, and there were no complications such as wound infection, venous thrombosis of the lower extremities, stiffness of the knee joint, graft failure, neurovascular injury, etc. No second revision surgery was performed during the follow-up. At last follow-up, the subjective function scores (IKDC subjective score, Tegner activity level, Lysholm score), loss of knee extension, thigh circumference difference, and Caton index were significantly improved when compared with those before operation ( P<0.05). Two patients still had patella alta, with Caton indexes of 1.29 and 1.32, respectively.
Conclusion: In the treatment of chronic patellar tendon ruptures and defects, the modified patellar tendon reconstruction using hamstring autograft can significantly improve the postoperative knee function, restore the normal range of knee extension, enhance the extensor and correct the patella alta.
目的: 探讨采用改良自体腘绳肌腱重建髌韧带治疗陈旧性髌韧带损伤伴缺损的临床疗效。.
方法: 回顾分析 2015 年 1 月—2018 年 8 月采用髌骨 1/2 及下 3/4 双骨隧道和胫骨结节后方单骨隧道自体腘绳肌腱倒 U 形环绕法重建髌韧带治疗的 11 例陈旧性髌韧带损伤伴缺损患者临床资料。其中男 8 例，女 3 例；年龄 10～61 岁，平均 30.1 岁。初次受伤至手术时间 2～36 个月，平均 9.5 个月。髌韧带损伤按 Yousef 分型标准，A2 型 7 例、B2 型 3 例、C2 型 1 例。术中测量髌骨复位时髌韧带缺损长度为 2.7～7.1 cm，平均 4.5 cm。术前及末次随访时行主观功能评分［包括国际膝关节文献委员会（IKDC）主观评分、Tegner 活动评级、Lysholm 评分］，计算伸膝丢失角度、Caton 指数以及健、患侧髌骨上极以上 15 cm 处的大腿周径差。.
结果: 11 例患者均获随访，随访时间 24～66 个月，平均 34.2 个月。术后切口均达Ⅰ期愈合，未出现切口感染、下肢静脉血栓形成、膝关节僵硬、移植物失效、神经血管损伤等并发症；随访期间均未行二次翻修手术。末次随访时，主观功能评分（IKDC 主观评分、Tenger 活动评级、Lysholm 评分）、伸膝丢失角度、大腿周径差及 Caton 指数均较术前显著改善，差异有统计学意义（ P<0.05）。有 2 例患者仍存在高位髌骨，Caton 指数分别为 1.29 和 1.32。.
结论: 采用改良自体腘绳肌腱重建髌韧带技术治疗陈旧性髌韧带损伤伴缺损，能显著改善患者术后膝关节功能，恢复正常伸膝活动范围，提升伸膝肌力并纠正高位髌骨。.
Keywords: Chronic patellar tendon rupture; autologous hamstring tendon; patella alta; patellar tendon reconstruction.