Revision Anterior Cruciate Ligament Surgery Using MacIntosh Technique with Patellar Tendon Reconstruction via Contralateral Patellar Tendon Graft: A Case Report

Abstract

Background: ACL reconstruction using the Kenneth Jones bone-patellar tendon-bone technique is a well-established procedure with excellent functional outcomes, although rare complications such as patellar tendon rupture may occur. In revision settings, alternative reconstructive approaches like the MacIntosh technique can provide effective management for complex postoperative failures. Aims: To report a rare case of early patellar tendon rupture following ACL reconstruction using the Kenneth Jones bone-patellar tendon-bone technique, and to describe the iterative surgical management using the MacIntosh technique combined with simultaneous patellar tendon reconstruction via a contralateral patellar tendon graft. Presentation of Case: A 22-year-old male patient (BMI 29) presented with complete loss of active knee extension in the immediate postoperative period following open ACL reconstruction using the Kenneth Jones technique. MRI confirmed complete rupture of the right patellar tendon and absence of the ACL. Revision surgery was performed combining ACL reconstruction using an ipsilateral fascia lata graft (MacIntosh technique) and patellar tendon reconstruction using a contralateral patellar tendon graft. Discussion: Patellar tendon rupture following ACL reconstruction represents a rare but serious complication. Mechanical, histological, and vascular alterations of the residual two-thirds of the harvested patellar tendon are implicated in this risk. The MacIntosh technique provides a reliable alternative in revision settings, with favourable functional outcomes. Conclusion: This case underscores the importance of rigorous surgical technique, careful postoperative surveillance, and thorough informed consent — encompassing the risk of patellar tendon rupture, donor-site morbidity, and the potential need for revision surgery — prior to ACL reconstruction using the Kenneth Jones procedure.