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Simultaneous patellar tendon and anterior cruciate ligament rupture: a systematic review, meta-analysis and algorithmic approach
Introduction Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combi...
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| Published in: | Archives of orthopaedic and trauma surgery 2024-12, Vol.145 (1), p.61 |
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| container_title | Archives of orthopaedic and trauma surgery |
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| creator | Ismailidis, Petros Neopoulos, Georgios Egloff, Christian Mündermann, Annegret Halbeisen, Florian S. Nüesch, Corina Appenzeller-Herzog, Christian Müller, Sebastian A. |
| description | Introduction
Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making.
Methods
The systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies.
Results
Thirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI,
p
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| doi_str_mv | 10.1007/s00402-024-05676-w |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11655589</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3147130510</sourcerecordid><originalsourceid>FETCH-LOGICAL-p184w-4297a96b820ebf06aa9ad12d1a36cabad311d01ba2810ecb1d84e0c29b6f2a543</originalsourceid><addsrcrecordid>eNpdkktvFDEQhC1ERJbAH-CALHHhwIRu2-MZc4lQxCNSJA7A2eqZ8e46mhe2J6u98dPj7IbnodWH_lQqVRdjLxDOEaB6GwEUiAKEKqDUlS52j9gKlVSFNKgfsxUYqYsaSjxlT2O8AUBRG3jCTqXRRplKrNjPr35Y-kSjm5bIZ0qu7ynw5MZuGjmNXZ7kgp8Cb8PS-gzw3m9ocGPiYZnTEtw7TjzuY3IDJd_y4G69273hg0tU0Ej9Pvp4lOo3U_BpO2SK5jlM1G6fsZM19dE9f9hn7PvHD98uPxfXXz5dXb6_Lmas1a5QwlRkdFMLcM0aNJGhDkWHJHVLDXUSsQNsSNQIrm2wq5WDVphGrwWVSp6xi6PuvDSD69rsP1Bv5-AHCns7kbf_Xka_tZvp1iLqsixrkxVePyiE6cfiYrKDj-19XofwrERVocxpQ0Zf_YfeTEvIURworTVqIzP18m9Lv738-k4G5BGI-TRuXPgjg2DvO2CPHbC5A_bQAbuTd7bxpoA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3146661693</pqid></control><display><type>article</type><title>Simultaneous patellar tendon and anterior cruciate ligament rupture: a systematic review, meta-analysis and algorithmic approach</title><source>Springer Link</source><creator>Ismailidis, Petros ; Neopoulos, Georgios ; Egloff, Christian ; Mündermann, Annegret ; Halbeisen, Florian S. ; Nüesch, Corina ; Appenzeller-Herzog, Christian ; Müller, Sebastian A.</creator><creatorcontrib>Ismailidis, Petros ; Neopoulos, Georgios ; Egloff, Christian ; Mündermann, Annegret ; Halbeisen, Florian S. ; Nüesch, Corina ; Appenzeller-Herzog, Christian ; Müller, Sebastian A.</creatorcontrib><description>Introduction
Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making.
Methods
The systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies.
Results
Thirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI,
p
< 0.001). Surgical treatment was used only for the PT in 21% of the cases and for the PT and ACL in 77% of the cases (48% one-stage, 52% two-stage surgical treatment).
