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Halvorson RT, Dilallo M, Garcia-Lopez E, Colyvas N, Wong SE. Extensor Mechanism Reconstruction Using Achilles Tendon Allograft With Suture Tape Augmentation. Arthrosc Tech 2023; 12:e2295-e2302. [PMID: 38196882 PMCID: PMC10773140 DOI: 10.1016/j.eats.2023.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/31/2023] [Indexed: 01/11/2024] Open
Abstract
The management of chronic extensor mechanism injuries represents a significant challenge for orthopaedic surgeons, with numerous options for graft choice and fixation construct, but no clear consensus on which technique achieves optimal outcomes. Although there is little published data regarding outcomes of different fixation methods, small case series have demonstrated modest success using Achilles tendon bone block allografts and transverse patellar screw fixation. In this technical note, we describe a surgical technique for the treatment of a chronic inferior pole patella fracture, with extensor mechanism reconstruction using an Achilles tendon allograft with suture tape augmentation. Our technique describes the use of vertical cannulated screws in the patella for passing tape augmentation sutures, increased construct security by suturing of the Achilles graft directly to the quadriceps tendon, and the use of a post screw in the proximal tibia for suture tape augmentation.
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Affiliation(s)
- Ryan T. Halvorson
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Marcus Dilallo
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Edgar Garcia-Lopez
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Nicholas Colyvas
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Stephanie E. Wong
- Department of Orthopaedic Surgery, University of California, San Francisco, California
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Complication after the reconstruction of the old patellar tendon rupture. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200914136n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Chronic patellar tendon rupture (PTR) occurs rarely; its frequency and prevalence are unknown. There are very little data on the late patellar tendon reconstruction in rheumatoid arthritis and its complications. Case report. We presented a surgical repair of a PTR with early postoperative rupture of the contralateral patellar tendon for a 21-year-old woman with a past medical history of juvenile rheumatoid arthritis (treated with corticosteroids) who sustained initial injury 11 months prior to the presentation. The contralateral side was used for autograft harvesting. We used bone-tendon-bone (BTB) autograft and allografts followed by double-wire loop reinforcement and immediate postoperative mobilization. The patient was followed for 2 years, and the function of both knees was re-stored completely, with a full active range of motion. In this case, reconstruction of an 11-month-old chronic PTR (with complete resorption of the tendon and completely separated infrapatellar pads, complicated by the contralateral PTR) with BTB autograft and allografts and double wire loop reinforcement gave an excellent functional result. Two years after the surgical treatment, the extensor function of both knees was completely restored with a full range of movements. The patient reported satisfying outcomes and was able to return to all pre-injury activities without the assistance of orthopedic devices. Conclusion. This case report highlights the importance of the early diagnosis and describes operative techniques used in chronic PTR repair and treatments of the early postoperative complications such as rupture of the contralateral tendon.
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Mahoney MR, Veravalli K, Mofidi A. Treatment of neglected quadriceps tendon ruptures using LARS™ ligament augmentation: A case series. Trauma Case Rep 2021; 32:100437. [PMID: 33665326 PMCID: PMC7905339 DOI: 10.1016/j.tcr.2021.100437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background Late presentation of Quadriceps tendon rupture (QTR) is rare. Treatment of neglected QTR's can be challenging due to scar tissue and muscle wasting and may require augmentation. Delayed tendon repairs tend to have less favourable outcome compared to acute repairs. There are very few case reports of delayed repair using various techniques. Methods a case series of 5 patients (6 tendon ruptures) presenting late with quadriceps tendon rupture. Repair was performed using a Codivilla V—Y plasty to extend the tendon, followed by LARS artificial ligament augmentation. All patients then received 6 weeks targeted physiotherapy after wound healing. Results Repair using our technique was possible in all patients. No patients needed to return to theatre due to re-rupture or infection. Only one patient required oral antibiotics for a superficial wound infection. No patient was left with a functional deficit following physiotherapy, with 4 of the 6 repairs achieving a full range of movement. Conclusions V—Y plasty followed by LARS augmentation can be used safely and reproducibly for the repair of delayed presentation quadriceps tendon ruptures in our cohort comprising of both healthy and co-morbid patients to achieve good functional results.
