Edge CC, Widmeyer J, Protzuk O, Johnson M, O’Connell R. Gouty destruction of a patellar tendon reconstruction and novel revision reconstruction technique: A case report. World J Orthop 2024; 15(7): 675-682 [PMID: 39070936 DOI: 10.5312/wjo.v15.i7.675]
Corresponding Author of This Article
Carl C Edge, MD, Researcher, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street 9th FloorBox 980153, Richmond, VA 23298-0153, United States. carl.edge@vcuhealth.org
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jul 18, 2024; 15(7): 675-682 Published online Jul 18, 2024. doi: 10.5312/wjo.v15.i7.675
Gouty destruction of a patellar tendon reconstruction and novel revision reconstruction technique: A case report
Carl C Edge, Jonathan Widmeyer, Omar Protzuk, Maya Johnson, Robert O’Connell
Carl C Edge, Jonathan Widmeyer, Omar Protzuk, Maya Johnson, Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
Robert O’Connell, Division of Sports Medicine, Orthowest, Carrolton, GA 30117, United States
Author contributions: Edge CC and Widmeyer J wrote the original manuscript; Edge CC, Protzuk O, Johnson M and O’Connell R conceptualised, wrote the review and edited; All authors have read and approved the final manuscript.
Informed consent statement: The patient provided informed written consent for collection and publication of information and imaging pertaining to this case.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carl C Edge, MD, Researcher, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street 9th FloorBox 980153, Richmond, VA 23298-0153, United States. carl.edge@vcuhealth.org
Received: April 3, 2024 Revised: May 7, 2024 Accepted: June 3, 2024 Published online: July 18, 2024 Processing time: 100 Days and 2.4 Hours
Abstract
BACKGROUND
Gout is a disease characterized by hyperuricemia, and resultant deposition of uric acid crystals in tissues. While typically manifested as intraarticular crystals or tophi, gout can also cause pathology at entheses. Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture. Furthermore, allografts can also be at risk of rupture in the setting of severe gout. We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction.
CASE SUMMARY
A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs. She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years. This patient presented with pain and extensor lag. A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle. The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction. She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks. At twelve weeks, she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises.
CONCLUSION
Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.
Core Tip: We present a case of a 56-year-old female with severe systemic tophaceous gout who presented with a rupture of her revision patellar tendon reconstruction due to severe gouty infiltration. The major takeaway from this case is that with multiple failed reconstructions of the patellar tendon, both structural and biologic reinforcement were sought to provide this patient the best chance for recovery and a substantial reconstruction. We provided a robust structural construct as well as biologic reinforcement with the use of an Achilles tendon allograft with a wedge-shaped bone block and a dermal allograft incorporated into the reconstruction.
