Knee sliced open by skate blade: a complete patellar tendon rupture in an elite long track speed skater

Key points

1. 01Return to elite speed skating competition was achieved at 11 months postoperatively
2. 02Transosseous suture repair without augmentation was used, as intraoperative tension was judged adequate
3. 03Limb symmetry index for single hop for distance reached 94% at 11 months, meeting the threshold for return to sport
4. 04Knee extensor peak torque deficit remained 40.1% at 1 year, limited by ongoing anterior knee pain during testing
5. 05MRI at 1 year showed mild quadriceps atrophy on the injured side but no major structural abnormality

How it was conducted

Design

Single-patient case report

Patient

Elite male long track speed skater, injured during a national championship at approximately 50 km/h collision

Injury

Complete proximal patellar tendon rupture, partial ACL tear, and 1 mm cartilage cut on non-weight-bearing femoral condyle

Surgery

Transosseous suture repair (Krackow whip stitch, Ti-Cron no.5) with absorbable suture approximation; no augmentation

Rehabilitation

Hinged brace for 8 weeks with gradual flexion increases; isometric then neuromuscular programme; physiotherapist-supervised

Follow-up

12 months with isokinetic dynamometry, single hop tests, KOOS, and MRI

What they found

• Knee extensor peak torque deficit: 67.6% at 6 months, improving to 40.1% at 1 year (right vs. left: 181.2 Nm vs. 302.4 Nm)
• Knee flexor peak torque deficit: 5.5% at 6 months, improving to 1.2% at 1 year
• Single hop for distance on injured leg: 129 cm at 5 months, 186 cm at 9 months, 199 cm at 11 months (54.3% improvement from 5 to 11 months)
• Limb symmetry index for single hop: 75% at 5 months, 86% at 9 months, 94% at 11 months
• KOOS sports and recreation: 40 at 6 months, 45 at 1 year; KOOS quality of life: 37.5 at 6 months, 50 at 1 year
• 5000 m personal record improved from 7:28.29 to 7:07.87 within the first postoperative season
• MRI at 1 year: mean quadriceps cross-sectional area 76.3 cm2 injured vs. 87.3 cm2 non-injured; Insall-Salvati ratio 1.1

Limitations

• Single case report; findings cannot be generalised beyond this individual patient
• Isokinetic strength tests were limited by anterior knee pain (pain score 4-6/10 during testing), likely underestimating true strength
• No long-term follow-up beyond 12 months; durability of recovery and progression of knee pain are unknown
• Comparison with non-athletic patients or other surgical techniques is not possible from this report

Why it matters

For patients

An elite athlete who suffers a complete patellar tendon rupture from a traumatic laceration can realistically expect to return to competitive sport at approximately 11 months if surgery and rehabilitation are performed correctly, though some anterior knee pain may persist.

For clinicians

Transosseous suture repair without augmentation can achieve adequate fixation when intraoperative tension is solid; supervised progressive rehabilitation with objective hop and strength testing guides safe return-to-sport timing.

For readers

This case illustrates that even a dramatic open knee injury in a professional speed skater is survivable for athletic career, and highlights the importance of structured physiotherapy and objective functional milestones over arbitrary time-based criteria.