膝蓋腱再断裂後3カ月の陳旧例に対し再再建術を行った1例

Re-reconstruction of a Rerupture Patellar Tendon 3 Months after the Injury. Case Report

　膝蓋腱断裂は通常早期に治療され陳旧例となることは稀である．陳旧性の膝蓋腱再断裂症例に対する観血的治療を経験したので報告する．症例は34歳の男性で，7年前に左膝蓋腱を断裂し，Leeds-Keio人工靱帯を用いて治療された．今回，再受傷し左膝蓋腱再断裂と診断され，受傷後約3カ月でLeeds-Keio人工靱帯で再再建術が行われた．膝蓋上囊のはく離と外側膝蓋支帯を切離し膝蓋骨を元位置へ整復できた．手術後7日で可動域訓練，21日で全荷重歩行を開始した．手術後約3年の現在，四頭筋筋力，可動域は十分に回復し，スポーツ活動も可能である．

　A treatment of a chronic rupture of the patellar tendon is an uncommon event, and is difficult to repair because of quadriceps contracture and scar tissue formation. We report a case of re-reconstruction for a chronic patellar tendon rerupture. A 34-year-old man whose left patellar tendon had been reconstructed with a Leeds-Keio ligament seven years before injured his left knee again while playing rugby, and we made a diagnosis of rerupture of the patellar tendon. The patient's left patellar tendon was reconstructed again approximately 3 months after the injury with a Leeds-Keio ligament. It was possible to reposition the patella by clearing the medial and lateral gutters in the suprapatellar pouch and releasing the lateral retinaculum. At 7 days post-op the patient began moving his left knee, and 21 days, walking with full weight bearing. Five months postoperatively the range of motion of the knee was 0-140°, and 3 years postoperatively the patient had recovered good quadriceps muscle strength and full range of motion of the left knee. The patient is able to enjoy skiing and rugby.