Patellar tendon reconstruction using a medial gastrocnemius flap: review of the literature and an illustrative case report, including some technical Tipps.

Abstract

Patients with chronic patellar tendon ruptures, failed primary repair, injuries with significant loss of tendon tissue or skin coverage require a complex reconstruction. Several reconstructive options are available, but in the case of a revision surgery with an associated infection, most of them seems contraindicated. The use of a vascularized gastrocnemius tendon graft to reconstruct the knee extensor apparatus, is in our opinion, the most appropriate treatment option. We will report a complex case of chronical patellar tendon rupture (after failed allograft reconstruction) in the context of an infection with soft tissue defect. This 65-year-old patient was successfully treated with the reconstruction of the patellar tendon and a soft tissue coverage using a medial gastrocnemius flap. We followed her up for three years and the clinical outcome was recorded including several clinical scores and isokinetic strength measurements, showing an excellent result, with full patient satisfaction and without any limitation in daily activities. In addition, we will review the literature about patellar tendon reconstruction using a medial gastrocnemius flap, presenting the indications and advantages of this technique, sharing our personal experience and some technical aspects of the technique. Finally, we discuss why this flap, is our first choice in such cases.