Incidence and Risk Factors of Acute Patellar Tendon Rupture, Repair Failure, and Return to Activity in the Active-Duty Military Population

Background: Patellar tendon ruptures have a reported incidence of 0.68 per 100,000 person-years in the general population. The epidemiology of surgically treated patellar tendon ruptures in the US military has yet to be reported, which would provide opportunity for identification of risk factors for these otherwise healthy and active patients. Purpose: To determine the incidence of patellar tendon rupture in the Military Health System (MHS) population and to analyze demographic patterns, surgical fixation methods, and rerupture rates. Study Design: Case-control study; Level of evidence, 3. Methods: We utilized the MHS Data Repository (MDR) to identity active-duty military servicemembers surgically treated for patellar tendon rupture between 2010 and 2015. Records were reviewed for demographic information, injury characteristics, fixation technique, and occurrence of rerupture. Risk factors for rupture were calculated using Poisson regression based on population counts and demographic data obtained in the MDR. Risk factors for rerupture and return to duty were analyzed via univariate analysis and multivariate regression. Results: A total of 504 operatively treated primary patellar tendon repairs in 483 patients were identified, with an overall incidence of 6 per 100,000 person-years. Mean age was 33.6 years (range, 17-54 years) and 98% of patients were male. Fixation method was 81% bone tunnels and 7% suture anchors, and 12% were unknown. Black race had a higher relative rate ratio for rupture compared with the race categories White (9.21; P < .0001) and Other (3.27; P < .0001). The rupture rate was higher in 35- to 44-year-old patients compared with those aged 18 to 24 years ( P < .0001), 25 to 34 years ( P < .0001), and 45 to 64 years ( P = .004). Return to full previous level of activity occurred in 75.8% of patients, 14.6% returned to activity with limitations, and 9.5% were medically separated. The rerupture rate was 3%. Fixation method, tobacco usage, body mass index, and race were not significant risk factors for rerupture. Conclusion: The incidence of patellar tendon rupture in the US military population is substantially higher than has been reported in the civilian population. Among military personnel, men, Black servicemembers, and those aged 35 to 44 years were at highest risk for patellar tendon rupture. Three-quarters of patients were able to return to full activity without limitations. The rerupture rate was low and unaffected by fixation method.

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Suicide Incidence and Risk Factors in an Active Duty US Military Population

American Journal of Public Health ◽

10.2105/ajph.2011.300484 ◽

2012 ◽

Vol 102 (S1) ◽

pp. S138-S146 ◽

Cited By ~ 75

Author(s):

Jeffrey Hyman ◽

Robert Ireland ◽

Lucinda Frost ◽

Linda Cottrell

Keyword(s):

Risk Factors ◽

Active Duty ◽

Military Population ◽

Us Military

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Patellar tendon rupture - treatment results

Medicinski pregled ◽

10.2298/mpns1502022k ◽

2015 ◽

Vol 68 (1-2) ◽

pp. 22-28 ◽

Cited By ~ 5

Author(s):

Nemanja Kovacev ◽

Jelena Antic ◽

Nemanja Gvozdenovic ◽

Mirko Obradovic ◽

Miodrag Vranjes ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Knee Joint ◽

Patellar Tendon ◽

Tendon Rupture ◽

Lysholm Score ◽

Patellar Tendon Rupture ◽

Treatment Results ◽

Timely Diagnosis ◽

Significant Difference

Introduction. Patellar tendon rupture is a rare injury which, if missed, leads to delayed surgical treatment and may result in the loss of the knee joint function. The aim of this study was to report our results of operative treatment of the patellar tendon rupture and point out the significance of timely diagnosis and surgical procedure. Material and Methods. This retrospective tenyear study included 20 patients, 15 males and 5 females, their mean age being 42 (20-84) years. Seven participants had an injury on the right side and 13 had an injury on the left side. Thirteen participants had the diagnosis set in the first seven days after the injury. The applied techniques were surgical suture of the tendon, bone-tendon-bone ligamentoplasty using allograft from a bone bank and bone-tendon-bone ligamentoplasty using contralateral autograft, and they were performed in 12, 5 and 3 patients, respectively. The treatment results were assessed by using the Lysholm score, measuring the range of movement in the knee joint and measuring the girth of the thigh 10 cm above the patella. Results. The follow-up period after the surgery was 4 years on average (1-10 years) and the average value of the Lysholm score was 83 (27-100). The result was found to be excellent in 11 cases, satisfactory in 5 cases and unsatisfactory in 4. A statistically significant difference (p=0.0197 p<0.05) was found in the average values of the Lysholm score between the group of patients with risk factors (71.78) and the subjects without risk factors (92.18). A statistically significant difference (p=0.008 p<0.01) was found in the Lysholm score between the patients with timely diagnosis (91.62) and cases of chronic tendon tear (67). Conclusion. Timely diagnosis and early surgical reparation are the basic imperatives in the treatment of this injury. Comorbidity and risk factors are related to a poorer postoperative Lysholm score. The method of choice is early surgical treatment.

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Point-of-care Ultrasound Diagnosis of Bilateral Patellar Tendon Rupture

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.10.44194 ◽

2020 ◽

Vol 4 (1) ◽

pp. 29-31

Author(s):

Kathleen Ogle ◽

Sohaib Mandoorah ◽

Matthew Fellin ◽

Hamid Shokoohi ◽

William Probasco ◽

...

