Divakar B Hamal

Conference 2023 Presentation

Project title

Simultaneous Bilateral Patella Tendon Rupture: A Systematic Review

Authors and Affiliations

Andre Rui Coelho Fernandes 1, Mariana Rufino 2, Divakar Hamal 3, Amr Sousa 2, Emma Fossett 4, Kamalpreet Cheema 2

1 Department of Orthopaedics, York & Scarborough NHS Trust
2. NHS, UK
3 Department of Cardio-Thoracics, Hull University NHS Trust
4 Department of Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trus

Abstract

Background

The extensor mechanism of the knee can be damaged due to various modes of injury and, in most cases, will need an urgent surgical opinion in order to repair it. A single patella tendon rupture is quite uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in English literature. Research in this area is confined to case series mainly, with some literature reviews but no evidence of more substantial analysis. This systematic review was done with the purpose of analysing relevant existing literature on bilateral simultaneous patellar tendon ruptures, namely data related to predisposing patient factors, mode/level of injury, relevant investigations, surgical procedural techniques and intra and postoperative complications, with the aim of proposing a systematic and standardised approach to the diagnosis and management of this injury.

Methods

A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms included “bilateral patella tendon rupture” AND “Bilateral” AND “Patellar” AND “Tendon” AND “Rupture”. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy.

Results

Bilateral patellar tendon rupture is a rare injury that should be considered in every patient with apparent knee extensor mechanism disruption, despite past medical history. Since examination signs are non-specific, an X-ray of each knee should be considered in anyone presenting with knee pain and swelling, as it is usually sufficient for diagnosis. Surgical treatment and physiotherapy generally have good outcomes with a low rate of complications.

Conclusions

The key limitation of this study was the low number of patients encompassed by the eligible literature. Moreover, certain aspects that could be of potential interest were not approached in every article. Being a rare and scarcely documented injury, there is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially better improve the outcomes in the management of this injury.