Neglected Patellar Tendon Rupture With Massive Proximal Patellar Migration Treated With Patellar Transport and Staged Allograft Reconstruction

Neglected or chronic ruptures of the patellar tendon are defined as ruptures presenting after 6 weeks. Late presentation is often due to neglect or missed diagnosis. With chronic ruptures, the patient presents with weakness, instability, and pain. Management of patients with chronic ruptures is difficult due to adhesions, proximal patellar migration, contracture, and quadriceps muscle atrophy. Before reconstruction of the patellar tendon (using autografts, allografts, or synthetic materials), the position of the patella must be normalized. Several methods had been reported to relocate the proximally migrated patella distally to its anatomic location, including preoperative traction, intraoperative traction, quadricepsplasty, and external fixation. The aim of this case report was to present the use of ring and wire external fixation applying the lengthening principles of Ilizarov to mobilize the proximally migrated patella distally as a successful treatment of chronic neglected patellar tendon rupture followed by second-stage patellar tendon reconstruction using an allograft. We report our experience in 2 cases, with an improved modification of the external fixator construct used for distal patellar transport in case 2. This report of 2 cases was approved by the Hospital for Special Surgery Institution Review Board.