Innovative Approach to Treating a Neglected Patella Tendon Tear: A Case Study
By Dr. Siddharth Gupta
Patella tendon tears, though uncommon, can have a significant impact on a patient’s mobility, especially if left untreated for an extended period. In this case study, we explore the challenges and innovative treatment approach used for a 17-year-old male who experienced a patella tendon tear following a road traffic accident (RTA). The case emphasizes the complexity of dealing with neglected tendon injuries and highlights the importance of timely diagnosis and intervention.
Case Overview
Our patient, a 17-year-old male, sustained a traumatic patella tendon tear as a result of an RTA nine months prior to his clinical visit. The injury, however, had been neglected, resulting in significant complications. The primary complaint was difficulty in climbing stairs or running, both essential aspects of daily functioning for a young, active individual. Upon physical examination, the most prominent finding was a lack of left knee extension, indicative of significant functional impairment. Preoperative X-rays showed left patella alta, while MRI confirmed the patella tendon tear and retraction of the quadriceps tendon.
Surgical Innovation
Given the complexity of the injury due to the prolonged delay in treatment, various surgical methods were considered. Ultimately, an innovative approach using a hamstring tendon graft was employed to reconstruct the damaged patella tendon. This technique is particularly useful in cases where the original tendon has retracted and cannot be reattached using conventional methods.
Pre- and Post-Operative Comparisons
Pre-operative X-rays clearly showed the extent of the injury, with the patella positioned higher than normal (patella alta). Following surgery, comparative X-rays revealed the successful restoration of the patella’s normal alignment. The post-operative recovery was closely monitored, with regular assessments at 3 weeks, 6 weeks, and 9 months.
Outcomes
The post-operative course was smooth, with the patient showing remarkable improvement. At 3 weeks, the surgical scar was healing well, and there were no signs of infection or complications. By 6 weeks, the patient regained functional use of the knee and was able to extend the leg, albeit with limited strength. At the 9-month follow-up, the patient had made a full recovery, with complete restoration of knee extension and the ability to run and climb stairs without discomfort.
Conclusion
This case highlights the importance of early diagnosis and intervention in tendon injuries. Neglected patella tendon tears pose significant challenges, but with innovative surgical techniques such as hamstring tendon reconstruction, excellent functional outcomes can still be achieved even after significant delays in treatment. The key takeaway for orthopedic practitioners is the value of flexibility and creativity in choosing surgical techniques based on the specific circumstances of the injury.