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Affiliation(s)
- Ms R Mahoney
- Morriston Hospital, Swansea SA6 6NL, United Kingdom of Great Britain and Northern Ireland
| | - K Veravalli
- Morriston Hospital, Swansea SA6 6NL, United Kingdom of Great Britain and Northern Ireland
| | - A Mofidi
- Morriston Hospital, Swansea SA6 6NL, United Kingdom of Great Britain and Northern Ireland
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Patellar tendon reconstruction with hamstring autograft for the treatment of chronic irreparable patellar tendon injuries. Knee 2020; 27:1841-1847. [PMID: 33197824 DOI: 10.1016/j.knee.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/07/2020] [Accepted: 09/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellar tendon injuries not amenable to primary repair present a challenging problem for surgeons and patients alike. No standard surgical technique exists for these injuries and few studies report outcomes after surgical treatment. METHODS A retrospective analysis was conducted for patients undergoing surgical treatment for irreparable patellar tendon tears. Patients were treated with an indirect tendon reconstruction technique using high-strength suture to set initial patellar height and hamstring autograft for biologic augmentation. Patients who underwent this procedure between 2012 and 2018 and met minimum two-year follow-up with completion of all outcome measurements including KOOS, PROMIS, VAS pain and satisfaction scores were included. RESULTS Eleven patients met inclusion criteria. Ten of eleven patients (91%) had intact repairs and final patient outcomes were collected at a mean of 54.9 ± 23.1 months after surgery. Only one patient experienced extensor lag at final follow-up (p < 0.001). The preoperative Caton-Dechamps ratio was 1.77 ± 0.58, which decreased to 0.98 ± 0.25 after surgery (p < 0.001). The mean postoperative KOOS ADL score was 61.5. The mean postoperative PROMIS Global Mental and Physical Health scores were 46.9 ± 8.7 and 42.0 ± 9.8. Post-operative mean VAS satisfaction score was 5.6 ± 3.4. CONCLUSIONS Patellar tendon reconstruction with autologous hamstring tendon graft and suture augmentation allows for acceptable outcomes in the setting of patellar tendon disruption with segmental defects when direct repair is not possible.
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Snedeker JG, Foolen J. Tendon injury and repair - A perspective on the basic mechanisms of tendon disease and future clinical therapy. Acta Biomater 2017; 63:18-36. [PMID: 28867648 DOI: 10.1016/j.actbio.2017.08.032] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/16/2017] [Accepted: 08/25/2017] [Indexed: 12/16/2022]
Abstract
Tendon is an intricately organized connective tissue that efficiently transfers muscle force to the bony skeleton. Its structure, function, and physiology reflect the extreme, repetitive mechanical stresses that tendon tissues bear. These mechanical demands also lie beneath high clinical rates of tendon disorders, and present daunting challenges for clinical treatment of these ailments. This article aims to provide perspective on the most urgent frontiers of tendon research and therapeutic development. We start by broadly introducing essential elements of current understanding about tendon structure, function, physiology, damage, and repair. We then introduce and describe a novel paradigm explaining tendon disease progression from initial accumulation of damage in the tendon core to eventual vascular recruitment from the surrounding synovial tissues. We conclude with a perspective on the important role that biomaterials will play in translating research discoveries to the patient. STATEMENT OF SIGNIFICANCE Tendon and ligament problems represent the most frequent musculoskeletal complaints for which patients seek medical attention. Current therapeutic options for addressing tendon disorders are often ineffective, and the need for improved understanding of tendon physiology is urgent. This perspective article summarizes essential elements of our current knowledge on tendon structure, function, physiology, damage, and repair. It also describes a novel framework to understand tendon physiology and pathophysiology that may be useful in pushing the field forward.
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Lomas A, Ryan C, Sorushanova A, Shologu N, Sideri A, Tsioli V, Fthenakis G, Tzora A, Skoufos I, Quinlan L, O'Laighin G, Mullen A, Kelly J, Kearns S, Biggs M, Pandit A, Zeugolis D. The past, present and future in scaffold-based tendon treatments. Adv Drug Deliv Rev 2015; 84:257-77. [PMID: 25499820 DOI: 10.1016/j.addr.2014.11.022] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 11/08/2014] [Accepted: 11/12/2014] [Indexed: 02/07/2023]
Abstract
Tendon injuries represent a significant clinical burden on healthcare systems worldwide. As the human population ages and the life expectancy increases, tendon injuries will become more prevalent, especially among young individuals with long life ahead of them. Advancements in engineering, chemistry and biology have made available an array of three-dimensional scaffold-based intervention strategies, natural or synthetic in origin. Further, functionalisation strategies, based on biophysical, biochemical and biological cues, offer control over cellular functions; localisation and sustained release of therapeutics/biologics; and the ability to positively interact with the host to promote repair and regeneration. Herein, we critically discuss current therapies and emerging technologies that aim to transform tendon treatments in the years to come.
