Surgical treatment of chronic proximal patellar tendon tears grades 3 and 4 using augmentation with quadriceps tendon-bone graft.

BACKGROUND

Chronic proximal patellar tendinosis with partial tendon tears represents a multifactorial overuse injury. Several surgical techniques have been described with various outcomes and the return to sports may fail.

HYPOTHESIS: Reconstruction of the proximal patellar tendon with augmentation using a quadriceps tendon-bone (QTB) graft improves knee function in patients presenting with proximal patellar tendinosis and partial tendon tears.

METHODS

Forty-seven patients (32 males, 15 females) with chronic proximal patellar tendinosis and tendon tears grade 3 and 4 were treated between 1992 and 2018. Patients were evaluated retrospectively using the Popkin-Golman (PG) MRI grading system and the removed tendon parts. The Tegner Activity Scale (TAS) and the Numerical Rating Scale (NRS) for pain were used as outcome measures before surgery and at follow up. Complete data were available in 100% of cases at 6 months follow up, and fifteen of them at later follow up.

RESULTS

The average follow up was 1.5 years (range, 0.5-16). The TAS improved from a mean preoperative score of 3.7 to a mean postoperative score of 9.1. The median NRS status decreased from an average of 6.4 to 1.1. Two patients needed additional arthroscopic scar tissue removal.

CONCLUSION

Reconstruction of proximal patellar tendon tears grades 3 and 4 with augmentation using a QTB graft is a valuable surgical salvage procedure in chronic cases. It improves knee function and yields good to excellent results in most cases including high level athletes. The use of MRI with the PG classification of tendon tears is highly recommended.

LEVEL OF EVIDENCE: Therapeutic case series, Level IV.