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Patella fracture: Revision using McLaughlin sling technique

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There has been a real paradigm shift for patellar fractures in the recent past. Whereas 20 years ago the peak age for patella fractures was still in men between 20 and 30 years of age, this has now shifted significantly towards patients of advanced age. This has resulted in a whole series of changes for the treatment of these injuries, which are due to the special requirements of the more geriatric patient population.

In this case, I will demonstrate a successful salvage operation in just such a situation: an elderly lady who has undergone multiple revision surgeries after a failed and then infected patella fracture. The bony structure of the patella suffered considerable damage as a result.

Despite advanced orthotic the patient was unable to walk properly and expressly requested further reconstruction. of the distal patellar pole and distal patellar tendon that had been lost during the infection surgery.

Reconstruction of the patellar tendon was with a tendon graft with additional augmentation using a McLaughlin sling (which is used if the fixation is unstable in flexion). By means of this complex surgical procedure, we were able to restore acceptable knee joint function to the patient.

This operative technique also demonstrates a whole series of salvage procedures that led to the final reconstruction.

A useful article that covers reconstructive options for this sort of complex situation, in particular how to augment the distal pole of the patella, is:

Haarna et al [Arch Bone Jt Surg 2021, 9(5), 554-558]

 Repair of ruptures through the larger tendons by removable staple suture; a preliminary report. Arch Surg.1946 May:52:547-56. HL McLaughlin.

Author: Peter Biberthaler MD

Institution: Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.

Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.

In the USA contact: fda.gov
In the UK contact: gov.uk
In the EU contact: ema.europa.eu

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