Abstract
This study performs a systematic review to determine (1) if a significant difference
exists in return to preinjury activity level between one- and two-stage treatment
of combined anterior cruciate ligament (ACL) and patellar tendon (PT) tears; and (2)
if a significant difference exists in the number of postoperative complications between
the two differing surgical treatment approaches. A systematic review was performed
using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)
guidelines and registered on PROSPERO. MEDLINE, Cochrane Central Register of Controlled
Trials, SCOPUS, and Sport Discus were searched for English language level I–IV evidence
studies on either one- (simultaneous) or two-stage (sequential) surgical treatment
of simultaneously sustained ipsilateral ACL and PT tears. The approach to initial
evaluation, diagnosis, treatment, and outcomes were qualitatively analyzed. Methodological
quality assessment of all included studies was completed using the Methodological
Index for Non-randomized Studies (MINORS). The Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) tool was used to assess quality of evidence and
provide strength of recommendation. Statistical analyses were done using Fischer's
exact test. Eleven articles (18 patients; 83% males; mean age, 31.1 ± 10.1 years;
mean follow-up, 2.2 ± 1.7 years; and mean MINORS 7.8/16) were analyzed. Eight patients
had a one-stage procedure (primary PT repair and ACL reconstruction), and 10 patients
underwent a two-stage procedure (primary PT repair first followed by ACL reconstruction)
with mean 28 ± 45.7 weeks (5 weeks–3 years) between surgeries. The rate for return
to preinjury activity level after surgery was not significantly different between
one- (88%) and two-stage (100%) (p = 0.444). There was a significantly higher complication rate (p = 0.023) in the one-stage (stiffness, instability, and patella baja) versus two-stage
surgery (no complications). There was no significant difference in return to preinjury
activity level between one- and two-stage PT repair and ACL reconstruction. However,
the one-stage combined surgery had a significantly higher complication rate compared
with two-stage surgery. The level of evidence is IV.
Keywords
anterior cruciate ligament - patella tendon - rupture - simultaneous
