Higher incidence of postoperative complications in patients with simultaneous patellar tendon and anterior cruciate ligament ruptures following single surgery: a case series and literature review

Background: Patients with simultaneous ruptures of the patellar tendon (PT) and anterior cruciate ligament (ACL) underwent PT repair and ACL reconstruction in a single or staged surgery. However, due to the limited cases, the design of previous studies was mostly case report with varying conclusions regarding recommended surgical strategy selection, the optimal surgical strategy remains a subject of debate.

Methods: We conducted a retrospective case series and literature review, including 10 cases from local institution and 27 cases from 17 studies. Demographic information, injury causes, surgical strategies, combined injuries, whether to return to (pre-injury level) sports, postoperative complications, Lysholm score and International Knee Documentation Committee (IKDC) score were identified retrospectively or reviewed from previous studies. The Fisher's exact test was used to compare the incidence of postoperative complications between different surgical strategy groups, and linear logistic regression was used to analyze factors influencing postoperative knee function scores.

Results: Of the 37 patients, 15 patients (40.5%) underwent single surgery and 22 patients (59.5%) underwent staged surgery. Postoperative complications occurred in 5 (33.3%) patients after single surgery and in none after staged surgery, with the former being significantly more frequent than the latter (P = 0.007). Linear regression of postoperative knee function scores showed that surgical strategy did not significantly affect postoperative Lysholm and IKDC scores (P = 0.327 and P = 0.348, respectively).

Conclusions: This study demonstrates that staged surgery significantly reduces postoperative complications compared to single surgery in patients with simultaneous PT and ACL ruptures and should be considered the preferred approach, especially when an expedited return to sports is not a priority.