Patellar and quadriceps tendon ruptures

Ten cases of rupture of quadriceps tendon and seven cases of rupture of the patellar ligament were studied. All patients were reexamined. One must differentiate between rupture of the quadriceps tendon (tendon ruptures in elderly patients with degeneratively changed tendon in trivial trauma) and rupture of the patellar tendon (tendon rupture in younger patients with considerable trauma). All the patients were discussed with regard to accident mechanism, histology, underlying systemic and local diseases, therapy and results. There were good results in all patients with rupture of the patella tendon. In seven of the ten patients with quadriceps tendon rupture, we noted also good results. Three patients had residual pain and restricted motion and function of the knee. In two of these cases, diagnosis and reconstruction was delayed for months, the other patient had an infection of an implanted knee endoprosthesis in the injured knee.     

Patellar tendon avulsion after reconstruction of the anterior cruciate ligament

We report a case of rupture of a reconstructed anterior cruciate ligament (ACL) combined with avulsion of the inferior patellar ligament. The two lesions were repaired during one operation using the quadriceps tendon as a graft for the damaged ACL.     

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.     

Rupture of the patellar ligament one month after treatment with fluoroquinolone

Musculoskeletal disorders including arthralgia and myalgia are adverse effect common to all fluoroquinolones. We report a case of spontaneous rupture of the patellar ligament in a 37-year-old man participating in leisure sports which occurred one month after a three-week course of Ciprofloxacine(R). Several cases of tendon ruptures have been reported in the literature, including the patellar tendon. Unusual features in our case were the one-month delay before tendon rupture and the absence of inaugural signs. We reviewed the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discussed proper management. Care must be taken when prescribing fluoroquinolones for patients at risk. Close follow-up is most important.     

Bifocal disruption of the knee extensor apparatus ("floating patella") in a 72-year-old patient

We present the unusual case of a simultaneous ipsilateral rupture of the quadriceps tendon and the patellar ligament in a 72-year-old male patient. No predisposing factors were diagnosed. After surgical treatment, the patient healed with full function and full range of motion.     

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.     

关节镜下股四头肌腱髌骨块嵌入挤压固定重建后交叉韧带

目的设计关节镜下股四头肌腱髌骨块嵌入和异体骨栓挤压固定方法重建后交叉韧带(PCL),观察其治疗PCL损伤的疗效。方法自2002年6月-2005年12月,对13例PCL损伤患者采用关节镜下股四头肌腱髌骨块嵌入和异体骨栓挤压固定方法进行重建。股四头肌腱移植物的获取中保证髌骨上极和股四头肌腱条的连接;股骨隧道制作为“瓶颈”样;股四头肌腱移植后将与之连接的髌骨块敲击嵌入股骨“瓶颈”样隧道,胫骨隧道内用特制异体骨栓挤压固定移植肌腱。治疗效果采用Lysholm评分和国际膝关节文献委员会(IKDC)的分级标准评定。结果所有患者获得3-37个月(平均19个月)随访,无患者发生神经血管损伤、移植物失败等严重并发症。所有患者均无膝关节不稳定症状,2例患者客观检查有后向不稳定体征;除3例患者剧烈活动后关节疼痛外,其余患者关节疼痛症状明显缓解。1例患者髌骨上极股四头肌腱内有少许钙化现象。Lysholm评分术后高于术前,差异有极显著性意义(P<0．01);IKDC评定结果明显优于术前。结论采用股四头肌腱移植物对取材部位无不良影响,移植物生物力学特性更接近PCL,且可以切取任意长度和宽度,保证远大于PCL的强度。移植物固定采用本设计的骨块嵌入和异体骨栓挤压的方法,成功率高、并发症少,有明显优越性。     

Gleichzeitige Patella- und kontralaterale Quadrizepssehnendurchtrennung

The simultaneous bilateral rupture of the quadriceps tendon is a rare injury; only occasional reports exist about the bilateral simultaneous rupture of the patellar tendon. Degenerative changes of the tendon due to drugs or diseases lead to the rupture. We describe two cases of simultaneous rupture of the patellar and contralateral quadriceps tendons; only one patient had special risks. We report the management of therapy and the functional results using the Lysholm score and Knee Rating Scale.     

