Management of Simultaneous Patellar Tendon and Anterior Cruciate Ligament Ruptures-ASystematic Review of Available Literature

Abstract

Background: Combined rupture of the anterior cruciate ligament (ACL) and patellar tendon (PT) is a rare injury pattern. Currently, little evidence exists to help guide management decisions for these patients. Methods: A systematic literature search was conducted using PubMed (MEDLINE) and Scopus (EMBASE and MEDLINE) for all articles reporting on combined rupture of the ACL and PT. The characteristic injury mechanisms, common presentation findings, and outcomes of simultaneous and staged treatment strategies were determined to provide guidance for the management of this uncommon injury pattern. An additional case report from our institution is also reported. Results: Overall, 17 studies met the inclusion criteria and were included in our qualitative review. The mean age at injury was 30 years (range, 15-50 years). A high-energy injury with a rapid deceleration event through a flexed knee on a fixed foot is commonly described as the mechanism of injury. Anterior cruciate ligament rupture was missed on initial clinical examination in 24.1% compared with 17.2% for PT rupture. Injuries to the medial collateral ligament and menisci occured in 65.5% of cases. Outcome scores were reported in 41.4% (12/22) of patients undergoing staged or simultaneous repair. The Lysholm score postoperatively was 96 6 3.3 for the staged group compared with 85.3 6 18.6 for simultaneous repair. There were no clear differences between range of motion, time to return to sport, and complication rates between the groups. Conclusions: A high index of suspicion is required to detect concomitant ACL injuries when assessing high-energy PT ruptures. Simultaneous or staged protocols to address both injuries are safe and effective management strategies for this rare combined injury pattern.