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