骨—髌腱—髌前骨膜—肌四头肌腱条骨块嵌入法重建前交叉韧带

为充分有效利用髌腱组织重建前交叉韧带,确保移植关节内段均为髌腱组织,增加移植物的有效长度,同时在关节外矫正前内旋不稳及改进移植物的固定方法,作者设计应用骨－髌腱－髌前骨膜－股四头肌腱条游离移植骨块嵌入法重建ＡＣＬ３８例。术后经平均２年７个月随访,效果良好,优良率８９．７％。     

Patellar tendon rupture 3 years after anterior cruciate ligament reconstruction with a central one third bone–patellar tendon–bone graft

Use of the central one third bone–patellar tendon–bone autograft is an accepted technique for anterior cruciate ligament (ACL) reconstruction. Patellar tendon rupture following ACL reconstruction is an acknowledged, although rarely reported, complication of this procedure. Of the limited patellar tendon rupture cases reported in the literature, most are described early in the postoperative period. We present a case of late patellar tendon rupture more than 3 years after uneventful ACL reconstruction in a 32-year-old man.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 648–652     

Neglected bilateral rupture of the patellar tendon: A case report

Simultaneous bilateral rupture of the patellar tendon (PT) is extremely rare and is generally associated to some chronic diseases. When the rupture becomes chronic, it is more difficult to repair that as it remained untreated.The diagnosis, which is clinical, is often delayed, guided by standard radiography and confirmed by ultrasound or MRI.The management of a bilateral neglected, chronic patellar tendon rupture must address some serious difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, the temporary protection of this repair.We report a case of neglected bilateral rupture of the patellar tendon in a chronic hemodialysis patient, treated with a plastic surgery of the ipsilateral quadriceps tendon.     

Simultaneous rupture of the quadriceps tendon with contralateral patellar tendon rupture: an unusual case and a review of the literature

Simultaneous rupture of quadriceps tendon with contralateral patellar tendon is very rare. There are only two case reports in English literature. We report the case of a healthy 41-year-old female with simultaneous rupture of her left quadriceps tendon and right patellar tendon. There were no known precipitating factors for this injury. Surgical repair and early rehabilitation achieved satisfactory outcome.     

Neglected patellar tendon rupture: preserve the fat pad

Management of neglected patellar tendon ruptures remains a difficult therapeutic endeavor, as complications such as adhesions, proximal patellar migration, and quadriceps contracture occur. Treatment goals include restoration of extensor mechanism, both structurally and functionally, which allows active knee extension. Few cases of neglected patellar tendon rupture have been reported in the literature, however, all have used preoperative or additional intraoperative procedures to relocate the patella or to provide additional support to the reconstructed tendon. This article presents a case of a 25-year-old man whose diagnosis of patellar tendon rupture was delayed by 1 year. The patella was mobile and could be brought down to its original position manually. The patellar tendon was successfully reconstructed with autogenous semitendinosus and gracilis tendon graft. No preoperative or intraoperative traction was used on the patella. Quadriceps lengthening was not performed and no hardware was used between the patella and the tibia to augment the reconstruction. Scar tissue was not excised and was used to cover the hamstring tendons. The patient achieved a good functional result after 5 months of rehabilitation. At 14-month follow-up, the patient had returned to his pre-injury level of work with no deterioration of knee function.     

