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Concomitant Patellar Tendon Tear (PTT) with Cruciate and/ Collateral ligament injury (Multi- Ligamentous Knee Injury –MLKI) and new pathoanatomical -Ganga PTT classification aids to strategize treatment options

Published:October 31, 2022DOI:https://doi.org/10.1016/j.injury.2022.10.031

      Highlights

      • The complex multi-ligament knee injury needs a systematic approach.
      • Patellar tendon tear associated with MLKI, restoration of extensor apparatus precedes other ligament reconstructions.
      • Further, longer and supervised rehabilitation is needed for adequate recovery.

      Abstract

      Introduction

      Concomitant patellar tendon (PT) tear with cruciate or multi-ligament knee injuries (MLKI) following high-velocity injury requires a systematic approach.

      Methods

      The study is a retrospective case series of patients (2008–2019) with concomitant PT ligament injury with cruciate or collateral ligament injury (MLKI), including bony avulsion injuries. Isolated cruciate and MLKI without patellar tendon tears are excluded. N = 32 patients (1 female and 31 male) are divided into two groups, Group 1 (11 patients) with PT tear and ACL tear and group 2 (21 patients) with PT tear and MLKIs. Patients were taken up for a single stage in types 1,2,3 and staged repair with reconstruction for types 4,5 of our new classification. All the patients are followed up regularly, and IKDC and Lyshom's score and objective radiological stress x-rays taken at each follow-up

      Results

      Incidence of PTT combined injuries among all knee ligament injuries is 0.57%. The mean age was 35.09+/-11.96 SD(group1) and 36.55+/-11.89 SD(group2). The average follow-up was 34.45 months +/- 12.86SD (group 1) and 35.3 months +/- 15.75 SD (group2). Mean post-operative Lysholm score and IKDC score of group 1 and group 2 improvement was statistically significant p-value <=0.01. The mean post-operative ROM of the two groups were 132.73 (SD 6.46) (Group 1) and 111.75 (15.75) (Group 2) and was a statistically significant p-value <0.01. Residual lag of 30° seen in all patients improved by 3rd month in group 1 and 6th month in group 2. Knee stiffness is seen in 2 patients and superficial infection in 2 patients.

      Conclusion

      PTT combined injuries are rare and occurs due to direct impact injuries. Single-stage PT repair with ACL reconstruction gives adequate stability, and extensor lag is eminent and needs supervised rehabilitation. PT with MLKI is a challenging scenario that can be performed in single-stage/multiple stages, depending on the injuries, surgical expertise, and institutional facilities. Newer simplified classification aids surgeons in planning a treatment strategy.

      Keywords

      Abbreviations:

      MLKI (Multi-Ligament Knee Injury), ACL (Anterior Cruciate Ligament), ACLR (Anterior Cruciate Ligament Recontruction), PTT (Patellar Tendon Tear), MCL (Medial Collateral Ligament), LCL (Lateral Collateral Ligament), PCL (Posterior Collateral Ligament), IKDC (International Knee Documentation Committee), RTA (Road Traffic Accidents), ROM (Range of movements)
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