Patellar Tendon Reconstruction Using Semitendinosus Autograft With Preserved Distal Insertion for Treatment of Patellar Tendon Rupture After Bone-Patellar Tendon-Bone ACL Reconstruction: A Case Report

Patellar tendon rupture after bone–patellar tendon–bone (BTB) anterior cruciate ligament (ACL) reconstruction is a rare but known complication. Other complications that are more common include anterior knee pain, pain with kneeling, and peri-incisional numbness. When the extensor mechanism fails after a BTB harvest, it is more commonly in the form of a patellar fracture. The rate of patellar tendon rupture has been reported to be about 0.25%, while patellar fractures are seen at a rate of 1.3%.1,7,18 Patellar tendon rupture can occur either in the early postoperative period, usually attributed to slip and fall–type injuries, or as a late manifestation by forced eccentric contraction in a flexed knee.4,6,8,9 A variety of reconstruction options have been reported in the literature.2,7,10 Much of the traditionally described patellar tendon repair techniques are difficult to apply to a harvested tendon because of the defect within the patella and tendon as well as the different patterns of rupture encountered in harvested tendons. Combined with the risk of patellar fracture after BTB ACL reconstruction, the decision to make additional drill holes through the bone before the defect has filled is met with hesitation.1

Trends in Utilization and Patient Demographics for Shoulder Instability Procedures from 2010 to 2019

INTRODUCTION: Improved technique and increased surgeon experience has optimized surgical care in patients with recurrent shoulder instability. Several techniques are used for surgical repair of shoulder instability, yet there is limited data on how utilization has changed over the past decade. The aim of this study was to assess trends in the utilization rate and patient demographics (age and gender) from 2010-2019 for four shoulder instability procedures: coracoid transfer/Latarjet procedure (LP), anterior bone block (ABB), open Bankart repair (OBR), and arthroscopic Bankart repair (ABR). METHODS: We identified over 87,00 patients using an all-payer claims database. The utilization rate was defined as the number of cases for a procedure divided by the total number surgical cases for shoulder instability for any given year. Age was divided into three groups: \u3c25, 25-35, \u3e35-years-old. Trends were reported in terms of compounded annual growth rates (CAGR). RESULTS: While ABR was the most common shoulder instability procedure overall (91% utilization rate), LP had the greatest increase in utilization from 2010-2019 (2.0% to 4.5%; CAGR: +9.8%). In comparison, the utilization for ABB increased +4.3% annually while OBR declined -6.9% annually. The utilization of ABR showed minimal change. Notably, LP was performed more frequently on younger patients over time. The percentage of patients \u3c25-years-old who underwent LP increased from 30% to 41% from 2010-2019 (+3.4%). There was a trend toward performing more LP on men versus women (+1.2% vs. -3.5%, P \u3c 0.05), although most cases (68%) were still performed on men. CONCLUSION: ABR continues to account for most shoulder instability procedures. LP had the greatest increase in utilization rate from 2010-2019 and has now surpassed OBR in utilization rate. ABB is also being more frequently performed but only represents a minority of stabilization cases. During the course of the study period, a greater percentage of patients undergoing shoulder instability procedure were male and \u3c25-years-old