A method of repair for quadriceps tendon or patellar ligament (tendon) ruptures without cast immobilization. Preliminary report

The quadriceps tendon and patellar tendon (ligament) were repaired with a Dacron vascular graft used as a tension suture material. In cases of quadriceps tendon ruptures, the Dacron graft is passed transversely through the patellar ligament just below the patella and crossed transversely at the level of the musculotendinous junction with two loops applying tension to the tendon, which brings the tendon ends together by creating a solid structure. In cases of patellar ligament ruptures, the Dacron graft is passed through a hole in the tibia posteriorly to the tibial tuberosity instead of through the patellar ligament below the patella. This technique enables early mobilization on the first day after surgery. The technique was first tested on six dogs with severed quadriceps tendons and patellar ligaments that were repaired with this suture method. All of the animals recovered from surgery and walked and ran normally on the repaired legs within 27 days and with only mild limping after 17 days. The technique was then used on six patients, four with complete quadriceps tendon rupture and two with complete tear (avulsion) of the patellar ligament (tendon). In all of the patients, excellent surgical results were obtained and leg immobilization was virtually eliminated. Physical therapy was prescribed the first day after surgery. The rehabilitation period was significantly reduced.     

Use of a turndown quadriceps tendon flap for rupture of the patellar tendon after total knee arthroplasty

Patellar tendon rupture is a devastating complication after total knee arthroplasty. The results of surgical treatment of this complication were discouraging in most of the reports. We describe a case of rupture of patellar tendon 7 weeks after total knee arthroplasty treated with a turndown quadriceps flap and circumferential wiring. Two years and 6 months after operation, the patient had no extension lag of the knee and knee flexion to 110 degrees .     

Outcome of quadriceps tendon repair

Complete rupture of the quadriceps tendon is a well-described injury. There is a scarcity of literature relating to the outcome of patients with this injury after surgery. We undertook a retrospective analysis of patients who had surgical repair of their quadriceps tendon at our institution over a 13-year period, totalling 21 patients. Males were more commonly affected, with a male/female ratio of 4:1. The peak incidence was in the sixth decade of life. Assessment consisted of the completion of a functional knee questionnaire and a clinical examination. Symptomatic outcome following surgical repair was good with a mean symptom score generated of 19.16 out of a maximum of 25 using the Rougraff et al scoring system. Most of the patients returned to their pre-injury level of activity. Five degrees deficit and extension lag was present in three patients; these patients had the quadriceps repaired using transosseous sutures. Patients who had direct repair of the tendon using the Bunnell technique had lower Rougraff scores than the rest.     

股前外侧皮瓣联合股直肌肌腱瓣移植修复前臂软组织伴肌腱缺损

2005年6月至2009年3月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧皮瓣,联合切取以旋股外侧动脉降支为蒂股直肌肌腱瓣游离移植修复7例前臂软组织伴肌腱缺损,术后疗效满意. 1.一般资料:本组7例,男6例,女1例;年龄18～42岁,平均26岁.均为外伤性前臂软组织缺损伴肌腱、血管缺损和部分骨质外露的创面.损伤原因:交通伤1例,机器绞伤2例,热压伤4例.左侧2例,右侧5例.前臂创面面积为8 cm×7cm～22cm×12 cm.其中背侧创面伴指伸肌腱缺损5例,掌侧创面伴指屈肌腱缺损2例,肌腱缺损长度为5～15 cm.1例急诊一期行修复术;2例因创面污染较重,清创术后二期行修复术;4例热压伤先行扩创、切痂后二期行修复术.     

股前外侧皮瓣联合股直肌肌腱瓣移植修复前臂软组织伴肌腱缺损

2005年6月至2009年3月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧皮瓣,联合切取以旋股外侧动脉降支为蒂股直肌肌腱瓣游离移植修复7例前臂软组织伴肌腱缺损,术后疗效满意. 1.一般资料:本组7例,男6例,女1例;年龄18～42岁,平均26岁.均为外伤性前臂软组织缺损伴肌腱、血管缺损和部分骨质外露的创面.损伤原因:交通伤1例,机器绞伤2例,热压伤4例.左侧2例,右侧5例.前臂创面面积为8 cm×7cm～22cm×12 cm.其中背侧创面伴指伸肌腱缺损5例,掌侧创面伴指屈肌腱缺损2例,肌腱缺损长度为5～15 cm.1例急诊一期行修复术;2例因创面污染较重,清创术后二期行修复术;4例热压伤先行扩创、切痂后二期行修复术.     

