Hi,
Here is the summary of my inquiry about the crossed-doubled patellar tendon.
5x confident about prior tendon translocation surgery (Roux-Goldthwait procedure)
2x favouring an anatomical variant, citing the below reference from Loizides A et al., 2017
Coincidentally, today I have received new clinical information that my patient was treated surgically in the 90s for repeated patellar dislocation. Bingo, case solved!
In fact, I now have serious doubts about the existence of a doubled crossed patellar tendon anatomic variant and I would like to open for discussion based on the following:
While I think there is consensus about patellar tendon variants, like the one published here:
The uncrossed-doubled patellar tendon: A novel imaging finding
Syed Mohammed Ali Haydar, Jonathan Miles, Rikin Hargunani
Radiol Case Rep. 2019 Dec; 14(12): 1509–1512. Published online 2019 Oct 18. doi: 10.1016/j.radcr.2019.09.029
I do have serious concerns that the crossed-doubled patellar tendon, as it is performed by the Roux-Goldthwait procedure, actually exists as a variant because there is only 1 (one!) publication on this finding and it is referenced over and over again. The patient in this case report actually had 2x knee surgery for 'hemangioma', when the patient was 15 y/o! I find that suspicious and I have serious concerns about some missing information.
Alexander Loizides, Carmelo Messina, Bernhard Glodny, Leonhard Gruber, Erich Brenner, Hannes Gruber, Benjamin Henninger
Surg Radiol Anat. 2017; 39(1): 111–114. Published online 2016 Jun 15. doi: 10.1007/s00276-016-1706-x
So with all of that said, I am really wondering, if we in this wonderful community of MSK experts, could find a consensus if a crossed-doubled patellar tendon actually exists as a variant or not? I am not aware of this variant being described in any anatomical textbook and I have not seen any cases published or posted cases in children which I find very suspicious. Please correct me if I am wrong.
I am neither bored, nor looking for trouble but if we agree this specific anatomic variant does not exist, I question if this case report can or should stand any longer because it confuses people who search for this and always come up with the same paper!
BTW, this topic had been brought up previously on OCAD on Feb. 27th 2019 by Avneesh and others, also posting at least two other cases of doubled patellar tendon without known prior surgery. At least one case also had patellar malalignment! The colleagues are cc'd.
Modified Roux-Goldthwait Procedure for Management of Patellar Dislocation in Skeletally Immature Patients with Down Syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394190/
Enjoy RSNA!
Björn
From: ocad-msk@googlegroups.com <ocad-msk@googlegroups.com> On Behalf Of Björn Jobke
Sent: 25 November 2019 15:52
To: OCAD <ocad-msk@googlegroups.com>
Subject: doubled crossed patellar tendon
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Hello OCAD,
My mystery case of the year.
52 y/o pat.
Relevant Clinical History: Recurrent patellar dislocation, since giving way whilst standing. Had injection for her pain few years back. Her pain has come back and bothering her too much. Diffuse tenderness present
No other history available.
No X-ray.
http://www.claripacs.com/a.php?a=125&mode=simple
What's going on? Variant or unknown prior surgical procedure?
Björn
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