Late Patellar Tendon Ruptures after Removal of the Central Third for Anterior Cruciate Ligament Reconstruction

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Abstract
Patellar tendon rupture after removal of the central third for ACL reconstruction is a rare complication. Only nine cases have been previously reported, and all of these occurred within the first 10 months after surgery. We report two cases of late patellar tendon ruptures occurring at more than 3 and 6 years, respectively, after surgery. A review of the literature has suggested but not conclusively supported that devascularization, an alteration in tendon healing and remodeling, or injury to the remaining tendon at the time of graft harvest may be possible causes of this rare complication. Biopsy tissue from any future patellar tendon ruptures after removal of its central third could contribute to a better understanding of this anomaly.

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