股前外侧皮瓣联合股直肌肌腱瓣移植修复前臂软组织伴肌腱缺损

2005年6月至2009年3月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧皮瓣,联合切取以旋股外侧动脉降支为蒂股直肌肌腱瓣游离移植修复7例前臂软组织伴肌腱缺损,术后疗效满意. 1.一般资料:本组7例,男6例,女1例;年龄18～42岁,平均26岁.均为外伤性前臂软组织缺损伴肌腱、血管缺损和部分骨质外露的创面.损伤原因:交通伤1例,机器绞伤2例,热压伤4例.左侧2例,右侧5例.前臂创面面积为8 cm×7cm～22cm×12 cm.其中背侧创面伴指伸肌腱缺损5例,掌侧创面伴指屈肌腱缺损2例,肌腱缺损长度为5～15 cm.1例急诊一期行修复术;2例因创面污染较重,清创术后二期行修复术;4例热压伤先行扩创、切痂后二期行修复术.     

Disruption of a patellar tendon repair

The patient was a 38-year-old man evaluated by a physical therapist 14 weeks after repair of the left patellar tendon. The physical therapist requested radiographs, which revealed findings consistent with a patellar tendon retear. The radiologist recommended further evaluation with magnetic resonance imaging, which showed a left patellar tendon tear. J Orthop Sports Phys Ther 2012;42(8):738. doi:10.2519/jospt.2012.0414.     

Simultaneous traumatic rupture of the patellar and contralateral quadriceps tendon

We report a very rare case of a simultaneous rupture of the right patellar and left quadriceps tendon in an otherwise healthy 37-year-old patient, who jumped off a kickboard. Suture of both tendons was performed on the day of trauma. We describe our postoperative treatment and report the follow-up examination one year after the trauma. Beside functional questionnaire, Lysholm score and physical examination and x-ray, quadriceps isokinetic testing was performed.     

Floating patella: combined quadriceps tendon, retinacula, and patellar tendon ruptures in a high-performance elite athlete

Simultaneous quadriceps and patellar tendon rupture is rare. To our knowledge, we present the first known case of simultaneous quadriceps tendon, patella tendon, and retinacula rupture in the ipsilateral knee of a high-performance elite athlete. This disabling injury in the active person results in an inability to actively obtain and maintain full knee extension. When the tendons do not heal properly, at the correct length and tension, knee range of motion and strength can become significantly altered, leading to early fatigue, patellofemoral pain, and possibly instability, preventing return to preinjury status. Immediate surgical repair is recommended for optimal return of knee function and power.     

Neglected patellar tendon rupture: a case of reconstruction without quadriceps lengthening

Neglected rupture of the patellar tendon is a rare, can be easily missed in a group of patients. We present a 24 year old, male patient who sustained right femoral diaphyseal and tibial plateau fractures and a patellar tendon rupture following a motor vehicle accident. The fractures were treated by open reduction internal fixation but the patellar tendon rupture was missed and the diagnosis was delayed by 7 months. Patella was migrated proximally. It was moved distally to the original location and neglected patellar tendon rupture treated successfully with modified Ecker technique. Neither preoperative traction nor additional intraoperative procedures were performed to relocate the patella to its anatomic position in the extended knee and good functional result was achieved with intensive rehabilitation.     

Rupture of the quadriceps tendon: an association with a patellar spur

We reviewed the records of 107 consecutive patients who had undergone surgery for disruption of the knee extensor mechanism to test whether an association existed between rupture of the quadriceps tendon and the presence of a patellar spur. The available standard pre-operative lateral radiographs were examined to see if a patellar spur was an indicator for rupture of the quadriceps tendon in this group of patients. Of the 107 patients, 12 underwent repair of a ruptured patellar tendon, 59 had an open reduction and internal fixation of a patellar fracture and 36 repair of a ruptured quadriceps tendon. In the 88 available lateral radiographs, patellar spurs were present significantly more commonly (p < 0.0005) in patients operated on for rupture of the quadriceps tendon (79%) than in patients with rupture of the patellar tendon (27%) or fracture of the patella (15%). In patients presenting with failure of the extensor mechanism of the knee in the presence of a patellar spur, rupture of the quadriceps tendon should be considered as a possible diagnosis.     

Gastrocnemius muscle flap including Achilles tendon after extensive patellectomy for soft tissue sarcoma.

