Patellarsehnenruptur: Internal Bracing und Augmentationstechnik

OBJECTIVE: To report a surgical technique for the treatment of patellar tendon ruptures augmented with an internal brace suture tape. INDICATIONS: Acute patellar tendon ruptures, fractures of the distal patellar pole, chronic insufficiency of the patellar tendon or revision surgery for failed repairs. CONTRAINDICATIONS: Severe damage to the surrounding soft tissue. Local infection. Life-threatening conditions. SURGICAL TECHNIQUE: Direct longitudinal anterior approach to the patellar tendon. Two parallel transosseous bone tunnels are drilled in the patella and tibial tuberosity with a 2.4 mm drill bit. Two separate FiberTapes® (Arthrex, Naples, FL; USA) are shuttled through the proximal and distal bone tunnels around the tendon in "X" and "O" type configuration. Patellar height is reestablished under fluoroscopic control and both FiberTapes are tied down. Both tendon ends are debrided and readapted with absorbable sutures. POSTOPERATIVE MANAGEMENT: Passive motion exercise to 90° of flexion from day 1. Partial load to 20 kg of body weight with knee in locked full extension brace during first 2 weeks. Isometric exercises from week 3. Passive flexion to 110° from week 4 (adapted to pain). Free active range of motion and weight bearing from week 7. RESULTS: In more than 10 years of clinical application, positive results were continuously found in acute as well as chronic patellar tendon ruptures. These results are consistent with those in the current literature.