Rupture of the quadriceps tendon

Twelve patients operated for fresh rupture of the quadriceps tendon were re-examined after 5 (2-11) years. The tendon was sutured end-to-end or to the patella. The result was good in seven cases, fair in four and poor in one case of re-rupture, left unrepaired.     

Rupture of the quadriceps tendon

A man over forty missteps, falls to the ground and is unable to arise. Inability to extend his knee, a swollen joint with a definite hollow above the patella, and a negative x-ray make the diagnosis of a ruptured quadriceps tendon. Immediate open operation is the only rational procedure.     

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: 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.     

Simultaneous rupture of the quadriceps tendon and contralateral patellar tendon in a patient with chronic renal failure

Simultaneous quadriceps and patellar tendon rupture is rare. Mechanical factors and coexisting systemic and local factors are taken into consideration in the pathogenesis of these ruptures. In patients with some chronic systemic diseases, simultaneous rupture can occur spontaneously or with minor traumas. We present a case of simultaneous quadriceps and patellar tendon rupture in a 21-year-old man with chronic renal failure in this report. He was treated surgically by osseotendinous repair with suture anchors and supplemental cerclage wire fixation on both sides. He regained his normal knee joint functions 18 months after the operation.This study was conducted at Ankara Numune Education and Research Hospital, Third Orthopedics and Traumatology Clinic, Talatbaa Bulvar, Shhiye, Ankara, Turkey     

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.     

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 .     

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.     

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。     

Rupture of the quadriceps tendon after total knee arthroplasty: A case report

Reported herein is the case of a 45-year-old woman with knee involvement due to rheumatoid arthritis. She had a total knee arthroplasty with a rupture of the quadriceps tendon 1 month later. Surgical repair of the rupture was performed following the Scuderi technique plus reinforcement with Dacron (Lig Aid, Levallois, Cedex. France) tape cerclage. An above-knee walking-plaster cast was applied with the knee in full extension for 6 weeks. The functional result was good 1 year after surgery.     

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.     

Ultrasonographic assessment of quadriceps and patellar tendon thicknesses in patients with patellofemoral pain syndrome

ObjectiveThe aim of this study was to compare ultrasonographically measured quadriceps and patellar tendon thicknesses between Patellofemoral Pain Syndrome (PFPS) patients and age- and gender-matched healthy controls.MethodsAmong patients who presented to physical therapy and rehabilitation outpatient clinic in January–December 2016, 61 volunteers (28 men and 33 women; mean age: 30.79 ± 6.55 years) who were eligible considering the inclusion and exclusion criteria were enrolled. 30 were diagnosed with PFPS, and the remaining were age- and gender-matched healthy volunteers. Mean age was 30.03 ± 5.67 years in healthy subjects and 45.2% were of male gender. The patient group had mean age of 31.57 ± 7.37 years and 46.7% of the patients were male. Q angles were measured at standing, supine and sitting positions. Patellar and femoral tendon thicknesses and areas were measured ultrasonographically. Kujala questionnaire were used to evaluate the functional status of the participants.ResultsNo significant difference was detected between groups regarding profession, educational background, and body mass indices (BMI) (p > 0.05). Q angle values were significantly higher in the patient group when compared to controls at standing (17.03 ± 3.84 vs. 13.87 ± 1.75°, p < 0.001), supine (16.20 ± 3.74 vs. 13.45 ± 1.79°, p = 0.001) and sitting (16.50 ± 3.28 vs. 13.71 ± 1.72°, p < 0.001) positions. Kujala score was significantly lower in the PFPS group when compared to controls (70.57 ± 8.37 vs. 98.58 ± 2.05, p < 0.001). Patellar (0.39 ± 0.08 vs. 0.32 ± 0.05 cm, p < 0.001) and quadriceps (0.64 ± 0.10 vs. 0.52 ± 0.09 cm, p < 0.001) tendon thicknesses were significantly higher in the PFPS group when compared to controls. There was no significant difference between groups regarding patellar tendon areas (p > 0.05). Patellar tendon thickness values of ≥0.35 cm were found to have 66.7% sensitivity and 67.7% specificity for PFPS diagnosis in the ROC curve analysis (area under curve: 0.771, 95% confidence interval: 0.655–0.887, p < 0.001). Quadriceps tendon thickness values of ≥0.54 cm were found to have 80% sensitivity and 71% specificity for PFPS diagnosis in the ROC curve analysis (area under curve: 0.824, 95% confidence interval: 0.710–0.939, p < 0.001). In PFPS patients, quadriceps tendon thickness had significant positive correlation with age (r = 0.405, p = 0.027) and BMI (r = 0.450, p = 0.013); and significant negative correlation with Kujala score (r = ?0.441, p = 0.015). In the multivariate regression analysis, quadriceps tendon thickness was independently associated with the presence of PFPS (Exp (B): 3.089, 95% confidence interval: 1.344–7.100, p = 0.008).ConclusionOur study demonstrates that ultrasonographically measured patellar and quadriceps tendon thicknesses are significantly higher in subjects with PFPS and particularly, quadriceps tendon thickness may be used for the diagnosis.Level of EvidenceLevel III, Therapeutic Study.     

尿毒症并发一侧髌韧带断裂对侧股四头肌肌腱断裂1例

正患者,男,36岁,主因摔倒致双侧膝关节疼痛伴活动受限18 d于2016年1月22日入院。现病史:患者18 d前因摔倒致双侧膝关节疼痛,当即感疼痛难忍,不能独立行走,自诉听到双侧膝关节"咔"的一声,曾服止痛药物治疗,效果不佳,为进一步诊治收入我科。自发病以来睡眠、大小便、体重等基本无变化。查体:慢性肾病面容。双侧膝关节肿胀明显,皮温皮色正常,无窦道及瘢痕,左侧髌骨下方及右侧髌骨上方触之有明显的空虚感,双膝压痛(+),双膝浮髌     

Freehand resection of the patella in total knee arthroplasty referencing the attachments of the quadriceps tendon and patellar tendon

A freehand technique of patellar resurfacing using anatomic references was prospectively evaluated. This technique utilizes an osteotomy beginning at the inferior pole of the patella just posterior to the insertion of the patellar tendon and is carried proximally posterior to the insertion of the quadriceps tendon. Evaluation of 55 total knee arthroplasties in 41 patients showed an average restored patellar thickness within 0.1 mm. The overall patellar thickness was restored to within 1 mm of its preoperative thickness in 50 (91%) of 55 knees. Patellar tilt was equal to or less than 4° in 42 (89%) of 47 arthroplasties evaluated radiographically. The patellar thickness averaged 17.9 mm, well above the critical value of 15 mm reported in the literature.