Gouty destruction of a patellar tendon reconstruction and novel revision reconstruction technique: A case report

Figure 1 Preoperative sagittal magnetic resonance imaging. (Proton Density weighted image fat saturation)-demonstrates avulsion fracture of the tibial tuberosity with patellar tendon rupture and patella alta.

Figure 2 Preoperative plain radiographs. A: Left knee lateral radiograph demonstrating patella alta and tibial tubercle avulsion fracture; B: Standing Anterior-Posterior radiograph bilateral knees. Note patella alta of left knee with normal patellar height of right side.

Figure 3 Intraoperative visualization of gouty infiltration of patellar tendon from prior allograft reconstruction. Gouty tophus noted within surrounding soft tissues with bony destruction of tibial tubercle.

Figure 4 Three-dimensional representation of bone block after contouring. A corresponding notch in the tibial tubercle was made to create a dovetail joint for bone block placement. This was done to prevent proximal migration a reinforce stability of the reconstruction.

Figure 5 Intraoperative images of reconstructive technique. A: Achilles bone block secured with screws with tensioning of graft proximally by transosseous tunnel technique; B: Dermal allograft placed overlying Achilles allograft using transverse slit to pass excess proximal tendon graft. Dermal allograft secured proximal to inferior pole patella with knotless fiber tack anchors; C: Dermal allograft secured distally with four swivel lock anchors with speed bridge technique and fiber tape; D: Extra proximal Achilles allograft reinforced to quadriceps tendon.

Figure 6  Active knee range of motion from 5 to 115 degrees at 1 year follow up.