A 72-year-old man developed a soft-tissue sarcoma anterior to his left knee. The tumour was excised widely combined with an extensive patellectomy. A gastrocnemius flap including Achilles tendon was used successfully to cover the soft-tissue defect and to reconstruct the knee extensor mechanism.     

Functional results after surgical repair of quadriceps tendon rupture

We present the long-term results of surgical repair of a traumatic rupture of the quadriceps tendon in a group of 24 patients with a mean age of 58 years. There were 21 male and 3 female patients. Fifteen patients were seen for clinical control after a mean follow-up of 75 months and they all presented with some quadriceps muscle atrophy. Twelve patients had normal knee mobility, three had a flexion deformity of 10 degrees and two had less than 120 degrees of knee flexion. Active knee extension was normal in all patients. Three patients experienced some decrease in stability of their knee joint. Subjectively all patients were satisfied with the result. Nine patients underwent a Cybex-test for evaluation of the isokinetic force of knee flexion and extension, with a comparison between the injured and the uninjured side. For concentric force there was a mean deficit at low speed of 36.1% for the quadriceps muscle; at high speed it was 28.2%. For the knee flexors, the deficits were 30.7% and 27.2% respectively. Regarding eccentric force, the mean deficit for knee extensors was 13.8% and 0.25% respectively and for knee flexors 6.5% and 5.5% respectively.     

Donor site morbidity after quadriceps tendon harvest for rotator cuff repair.

BACKGROUND: The central quadriceps tendon provides a useful free tendon graft, although the morbidity of harvesting it is unknown in elderly patients. METHODS: The donor site morbidities of 10 patients after central quadriceps tendon (CQT) graft harvest were reviewed for rotator cuff repair. Patients were reviewed by questionnaire and clinical examination at a minimum of 5 months after surgery. RESULTS: A majority of patients reported significant donor site pain and reduction in knee reliability and function. Six of 10 patients had reduced quadriceps power attributable to the graft harvest. CONCLUSION: The harvesting of the CQT graft is associated with significant morbidity, especially in an elderly population with limited functional reserve.     

Biomechanical comparison of quadriceps tendon fixation with patellar tendon bone plug interference fixation in cruciate ligament reconstruction

Purpose: The purpose of this study was to use current fixation techniques and compare the stiffness and ultimate tensile failure of the tendinous end of the quadriceps tendon (QT) with the bone plug end of the bone–patellar tendon–bone (BPTB) graft using current techniques of fixation. Type of Study: Randomized trial of elderly cadaver knees. Materials and Methods: Tibial and femoral biodegradable interference fixation and femoral EndoButton (Smith & Nephew, Acufex, Mansfield, MA) fixation in bone tunnels with the QT and the BPTB graft were compared by using 10 pairs of elderly cadavers and biomechanical testing. Two groups, fixation at time zero (simulating fixation in the operating room) and testing after 1,000 loading cycles (simulating patient rehabilitation exercises), were used. Results: At time zero fixation, stiffness of the soft tissue QT tibial tunnel interference fixation was 59% less stiff than the stiffness of the interference fixation of a BPTB plug in a femoral tunnel (P = .11). The EndoButton femoral fixation resulted in a decrease in stiffness at time zero compared with femoral tunnel interference fixation of the soft tissue QT (P = .03). All groups improved stiffness with cycling the construct to 1,000 cycles. Conclusions: Placement of the QT tendinous end of the graft in the femoral bone tunnel when using a interference fixation will approximate the stiffness of a bone plug in the tibial bone tunnel with interference fixation. The EndoButton fixation is not as stiff as either of the femoral interference fixation options. The addition of more than 20 loading cycles could remove laxity from the graft fixation–graft cruciate ligament complex and improve its stiffness.     

Simultaneous chronic rupture of quadriceps tendon and contra-lateral patellar tendon in a patient affected by tertiary hyperparatiroidism

Spontaneous ruptures of the extensor mechanism of the knee are very rare. They tend to increase considerably in patients with metabolic diseases such as chronic renal failure, hyperparathyroidism, diabetes, gout, and systemic lupus erythematosus. The reported case regards a 48-year-old man with chronic, spontaneous and simultaneous quadriceps, and contra-lateral patellar tendon rupture. The patient suffered from chronic renal failure and for the past year from tertiary hyperparathyroidism. Ruptured tendons were repaired and both knee were evaluated monthly for the next 12 months. Good functional recovery was achieved on both knees without relapse. This case emphasizes the importance of long-term high parathyroid hormone level in the etiology of tendons ruptures.