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Abstract
Patellar tendon rerupture is a relatively uncommon condition that severely compromises the function of the extensor mechanism of the knee. Few cases described in the literature does not show a unique mode of treatment for this type of lesion. We report the case of a young athlete with traumatic patellar tendon rerupture. The first rupture was treated with the use of Statak anchors. Following a second rerupture incident as a result of a sporting accodent, the tendon was reconstructed with the use of an autologous graft tendon of semitendinosus and biological augmentation with gracilis tendon. For both tendons the distal insertion part was preserved to facilitate the healing process. The treatment was completed with the application of a neutralization cerclage wire and with local injection of plateket reach plasma (PRP). At 12 months follow up, a full recovery of the structure and function of the extensor mechanism was observed and the patient was able to resume normal sports competitive activity.
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Sundararajan SR, Srikanth KP, Rajasekaran S. Neglected patellar tendon ruptures: a simple modified reconstruction using hamstrings tendon graft. INTERNATIONAL ORTHOPAEDICS 2013; 37:2159-64. [PMID: 24081511 DOI: 10.1007/s00264-013-2112-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 09/07/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE We hereby describe a cost effective and simple anatomical reconstruction without requirement for allograft or implants for neglected chronic patellar tendon injuries. This has been validated in seven patients with an average follow up of greater than three years resulting in good outcome. METHODS Seven patients (six males, one female) of mean age 41.8 years (range up to 57 years) presented with neglected patellar tendon injury. The time since injury ranged between three months and three years (average nine months). Active extension was not possible in three patients, and four patients had an extensor lag between 40° and 80° (average 62.5°). Four patients had quadriceps strength of grade 2/5 and three patients had grade 3/5. All patients had severe functional limitation with an average IKDC score of 46.8 (range 39-57). They all underwent patellar tendon reconstruction using hamstrings tendon autograft. RESULTS Postoperatively with a mean follow up of 40.7 months (range 31-52 months), all patients had a stable knee with mean flexion of 125° (range 120°-130°) and without any extension lag. Quadriceps power was regained in five cases to 5/5 and in two cases to 4/5. With an improvement in the IKDC score to 86.8 (range 80-92), excellent outcome was noted in five patients and good outcome in two patients. The average postoperative Lysholm score was 92.4 (range 89-95) and the average Kujala score was 94.5 (range 92-97). CONCLUSION Patellar tendon reconstruction using hamstrings autograft for neglected patellar tendon injuries provides good stability and excellent outcome. Compared to previous techniques described, our technique is unique in being cost effective and a simple anatomical reconstruction without the requirement for allograft or implants.
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Affiliation(s)
- S R Sundararajan
- Department of Orthopaedics, Ganga Hospital, #313, Mettupalayam Road, Coimbatore, 641043, Tamil Nadu, India
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Druskin SC, Rodeo SA. Novel treatment of a failed quadriceps tendon repair in a diabetic patient using a patella-quadriceps tendon allograft. HSS J 2013; 9:195-9. [PMID: 24426867 PMCID: PMC3757493 DOI: 10.1007/s11420-012-9285-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 06/04/2012] [Indexed: 02/07/2023]
Abstract
Recurrent quadriceps tendon rupture is a debilitating condition that may be challenging to treat, especially in the presence of systemic disease such as diabetes mellitus (Bedi et al., J Shoulder Elbow Surg 19:978-988, 2010; Chbnou and Frenette, Am J Physiol Regul Integr Comp Physiol 5:R952-R957, 2004; Chen et al., J Shoulder Elbow Surg 5:416-421, 2003). Many surgical treatment protocols have been proposed (Azar, in Canale and Beatty, eds., Campbell's Operative Orthopedics, Mosby/Elsevier, Philadelphia, PA, 2008; Ilan et al., J Am Acad Orthop Surg 3:192-200, 2003; Rodeo and Izawa, in Garrett et al., eds., Principles and Practice of Orthopedic Sports Medicine, Lippincott Williams & Wilkins, Philadelphia, PA, 2000). We report the case of a diabetic male with multiple treatment failures. He ultimately sustained a good outcome following treatment with a novel surgical technique that utilized a patella quadriceps tendon allograft. Tendon allograft-to-native bone healing had previously failed in this patient, so we used a bone-tendon construct allograft to provide an allograft bone-to-native bone healing site. Now, 13 months postoperative, the patient has increased strength, minimal pain, 20 ° of extensor lag and 130 ° of flexion.
