A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively
Journal Title: TRAUMA INTERNATIONAL - Year 2018, Vol 0, Issue 0
Abstract
Introduction: Extensor mechanism disruption with other ligament injuries at knee is rare. Rupture of the patellar tendon (PT) usually occurs at the inferior pole of patella leading to proximal retraction of 3–5 cm due to contraction of quadriceps. The medial collateral ligament (MCL) is the most frequently damaged ligamentous stabilizer of the knee. MCL injuries do occur as isolated lesions or in combination with damage to other ligamentous structures (meniscus and/or cruciate ligaments). Non-operative treatment is reasonable for the second-degree and some third-degree tears, but when they occur in conjunction with meniscal tears, they are best treated by surgical repair. The incidence of meniscal tears with acute anterior cruciate ligament (ACL) injuries ranges from 50% to 70%. The risk of lateral meniscus (LM) injury is high in ACL deficient knee as a result of abnormal loading and shear stress. However, simultaneous rupture of both the PT, ACL, MCL, and LM is a relatively rare injury. Our is a case of a 60-year-old male with a history of roadside accident presenting with simultaneous PT, ACL, MCL, and LM injury. We managed the patient with acute repairing of the PT with Ethibond no.5 sutures protected with stainless steel wire and the MCL repaired with Ethibond no.5 sutures. The ACL was not repaired as the limited literature has shown high incidence of arthrofibrosis in acute repair (Shelbourne et al.). Complex tear of anterior horn of LM was seen and was shaved off. We were able to achieve full extension at 3 months. In conclusion, we want to highlight the rarity of such injuries favoring the immediate repair of PT and delayed repair of ACL for achieving optimal results. The use of our treatment algorithm may facilitate clinical decision-making in an attempt to restore stability, preserve ROM, and maximize return to activity.
Authors and Affiliations
Naveen Mittal, Robin Bohat, Ankush Jindal, Akash Singhal
Keywords
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