Semitendinosus Autograft Augmentation for a Patella Tendon Rupture after BTB ACL Reconstruction

Patellar tendon rupture is a rare, but major event that often requires surgical repair in order to reestablish function of the extensor mechanism of the knee. Rupture of the tendon usually occurs in the 3rd or 4th decade of life and results from slip and fall accidents, or powerful contraction of the quadriceps such as during sporting events or weight lifting [1-3]. Anterior Cruciate Ligament (ACL) reconstruction using the central 1/3rd of the patellar tendon has been associated with rupture of the patellar tendon however this event is exceedingly rare occurring in less than 1% of all cases performed [1]. In the event of previous ACL repair, patellar tendon rupture usually occurs in a short time period after ACL reconstruction [4]. Comorbidities including diabetes mellitus (DM), systemic lupus erythematous (SLE) and chronic steroid use have been shown to precipitate rupture of the patellar tendon [5]. Patellar tendon rupture many years after ACL reconstruction has been sparsely studied in literature thus there is no consensus on the best method of repair. Some data suggests that late rupture of the patellar tendon following surgical harvesting of a portion of the tendon is due to devascularization, remodeling and weakening of the patellar tendon [4]. This case report involves a patient with acute patellar tendon rupture over 10 years after reconstruction of ACL. Augmentation of patellar tendon repair has been shown to have superior strength of repair as well as restored quadriceps strength and Range of Motion (ROM) [2,3,5]. There were no reported complications in the immediate post operative period and the patient was able to be discharged to home with a brace and crutches post op day three.