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Affiliation(s)
- Sasha C. Druskin
- />Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA
| | - Scott A. Rodeo
- />Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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10
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Reconstruction of the patellar tendon using a Y-shaped flap folded back from the vastus lateralis fascia. Knee 2013; 20:139-43. [PMID: 22717221 DOI: 10.1016/j.knee.2012.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/22/2012] [Accepted: 05/23/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neglected and repeated ruptures of the patellar tendon are fortunately an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by contractures of the quadriceps muscle and extensive scar tissue formation, and clinical findings are similar regardless of whether the rupture occurred during or after total knee arthroplasty. In both cases, reconstruction is the treatment. METHODS Here, we present data on reconstruction of the patellar tendon using our own method, which is performed in the following manner: the fascia flap shafted in the distal direction is separated from the vastus lateralis fascia of the quadriceps muscle, then folded back and fixed to the tibial tuberosity enclosing the patella in a Y shape. We used this new method in sixteen cases. All of the patients were examined clinically for an average of twenty-eight months. The Knee Society score was determined prior to surgery and on follow up. RESULTS Both the physical and ultrasound monitoring showed that all sixteen tendons healed properly, indicating that there was no need for any further surgical interventions. The mean Knee Society pain and function scores as well as the average range of motion of the knee increased significantly after the operations. CONCLUSION We believe that the presented method is an acceptable option for functional and biomechanical repair of the patellar tendon for the following reasons: the static balance of the knee joint remains unaltered, the quadriceps muscle is not damaged, and the central pulling direction remains steady.
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11
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Naim S, Gougoulias N, Griffiths D. Patellar tendon reconstruction using LARS ligament: surgical technique and case report. Strategies Trauma Limb Reconstr 2011; 6:39-41. [PMID: 21589681 PMCID: PMC3058183 DOI: 10.1007/s11751-010-0101-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 12/28/2010] [Indexed: 12/16/2022] Open
Abstract
Neglected patella tendon ruptures require reconstruction using tendon grafts. The LARS ligament has been successfully used in cruciate and collateral knee ligament reconstruction. We present a technique using LARS ligament for the reconstruction of a chronic patella tendon rupture in a low-demand patient. The result after 1-year follow-up was deemed successful.
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Affiliation(s)
- Soulat Naim
- University Hospital North Staffordshire, Stoke on Trent, UK
- Orthopaedic Department, City General, Newcastle Road, Stoke-on-Trent, ST4 6QG UK
| | - Nikolaos Gougoulias
- University Hospital North Staffordshire, Stoke on Trent, UK
- Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, GU16 7UJ UK
| | - David Griffiths
- University Hospital North Staffordshire, Stoke on Trent, UK
- Orthopaedic Department, City General, Newcastle Road, Stoke-on-Trent, ST4 6QG UK
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12
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13
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Savarese E, Bisicchia S, Amendola A. Bilateral spontaneous concurrent rupture of the patellar tendon in a healthy man: case report and review of the literature. Musculoskelet Surg 2010; 94:81-8. [PMID: 20480273 DOI: 10.1007/s12306-010-0077-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 04/06/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Eugenio Savarese
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, 81 Oxford Street, Rome, Italy.
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14
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Milankov MZ, Miljkovic N, Stankovic M. Reconstruction of chronic patellar tendon rupture with contralateral BTB autograft: a case report. Knee Surg Sports Traumatol Arthrosc 2007; 15:1445-8. [PMID: 17579835 DOI: 10.1007/s00167-007-0365-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 05/09/2007] [Indexed: 11/27/2022]
Abstract
Chronic patellar tendon rupture is a rare disabling injury that is technically difficult to repair. Many different surgical methods have been reported for the reconstruction of chronic patellar tendon ruptures. We are reporting the use of contralateral bone-tendon-bone (BTB) autograft for chronic patellar tendon rupture reconstruction followed by double-wire loop reinforcement and without postoperative immobilization. One year after the operation, our patient had full knee extension and up to 130 degrees of flexion. He had good quadriceps strength, and isokinetic muscle testing showed no deficit comparing to his right leg. Patient returned to playing basketball in his spare time, without having any limitation.
