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- Title
12-YEAR-OLD CHILD WITH SEQUENTIAL OPERATIONS IN PATELLAR TENDON RECONSTRUCTION: A CASE STUDY.
- Authors
Tanas, Anatol; Solovastru, Stefania; Trinca, Flavia-Teodora; Butuc, Loredana; Derzsi, Zoltan; Solyom, Arpad
- Abstract
Introduction: Ruptures of the patellar tendon are rare, resulting from direct or indirect injuries. Patellar fractures with concurrent tendinous damage present unique challenges in pediatric orthopedics, affecting growth and knee functionality. This case report examines a complex injury in a 12-year-old boy, emphasizing diagnostic difficulties, management pitfalls, and a correct surgical solution. Case Report: In July 2023, a 12-year-old boy suffered a lower pole fracture of the right patella, initially treated with immobilization. The lack of progress by September and a misdiagnosis of ossifying myositis in the right quadriceps tendon demanded further investigation. Radiographic and ultrasonographic assessments revealed an older fracture at the inferolateral pole of the patella with an intraarticular bone fragment suggesting a possible rupture of the right patellar ligament. A December 2023 surgical attempt to remove the bony formation and reconstruction failed to repair the patellar tendon rupture, severely impairing the knee's functionality, including the inability to perform active leg extension. Faced with a persistent rupture and a patella ascended by 5 cm, a decisive and innovative surgical strategy was required. On March 5, 2024, a meticulous procedure utilizing autografts from the semitendinosus and gracilis tendons was performed to reconstruct the patellar tendon, aiming to restore knee integrity and functionality. This involved releasing quadriceps muscle, detailed graft preparation, creation of tunnels within the patella, and integration of the tendon pull-through technique into the existing tendon structure, secured with Ti-Cron sutures. The postoperative phase showed a favorable outcome, with the early removal of the Redon drain and continued immobilization for three weeks with regular X-ray monitoring to confirm the correct positioning and to promote healing. Discussions : This case underscores the challenges in diagnosing complex knee injuries in pediatric patients, where misdiagnosis can lead to prolonged discomfort and the potential for long-term functional impairment. The innovative surgical use of semitendinosus and gracilis tendon autografts for patellar tendon reconstruction effectively addresses structural damage and functional deficits caused by the injury. Conclusions: Timely and accurate diagnosis is crucial in managing complex patellar injuries in children to prevent the aftereffects of incorrect treatment approaches. The described surgical intervention showcases the feasibility and effectiveness of autograft augmentation using semitendinosus and gracilis tendons for reconstructing the patellar tendon, offering a promising solution for similar cases. This approach not only addresses the immediate structural issues but also aims to restore long-term knee function, highlighting the importance of tailored surgical strategies in pediatric orthopedic injuries.
- Subjects
ROMANIA; PATELLA fractures; AUTOGRAFTS; CONFERENCES &; conventions; KNEE joint; REOPERATION; PLASTIC surgery; TENDON rupture; PATELLAR tendon
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p147
- ISSN
2668-7755
- Publication type
Article