PMC6087580_01
T2-weighted MRI of the right knee demonstrating patella alta and a full thickness tear of his proximal patellar tendon, two months following injury and one month prior to this patient's primary procedure. Insall-Salvati Index = 1.4, Caton-Deschamps Index = 1.34.
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This patellar height was corrected to an Insall-Salvati Index (ISI) and Caton-Deschamps Index (CDI) of 1.23 and 1.14 (Figure 1) from 1.4 and 1.34, respectively (Figure 2).
Postoperative lateral X-ray of the patient's right knee demonstrating a corrected patella alta deformity immediately following the first procedure. Insall-Salvati Index = 1.23, Caton-Deschamps Index (CDI) = 1.14.
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This patellar height was corrected to an Insall-Salvati Index (ISI) and Caton-Deschamps Index (CDI) of 1.23 and 1.14 (Figure 1) from 1.4 and 1.34, respectively (Figure 2).
Lateral X-ray (a) and T2-weighted MRI (b) of the patient's right knee eleven months following the index procedure showing proximal migration of the patella and a redundant but intact patellar tendon. CDI = 1.51, ISI = 1.55.
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T2-weighted MRI and lateral knee radiograph at 11-month follow-up confirmed patella alta deformity (CDI = 1.51, ISI = 1.55), an intact albeit lax patellar tendon, and cartilage fissuring near the inferior patellar apex (Figure 3).
Schematic demonstrating the anchor placement and stitching technique used to fixate the patellar tendon repair.
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Krackow sutures were passed through the midsubstance of the patellar tendon, and with the opposite limb of each stitch, a half hitch was made such that a pulley mechanism was created (Figure 4).
Postoperative AP (a) and lateral (b) view of the right knee displaying a corrected patellar height after the revision procedure. Caton-Deschamps Index = 1.09, Insall-Salvati Index = 1.16.
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Postoperative lateral knee radiograph displayed a CDI of 1.09 and an ISI of 1.16 (Figure 5), which confirmed that patella alta had been corrected.
Postoperative MRI of the right knee at 18-month follow-up. Caton-Deschamps = 1.35.
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At 18-month follow-up, the patient had a repeat MRI performed which demonstrated a CDI of 1.35 (Figure 6).
Postoperative examination of the patient's active range of motion at 1-year follow-up. (a) Patients' surgical leg in full extension. (b) Patients' leg in 135 degrees of flexion.
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At his 1-year follow-up examination, the patient did not appear in acute distress, had no joint effusion, did not have patellar apprehension, demonstrated a nonantalgic gait, showed full active range of motion with no lag (Figure 7), displayed a negative Clarke exam, and had 4/5 quadriceps strength. Despite a relatively benign physical exam (Figure 7) and subjective reporting of satisfaction with the revision procedure and his outcome, the patient reported moderate functional limitations.