Conclusion
Combined ACL and PT rupture is rare, and recognizing its full extent is crucial for successful management. Performing an MRI in PT rupture from high-energy trauma and diagnostic arthroscopy/arthrotomy when MRI is not done is essential. PT ruptures should be treated surgically. For ACL rupture, conservative and operative treatment, one- or two-stage surgery are possible based on the patient's profile and concomitant injuries. Based on the limited available literature, this systematic review provides a diagnostic and therapeutic algorithm to assist in clinical decision-making.</description><identifier>ISSN: 0936-8051</identifier><identifier>ISSN: 1434-3916</identifier><identifier>EISSN: 1434-3916</identifier><identifier>DOI: 10.1007/s00402-024-05676-w</identifier><identifier>PMID: 39694972</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Algorithms ; Anterior Cruciate Ligament Injuries - complications ; Anterior Cruciate Ligament Injuries - surgery ; Anterior Cruciate Ligament Reconstruction - methods ; Decision making ; Humans ; Injuries ; Magnetic Resonance Imaging ; Medicine ; Medicine & Public Health ; Orthopedics ; Patellar Ligament - diagnostic imaging ; Patellar Ligament - injuries ; Review ; Rupture - surgery ; Systematic review</subject><ispartof>Archives of orthopaedic and trauma surgery, 2024-12, Vol.145 (1), p.61</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>Copyright Springer Nature B.V. Dec 2025</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0003-1551-7902</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39694972$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ismailidis, Petros</creatorcontrib><creatorcontrib>Neopoulos, Georgios</creatorcontrib><creatorcontrib>Egloff, Christian</creatorcontrib><creatorcontrib>Mündermann, Annegret</creatorcontrib><creatorcontrib>Halbeisen, Florian S.</creatorcontrib><creatorcontrib>Nüesch, Corina</creatorcontrib><creatorcontrib>Appenzeller-Herzog, Christian</creatorcontrib><creatorcontrib>Müller, Sebastian A.</creatorcontrib><title>Simultaneous patellar tendon and anterior cruciate ligament rupture: a systematic review, meta-analysis and algorithmic approach</title><title>Archives of orthopaedic and trauma surgery</title><addtitle>Arch Orthop Trauma Surg</addtitle><addtitle>Arch Orthop Trauma Surg</addtitle><description>Introduction
Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making.
Methods
The systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies.
Results
Thirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI,
p
< 0.001). Surgical treatment was used only for the PT in 21% of the cases and for the PT and ACL in 77% of the cases (48% one-stage, 52% two-stage surgical treatment).
Conclusion
Combined ACL and PT rupture is rare, and recognizing its full extent is crucial for successful management. Performing an MRI in PT rupture from high-energy trauma and diagnostic arthroscopy/arthrotomy when MRI is not done is essential. PT ruptures should be treated surgically. For ACL rupture, conservative and operative treatment, one- or two-stage surgery are possible based on the patient's profile and concomitant injuries. Based on the limited available literature, this systematic review provides a diagnostic and therapeutic algorithm to assist in clinical decision-making.</description><subject>Algorithms</subject><subject>Anterior Cruciate Ligament Injuries - complications</subject><subject>Anterior Cruciate Ligament Injuries - surgery</subject><subject>Anterior Cruciate Ligament Reconstruction - methods</subject><subject>Decision making</subject><subject>Humans</subject><subject>Injuries</subject><subject>Magnetic Resonance Imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Patellar Ligament - diagnostic imaging</subject><subject>Patellar Ligament - injuries</subject><subject>Review</subject><subject>Rupture - surgery</subject><subject>Systematic review</subject><issn>0936-8051</issn><issn>1434-3916</issn><issn>1434-3916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdkktvFDEQhC1ERJbAH-CALHHhwIRu2-MZc4lQxCNSJA7A2eqZ8e46mhe2J6u98dPj7IbnodWH_lQqVRdjLxDOEaB6GwEUiAKEKqDUlS52j9gKlVSFNKgfsxUYqYsaSjxlT2O8AUBRG3jCTqXRRplKrNjPr35Y-kSjm5bIZ0qu7ynw5MZuGjmNXZ7kgp8Cb8PS-gzw3m9ocGPiYZnTEtw7TjzuY3IDJd_y4G69273hg0tU0Ej9Pvp4lOo3U_BpO2SK5jlM1G6fsZM19dE9f9hn7PvHD98uPxfXXz5dXb6_Lmas1a5QwlRkdFMLcM0aNJGhDkWHJHVLDXUSsQNsSNQIrm2wq5WDVphGrwWVSp6xi6PuvDSD69rsP1Bv5-AHCns7kbf_Xka_tZvp1iLqsixrkxVePyiE6cfiYrKDj-19XofwrERVocxpQ0Zf_YfeTEvIURworTVqIzP18m9Lv738-k4G5BGI-TRuXPgjg2DvO2CPHbC5A_bQAbuTd7bxpoA</recordid><startdate>20241218</startdate><enddate>20241218</enddate><creator>Ismailidis, Petros</creator><creator>Neopoulos, Georgios</creator><creator>Egloff, Christian</creator><creator>Mündermann, Annegret</creator><creator>Halbeisen, Florian S.