Ruptures of the extensor mechanism of the knee joint. Clinical results and patellofemoral articulation

The functional results of 28 cases of rupture of the quadriceps and patellar tendons are reported. Excellent or good results were noted in 15 of 18 quadriceps and 7 of 10 patellar tendons. Radiographic comparison with the opposite knee disclosed incongruences between the patella and the femoral groove in the tangential view and/or cranial-caudal position of the patella in the lateral view in 13 of the quadriceps tendon ruptures and seven of the patellar tendon ruptures. Patients with residual pain had patellofemoral incongruity but since two-thirds of the patients with incongruity were asymptomatic, incongruity alone may not be the cause of the symptoms. There was no positive correlation to muscular strength or range of movement. Nevertheless, exact adaptation of the patellar tendon and periarticular tissue seems necessary to obtain correct patello-femoral articulation. Reinforcement of the tendon with a wire cerclage is recommended to decrease the tension on the suture line and the consequent risk of a secondary rupture. In acute ruptures of the quadriceps tendon end-to-end sutures are sufficient.     

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 .     

膝关节髌韧带迂曲征的影像学观察

[目的]对髌韧带在矢状位MRI迂曲征进行相关测量和分析.[方法]回顾性分析40例双侧膝关节MRI图像,40例患者均表现为一侧髌韧带迂曲,另一侧髌韧带正常.在矢状面MRI测量髌韧带长度和髌骨长度;在横切面MRI图像上测量髌韧带近端、中部、远端的横截面积.比较两侧髌腱测量结果以及其他病理所见.[结果]髌韧带迂曲征发生在近端...     

Acute traumatic rupture of the patellar tendon in pediatric population: Case series and review of the literature

BackgroundIntact knee extensor mechanism is required for the normal function of the lower extremity. Patellar tendon rupture is a relatively rare injury with peak age incidence around 40 years and usually occurs midsubstance. The occurrence of pure patellar tendon rupture without bony avulsion is an extremely rare injury in the pediatric population with few cases reported in the literature with limited information regarding frequency, complications, and outcomes in children. However, due to increased participation in sports and high-energy recreational activities during childhood, the frequency of such injuries has progressively increased.ObjectiveTo evaluate the frequency of pediatric patellar tendon rupture injuries and describe the radiological findings, treatment modalities, and outcome of such injuries.MethodsDemographic and clinical data on a series of patients who sustained patellar tendon rupture were reviewed. These data included age at time of injury, sex, laterality, mechanism of injury, associated injuries, complications, presence or absence of Osgood-Schlatter disease, diagnostic imaging such as plain radiographs and magnetic resonance images (MRI), surgical technique, method of fixation, period of postoperative immobilization, total duration of physiotherapy, time to return to sports activities and follow-up duration. Insall-Salvati ratio was calculated on the preoperative lateral x-ray. The functional outcome was evaluated with regard to final knee active range of motion (AROM), manual quadriceps muscle testing, and presence or the absence of terminal extension lag. Clinical outcome rating using knee society score (KSS) was performed and functional outcome was further classified according to the calculated score.ResultsFive male patients with patellar tendon rupture (7%) were identified among 71 pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. The mean age at the time of injury was 13.6 years (range: 12–15 years). The injury occurred in relation to sports activities in 4 patients. Osteogenesis imperfecta and Osgood-Schlatter disease were identified in 2 patients. High riding patella is the hallmark diagnostic sign detected in plain x-ray with preoperative Insall-Salvati ratio ranged from 1.7 to 2.5. Three patients had pure soft tissue avulsion distally from the proximal tibia, 1 patient had pure soft tissue avulsion proximally from the inferior patellar pole, and 1 patient with midsubstance tendinous disruption. No associated intra-articular lesions were identified. Suture bridge double row technique, transpatellar suturing, and transosseous suturing through the proximal tibia were used for patellar tendon reinsertion. After a mean follow-up period of 18. 4 weeks (range: 10–30 weeks), patients achieved AROM ranging from 0 to 120° to 0–137° without terminal extension lag. The mean time to return to sports activity was 22 weeks (range: 13–30 weeks). Quadriceps muscle strength was 5/5 at the final follow-up visit in all patients; however, relative muscle atrophy was noted in comparison to the other side in one patient. The mean KSS was 91.8 points (range: 79–100 points) with excellent outcome in 4 patients and good outcome in 1 patient.ConclusionPatellar tendon rupture is rare in the pediatric population and represents 7% of pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. Ruptures may occur midsubstance, or from proximal or distal insertions. High riding patella is the hallmark diagnostic sign for such injury. Although rare, it is considered a serious injury that necessitates early diagnosis and surgical intervention. Functional range of motion was obtained in all patients with different modalities of treatment.     

