PMC5306983_01
Lateral (a) and anteroposterior (b) knee views demonstrating a gap between the two parts of a duplicate patella. (c) Soft tissue is identified between the two parts of the patella (MRI T1 sagittal view).
CRIOR2017-9475148.001.jpg
PMC5306983_01_CRIOR2017-9475148.001.jpg
fig1
Knee radiographs were obtained and demonstrated a significant diastasis between two patellar parts (Figures 1(a) and 1(b)). Magnetic resonance imaging (MRI) confirmed the presence of an intermediate ruptured tendon between the two patellar parts (Figure 1(c)).
Surgical pictures presenting (a) the proximal and distal stumps of the ruptured intermediate tendon, (b) the use of two 1.6 mm K-wires to reduce both patella parts, and (c) the tenorrhaphy protected with two K-wires.
CRIOR2017-9475148.002.jpg
PMC5306983_01_CRIOR2017-9475148.002.jpg
fig2
A strip of tendon with the characteristics of a fully developed insertion was observed at both the distal part of the proximal patellar piece and the proximal aspect of the distal patellar part (Figure 2(a)). The knee was positioned at 60  of flexion, and the two patellar parts were brought closer with two 1.6 mm K-wires without removing any tissue at the interface (Figure 2(b)). Tenorrhaphy was performed (without any excessive tension or shortening of the tendon) through multiple sutures with Ethibond 1 (Figure 2(c)).
Immediate postoperative (a) and 8-month (b) lateral knee views.
CRIOR2017-9475148.003.jpg
PMC5306983_01_CRIOR2017-9475148.003.jpg
fig3
A figure-of-eight tension band wire was added to protect the tenorrhaphy (Figure 3(a)). The last radiographs illustrate a typically healed duplicate patella with a free space between the two parts, as bone healing was not the goal (Figure 3(b)).