</creator><creator>Nüesch, Corina</creator><creator>Appenzeller-Herzog, Christian</creator><creator>Müller, Sebastian A.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1551-7902</orcidid></search><sort><creationdate>20241218</creationdate><title>Simultaneous patellar tendon and anterior cruciate ligament rupture: a systematic review, meta-analysis and algorithmic approach</title><author>Ismailidis, Petros ; Neopoulos, Georgios ; Egloff, Christian ; Mündermann, Annegret ; Halbeisen, Florian S. ; Nüesch, Corina ; Appenzeller-Herzog, Christian ; Müller, Sebastian A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p184w-4297a96b820ebf06aa9ad12d1a36cabad311d01ba2810ecb1d84e0c29b6f2a543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Algorithms</topic><topic>Anterior Cruciate Ligament Injuries - complications</topic><topic>Anterior Cruciate Ligament Injuries - surgery</topic><topic>Anterior Cruciate Ligament Reconstruction - methods</topic><topic>Decision making</topic><topic>Humans</topic><topic>Injuries</topic><topic>Magnetic Resonance Imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Patellar Ligament - diagnostic imaging</topic><topic>Patellar Ligament - injuries</topic><topic>Review</topic><topic>Rupture - surgery</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ismailidis, Petros</creatorcontrib><creatorcontrib>Neopoulos, Georgios</creatorcontrib><creatorcontrib>Egloff, Christian</creatorcontrib><creatorcontrib>Mündermann, Annegret</creatorcontrib><creatorcontrib>Halbeisen, Florian S.</creatorcontrib><creatorcontrib>Nüesch, Corina</creatorcontrib><creatorcontrib>Appenzeller-Herzog, Christian</creatorcontrib><creatorcontrib>Müller, Sebastian A.</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of orthopaedic and trauma surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ismailidis, Petros</au><au>Neopoulos, Georgios</au><au>Egloff, Christian</au><au>Mündermann, Annegret</au><au>Halbeisen, Florian S.</au><au>Nüesch, Corina</au><au>Appenzeller-Herzog, Christian</au><au>Müller, Sebastian A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Simultaneous patellar tendon and anterior cruciate ligament rupture: a systematic review, meta-analysis and algorithmic approach</atitle><jtitle>Archives of orthopaedic and trauma surgery</jtitle><stitle>Arch Orthop Trauma Surg</stitle><addtitle>Arch Orthop Trauma Surg</addtitle><date>2024-12-18</date><risdate>2024</risdate><volume>145</volume><issue>1</issue><spage>61</spage><pages>61-</pages><issn>0936-8051</issn><issn>1434-3916</issn><eissn>1434-3916</eissn><abstract>Introduction
Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making.
Methods
The systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies.
Results
Thirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI,
p
< 0.001). Surgical treatment was used only for the PT in 21% of the cases and for the PT and ACL in 77% of the cases (48% one-stage, 52% two-stage surgical treatment).
Conclusion
Combined ACL and PT rupture is rare, and recognizing its full extent is crucial for successful management. Performing an MRI in PT rupture from high-energy trauma and diagnostic arthroscopy/arthrotomy when MRI is not done is essential. PT ruptures should be treated surgically. For ACL rupture, conservative and operative treatment, one- or two-stage surgery are possible based on the patient's profile and concomitant injuries. Based on the limited available literature, this systematic review provides a diagnostic and therapeutic algorithm to assist in clinical decision-making.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>39694972</pmid><doi>10.1007/s00402-024-05676-w</doi><orcidid>https://orcid.org/0000-0003-1551-7902</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Algorithms Anterior Cruciate Ligament Injuries - complications Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction - methods Decision making Humans Injuries Magnetic Resonance Imaging Medicine Medicine & Public Health Orthopedics Patellar Ligament - diagnostic imaging Patellar Ligament - injuries Review Rupture - surgery Systematic review |
| title | Simultaneous patellar tendon and anterior cruciate ligament rupture: a systematic review, meta-analysis and algorithmic approach |
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