Editorial Commentary: Graft Choice for Anterior Cruciate Ligament Reconstruction: Will There Ever Be a Correct Answer? Probably Not

Graft choice for anterior cruciate ligament reconstruction has been a great controversy in the sports medicine literature for the last 25 years. It has been well studied in the orthopaedic literature, with numerous randomized control trials and large database studies. There remain advantages and disadvantages to each autograft choice, primarily bone–patellar tendon–bone, quadrupled hamstring, as well as allograft. More recently, quadriceps autograft has also been studied as a suitable alternative. Most studies show nearly equivalent functional outcomes for autograft anterior cruciate ligament using bone–patellar tendon–bone and hamstring autografts in athletes younger than the age of 25 years, whereas allograft may be preferred for older athletes.     

高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂

目的 探讨陈旧性髌腱断裂的临床特点,介绍采用高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂的手术方法 和术后康复方法 .方法 2002年1月至2007年2月,收治陈旧性髌腱断裂6例,手术切断超长的瘢痕愈合髌腱组织.恢复长度后重新吻合,并在胫骨结节和髌骨两端钻骨孔,采用4根高强度聚酯纤维缝线经骨孔减张保护.术后对患者采用积极的康复锻炼方案:术后第1天即町下地直立行走及被动屈膝90°,休息和睡眠时不须支具石膏固定保护;术后3周起开始练习主动抬腿;术后6周后开始练习快走,负重2 kg直腿抬高;术后12周后开始练习上下楼梯和下蹲;术后6个月后开始正常运动以及蹬跳运动.结果 术后随访1～5年,平均3.2年.患者早期即可以活动并可以下床直立行走,所有患者均未出现再断裂.手术6个月以后,患者均恢复正常的平地行走、跑步能力等,屈膝基本达到对侧的水平,股四头肌力量良好.Lysholm评分均能达到100分.结论 高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂,创伤小,方法 简单,不须外加牵引,不须石膏固定,不须二次手术取内固定.积极的康复训练允许患者早期行走,效果可靠.     

Considerations in spontaneous quadriceps tendon rupture repair in end-stage renal disease patients: A case report

IntroductionSpontaneous quadriceps tendon rupture (SQTR) is a rare injury to the knee extensor mechanism that is usually associated with systemic diseases such as end stage renal diseases (ESRD) and it is more prevalent in the elderly. Due to the underlying pathology, quadriceps tendon rupture warrants special considerations and management in its repair.Case reportWe present two cases of quadriceps tendon rupture in end-stage renal disease (ESRD) patients. The first case; a 57 years old female who had bilateral SQTR and is undergoing hemodialysis. The second patient, a 26 years old male had unilateral quadriceps tendon rupture caused by minimal trauma.The first patient had a trans-osseous repair by direct suturing the quadriceps tendon stump to the proximal pole patella. The second patient was repaired with a modified Bunnel suture and anchor placement on the proximal pole patella. The first case had a re-rupture of the right quadriceps tendon and the second case has recovered with improved outcomes.DiscussionSpontaneous quadriceps tendon rupture is usually underlined by degenerative changes of the tendons. Special care is needed to address the pathologic tendon underlying SQTR. The current surgical literature still lacks the statistical data that shows which surgical approach is most optimal for SQTR in ESRD patients.ConclusionSQTR rupture is generally an injury of brittle tendons caused by underlying diseases. A multidisciplinary and comprehensive approach including a proper surgical approach and postoperative managements are crucial for good functional outcomes of the extensor mechanism.