Patellar Tendon Rupture After Anterior Cruciate Ligament Surgery

Patellar tendon ruptures after anterior cruciate ligament (ACL) surgery can become a potentially serious postoperative complication if handled incorrectly. Proper surgical and rehabilitation must be undertaken to ensure that the overall results of both the initial ACL reconstruction and subsequent tendon rupture are satisfactory. If properly managed, postoperative patellar tendon rupture can be treated and the overall outcome of the ACL surgery is not affected. In our experience of 5,000 ACL reconstructions, a total of 11 patellar tendon ruptures have occurred with 6 occurring after an ipsilateral ACL reconstruction and 5 occurring after a contralateral ACL reconstruction. All patellar tendons were repaired using suture anchors and augmented with a Dall-Miles cable. Follow-up at an average of 3.1 years postoperatively shows that patients regained full knee hyperextension with 141° of flexion on the involved side with average of 143° on the uninvolved knee. Average return of strength was 94% measured with isokinetic testing. Single leg hop scores averaged 96% compared with opposite noninvolved knee. In this article, we discuss the surgical technique, rehabilitation, and results of our experience treating this potentially difficult postoperative complication after ACL reconstruction.