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Affiliation(s)
- Miroslav Z Milankov
- Department of Orthopaedic Surgery and Traumatology, Institute of Surgery, Clinical Center, Medical School, University of Novi Sad, Hajduk Veljkova 1, 21 000, Novi Sad, Serbia.
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15
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Leopardi P, Vico GD, Rosa D, Cigala F, Maffulli N. Reconstruction of a chronic quadriceps tendon tear in a body builder. Knee Surg Sports Traumatol Arthrosc 2006; 14:1007-11. [PMID: 16465535 DOI: 10.1007/s00167-006-0044-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 08/17/2005] [Indexed: 10/25/2022]
Abstract
Chronic quadriceps tendon tears are uncommon. We report about a body builder taking a cocktail of anabolic drugs for several years in whom reconstruction of a chronic quadriceps tendon tear was performed using ipsilateral hamstring tendons with good results despite the 7 month delay between injury and surgery. The use of hamstring tendons is a good option for the management of these lesions.
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Affiliation(s)
- Paolo Leopardi
- Department of Orthopaedics, Faculty of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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16
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Abstract
Patella tendon rupture is a debilitating injury that often occurs in the setting of preexisting tendon degeneration. Prompt diagnosis and treatment is essential to prevent retraction of the patella with subsequent adhesions and quadriceps contractures. In the setting of a chronic rupture, augmentation with hamstring tendons or allograft reconstruction generally is necessary. Patients who undergo delayed repair are at risk for a compromised result secondary to loss of full knee flexion and decreased quadriceps strength, although a functional extensor mechanism is likely to be reestablished. Overall the results of chronic repair are less satisfactory than the acute repair, but still provide an extensor mechanism for the patient and thus provide function.
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Affiliation(s)
- Patrick E Greis
- Department of Orthopedics, University of Utah, Salt Lake City, Utah 84132, USA
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17
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Abstract
Patella baja is a complication of chronic quadriceps tendon rupture. In this case we present the treatment of this problem by the proximal transfer of the tibial tubercle allowing an environment in which the quadriceps tendon can heal.
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Affiliation(s)
- Michael Hockings
- Orthopaedic and Arthritic Institute, Sunnybrook and Women's Health Science Centre, University of Toronto, 43 Wellesley Street East, Toronto, Ontario, Canada.
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18
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Abstract
Certain similarities can clearly be appreciated between Achilles and patellar tendon ruptures. Both are strong tendons that transmit force bridging at least one joint of the lower limb. When healthy, both require massive forces to be disrupted, and both can be weakened through certain systemic disease processes, steroids, and fluoroquinones. Both allow for a variety of innovative management possibilities that ultimately lend themselves to individual surgical preference. We feel that, although surgical management plays an important role in restoring continuity in knee extension and in plantar flexion, functional outcome inevitably relies on patient motivation and a well-established physiotherapy regime. Sports physicians should be able to identify both conditions early in their presentation, but still hold a high index of suspicion for these problems in athletes who have an acute exacerbation of ongoing tendinopathy.
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Affiliation(s)
- Nicola Maffulli
- Department of Trauma and Orthopaedics, Keele University School of Medicine, Thornburrow Drive, Hartshill ST47QB, UK.
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19
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Toms AD, Smith A, White SH. Analysis of the Leeds-Keio ligament for extensor mechanism repair: favourable mechanical and functional outcome. Knee 2003; 10:131-4. [PMID: 12787994 DOI: 10.1016/s0968-0160(02)00051-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Many techniques have been described for the challenging problem of extensor mechanism rupture, including the use of synthetic grafts. In 1994 Fujikawa et al. [J. Bone Surg. 1994:76B:200-203] reported excellent results using the Leeds-Keio polyester ligament. Patients were mobilised early, had few post operative complications and minimal extensor lag. This is the first independent assessment of this technique using both subjective and objective analysis of outcome. We reviewed 11 patients (12 knees) whose extensor mechanisms were repaired as described in the original paper. At a mean of 3 years after surgery there were no infections and no re-ruptures. Good functional recovery was observed with a mean Tegner activity score of 1.7, Lysholm score of 66 and Irrgang score of 58%. Indeed, 80% of working patients returned to their former employment. However, objective tests showed peak extensor torque recovered to only half normal strength. We conclude the results of this technique of repair compare favourably with other described techniques especially in complex cases.