Keyword(s):

Patellar Tendon ◽

Tendon Rupture ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Minor Trauma ◽

Musculoskeletal Complaints ◽

Emergency Physicians ◽

Patellar Tendon Rupture ◽

Tendon Ruptures ◽

Orthopedic Injuries

Musculoskeletal complaints are one cornerstone of urgent issues for which orthopedic and emergency physicians provide care. Ultrasound can be a useful diagnostic tool to help identify musculoskeletal injuries. We describe a case of bilateral patellar tendon rupture that presented after minor trauma, and had the diagnosis confirmed at the bedside by point-of-care ultrasound.Physicians caring for patients with orthopedic injuries should be familiar with the use of ultrasound to diagnose tendon ruptures.

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Traumatic bilateral concurrent patellar tendon rupture: an alterative fixation method

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-002-0332-9 ◽

2003 ◽

Vol 11 (2) ◽

pp. 105-111 ◽

Cited By ~ 22

Author(s):

Hok-Ming Ho ◽

Wai-Keung Edison Lee

Keyword(s):

Patellar Tendon ◽

Tendon Rupture ◽

Fixation Method ◽

Patellar Tendon Rupture

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Patellar Tendon Rupture Following Total Knee Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001913010239 ◽

2019 ◽

Vol 13 (1) ◽

pp. 239-243

Author(s):

Steven T. Heer ◽

James O’Dowd ◽

Rebecca R. Butler ◽

David O. Dewitt ◽

Gaurav Khanna ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patellar Tendon ◽

Knee Arthroplasty ◽

Tendon Rupture ◽

Primary Repair ◽

Bone Tunnel ◽

Fixation Method ◽

Patellar Tendon Rupture ◽

Significant Difference ◽

Total Knee

Background: Patellar tendon rupture following Total Knee Arthroplasty (TKA) is rare. There is no consensus on optimal treatment. Methods: All patients who underwent a primary repair of a traumatic patellar tendon rupture following a TKA between 2008 and 2016, were retrospectively reviewed. Patient information, implant, repair type (anchor vs. bone tunnel), graft use, and complications were recorded. Results: Twenty-six patients met our inclusion criteria. The average age was 69.7+11 years. There were 19 females (73.1%). The average time from TKA to PT rupture was 13.6 months (range: 0- 135 months). The average incidence was 62.32 per 100,000 TKA. PT was repaired with anchors (A) in 9 (4 with a graft) and trans-osseous tunnels (TO) in 12 (5 required graft), and 5 with other methods. There was a significant improvement in KSS from 61 to 83 (P=0.023). There was a significant difference in time from PT tear to surgery in patients with grafts (42 days) and those without grafts (6 days) (P<0.001). Compared to A repair, TO had 2.39 times odds of re-tear (95% CI: 0.38,15.4; P=0.354) and 1.37 times odds of infection (95% CI:0.074,25.6; P=0.83). Repairs with a graft had a 1.90 times odds of re-tear (95% CI: 0.29, 12.19; P=0.49) and 6.3 time odds of infection (95% CI 0.26, 166.7; P=0.25). Conclusion: Surgical repair of PT tears following TKA leads to significant clinical improvement, regardless of the fixation method or graft use. We found no difference in outcomes between A and TO repairs and or with graft use.

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Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use

Case Reports in Orthopedics ◽

10.1155/2015/215796 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

S. De Giorgi ◽

A. Notarnicola ◽

G. Vicenti ◽

B. Moretti

Keyword(s):

Patellar Tendon ◽

Tendon Rupture ◽

Systemic Disease ◽

Relevant Literature ◽

Recurrent Dislocation ◽

Lateral Release ◽

Patellar Tendon Rupture ◽

Arthroscopic Technique ◽

First Case ◽

Tendon Ruptures

Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency) that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release.

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Open knee dislocation with a patellar tendon rupture: Result of staged surgical repair

SAGE Open Medical Case Reports ◽

10.1177/2050313x18823102 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1882310

Author(s):

Tsuneari Takahashi ◽

Tomohiro Matsumura ◽

Kazuaki Ishihara ◽

Shuhei Hiyama ◽

Katsushi Takeshita

Keyword(s):

Posterior Cruciate Ligament ◽

Surgical Management ◽

Patellar Tendon ◽

Tendon Rupture ◽

Cruciate Ligament ◽

Knee Dislocation ◽

Patellar Tendon Rupture ◽

Collateral Ligament ◽

Range Of Movement ◽

Multiligament Injury

Knee dislocation with concomitant multiligament injury is a rare and devastating injury. We report the successful repair of a rare case of open knee dislocation with concomitant multiligament injury and patellar tendon rupture of an 18-year-old male due to a motorcycle accident. The patient presented with an open wound running parallel to the knee joint line and patellar tendon rupture with full exposure of the cartilage of the distal femur. Staged surgical management including the application of a ring-type external fixator with a hinged joint, lateral collateral ligament repair, medial collateral ligament reconstruction using autogenous hamstring tendon, and joint release was performed. Range of movement was recovered to 0 degrees of knee extension and 80 degrees of knee flexion, and extension lag was negative. The Lysholm score of the patient was recovered to 92. The patient was able to return to work in the construction field 2 years after sustaining the injury. The patient had no complaint of pain and was able to resume construction work, even though reconstruction of the anterior cruciate ligament and posterior cruciate ligament was not performed. The application of a hinged ring-type external fixation device might play a key role in early range of movement restoration and to maintain the reduced position and acceptable recovery of the posterior cruciate ligament injury without the need for reconstructive surgery. This report is the first to describe the safety and effectiveness of staged surgical management for the repair of open knee dislocation with concomitant multiligament injury and patellar tendon rupture. However, further studies with longer follow-up periods will be needed to observe the development of osteoarthritis or weakness of the knee. Staged surgical management is a safe and effective procedure for repairing an open knee dislocation with concomitant multiligament injury and patellar tendon rupture.

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