Late reconstruction of the patellar tendon in rheumatoid arthritis using bone-patellar tendon-bone allograft

• A lady with rheumatoid arthritis had a chronic patellar tendon rupture.
• She underwent patellar tendon reconstruction with a massive BTB allograft.
• She now has an active range of motion between −20 and 120°.

Introductionchronic patellar tendon rupture is rare and its incidence and prevalence are unknown. Furthermore, the data about late reconstruction of the patellar tendon in rheumatoid arthritis is limited. Such condition, if not managed properly, can substantially affect the patient's activities of daily living.Case presentationWe report a case of chronic patellar tendon rupture in a 49 years old lady who has been suffering from rheumatoid arthritis for over 20 years. She presented with an inability to extend the right knee which started suddenly a year and a half ago without any history of trauma. She underwent reconstruction of the patellar tendon using a massive BTB allograft. Three years after surgery, the patient had an active range of motion between −20 and 120° and was walking normally without any external support.DiscussionWhen the primary repair of the patellar tendon is not possible, it is necessary to either repair with autologous augmentation or use a graft to reconstruct the tendon. We believe autografts may not be suitable in the presence of rheumatoid arthritis since the disease is associated with excessive levels of collagenase that could contribute to the degeneration of the tendons.ConclusionLate patellar tendon reconstruction in rheumatoid arthritis is a challenging procedure, and we believe it is best performed using an allograft to achieve the desired outcome.