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Affiliation(s)
- A D Toms
- Robert Jones & Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire, UK
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20
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Abstract
The repair of ruptured quadriceps tendon is commonly performed by weaving sutures through the ruptured tendon and then attaching the tendon to the bone by passing these sutures through tunnels in the superior patella. This technical note is the first report we are aware of in the English language literature of a technique that uses suture anchors to attach the tendon to bone.
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Affiliation(s)
- David P Richards
- Plano Orthopedic and Sports Medicine Center, Plano, Texas 75093, USA
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21
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Fukui N, Cho N, Tashiro T, Nakamura K. Anatomical reconstruction of the patellar tendon: a new technique with hamstring tendons and iliotibial tract. J Orthop Trauma 1999; 13:375-9. [PMID: 10406707 DOI: 10.1097/00005131-199906000-00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A new technique of patellar tendon reconstruction was performed in a patient who lost tendon and tibial tuberosity during wide excision surgery for a malignancy. In this procedure, the tendon was anatomically replaced by a graft composed of ipsilateral hamstring tendons and iliotibial tract, with the biomechanical conditions considered. Both ends of the graft were secured in the size-matched bone tunnels in the patella and tibia by screw post fixation, which is a technique established in ligament reconstruction surgery in the knee joint. At the twenty-month follow-up, the result was deemed successful.
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Affiliation(s)
- N Fukui
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Japan
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22
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Edwards TB, Lewis JE, Guanche CA. Patellar tendon and tibial tubercle reconstruction using quadriceps tendon with patellar bone plug autograft. J Orthop Trauma 1997; 11:304-7. [PMID: 9258831 DOI: 10.1097/00005131-199705000-00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This report describes a technique for the reconstruction of a patellar tendon-tibial tubercle deficiency. This technique uses an easy-to-harvest, low-morbidity graft (autogenous quadriceps tendon), while allowing aggressive rehabilitation as a result of the strength of the graft.
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Affiliation(s)
- T B Edwards
- Department of Orthopaedic Surgery, Louisiana State University Medical Center, New Orleans 70112, USA
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23
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Abstract
Rupture of the patellar tendon is a relatively infrequent, yet disabling, injury, which is most commonly seen in patients less than 40 years of age. It tends to occur during athletic activities when a violent contraction of the quadriceps muscle group is resisted by the flexed knee. Rupture usually represents the final stage of a degenerative tendinopathy resulting from repetitive microtrauma to the patellar tendon. This injury may also occur during less strenuous activity in patients whose tendons are weakened by systemic illness or the administration of local or systemic corticosteroid medications. The diagnosis is made on the basis of the presence of a painful, palpable defect in the substance of the tendon; an inability to completely extend the knee against gravity; and the existence of patella alta confirmed by lateral radiographs. Ultrasonography and magnetic resonance imaging are useful in identifying a neglected rupture, as well as when the diagnosis is in question or an intra-articular injury is suspected. The prognosis after a patellar tendon rupture depends in large part on the interval between injury and repair. Surgery soon after the injury is recommended for optimal results. This is best accomplished by accurate reapproximation of the ruptured tendon ends, repair of the torn extensor retinacula, and placement of a reinforcing cerclage suture. An aggressive rehabilitation program, emphasizing early range-of-motion exercises, protected weight bearing, and quadriceps strengthening, will enhance the results of surgery. Patients who undergo delayed repair are at risk for a compromised result secondary to loss of full knee flexion and decreased quadriceps strength, although a functional extensor mechanism is likely to be reestablished.
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Olesen HP, Levander B, Kofoed H. Strength of implanted carbon fibers. Studies of the lumbar spine in goats. ACTA ORTHOPAEDICA SCANDINAVICA 1988; 59:53-5. [PMID: 3281405 DOI: 10.3109/17453678809149345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The L3-4 supraspinous and interspinous ligaments in 10 goats were replaced with carbon fibers stabilized with silk-suture seizing. The implants were removed after 3 weeks in 5 animals and after 3 months in the other 5. The maximum traction strength of nonimplanted slings was 157 +/- 9 kg (M +/- SD). After implantation, the strength was reduced to 136 +/- 17 kg, and after 3 months to 107 +/- 9 kg. However, the maximum strength of the spinous processes was 71 +/- 19 kg, which was less than the strength of 3-month implants. We concluded that the carbon fiber sling stabilized with silk sutures could be used for replacement of the interspinous ligament.
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Affiliation(s)
- H P Olesen
- Institute for Experimental Research in Surgery, University of Copenhagen, Denmark
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