REPAIR OF PATELLAR TENDON DISRUPTIONS WITHOUT HARDWARE

Acute repair of disruptions of the knee extensor mechanism is indicate d to reestablish extensor continuity and allow for early motion. This study reviews the results of acute primary repair of patellar tendon r uptures augmented by a nonabsorbable polyester tape (Mersilene; Ethico n, Inc.) followed by immediate mobilization. Twenty-four patients with disruptions of their patellar tendons were treated using the describe d technique. The ruptured tendon was initially approximated using an e nd-to-end suture repair with no. 5 Ticron suture in a whipstitch manne r. An O Vicryl suture was used to approximate the free tendon edges. A 5-mm Mersilene tape was then used in a cerclage manner to augment and protect the repair. Postsurgery, passive range of motion (ROM) was be gun immediately in the knees with isolated injury or in those patients whose concomitant injuries would allow for early motion. Using clinic al and radiographic criteria, follow-up evaluations of 19 patients wer e performed at an average of 22.4 months. In patients with isolated in juries, active ROM was from 0 degrees extension to 132 degrees flexion (contralateral knee 0-135 degrees). Two patients had prominent knots; in one, the knots were painful and were removed surgically. Six patie nts developed patellofemoral chondrosis. Five patients had the Mersile ne tape tied with the knee in full extension, and all developed patell ofemoral pain. The other repairs were done with the knee flexed to 90 degrees before tying; one patient in this group developed patellofemor al symptoms. All patients with isolated injuries have returned to empl oyment. There were no reruptures or infections. Acute repair of patell ar tendon disruptions using a whipstitch suture for primary stabilizat ion and a woven polyester tape as augmentation is reliable. The techni que allows for early motion and in most cases obviates the need for se condary removal of the fixation device. Proper tensioning of the tape can be assured if the knee is flexed 90 degrees at the time of augment ation, which preserves the functional length of the patellar tendon an d may diminish the likelihood of patellofemoral symptoms.