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Street JM, Goalan R, Kumar A. Bilateral quadriceps tendon rupture: two injuries 6 years apart. BMJ Case Rep 2024; 17:e254759. [PMID: 38649242 PMCID: PMC11043770 DOI: 10.1136/bcr-2023-254759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
We present a case of a fit man in his 50s, with simultaneous bilateral quadriceps tendon repair of injuries sustained 6 years apart. Spontaneous closed ruptures of the quadriceps tendon are uncommon. Clinical data of a single case of bilateral quadriceps tendon injury with simultaneous repair was gathered via the patient, notes and surgeon. Diagnosis was primarily based on history and clinical examination. Suggestive features on the plain radiographic imaging were also present. Confirmation was attempted using ultrasonography but yielded conflicting reports. The patient was screened for any associated predisposing conditions that would preclude surgical intervention or increase risk of recurrence. Repairs were accomplished by employing a combination of suture anchors and transpatellar cerclage reinforcement. Apposition of the tendon to the superior patellar pole was successful although with decreased passive flexion on the neglected side (approximately 30°) compared with the acute (approximately 90°). Follow-up continues with postoperative rehabilitation.
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Affiliation(s)
- Jean-Marc Street
- College of Medicine and Veterinary Medicine, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Eric Williams Medical Sciences Complex Compound, Champs Fleurs, Trinidad and Tobago
| | - Raakesh Goalan
- Eric Williams Medical Sciences Complex Compound, Champs Fleurs, Trinidad and Tobago
| | - Anil Kumar
- Eric Williams Medical Sciences Complex Compound, Champs Fleurs, Trinidad and Tobago
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Coladonato C, Hanna AJ, Patel NK, Sonnier JH, Connors G, Sabitsky M, Johnson E, Mazur DW, Brahmabhatt S, Freedman KB. Risk Factors Associated With Poor Outcomes After Quadriceps Tendon Repair. Orthop J Sports Med 2024; 12:23259671241229105. [PMID: 38379579 PMCID: PMC10878232 DOI: 10.1177/23259671241229105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 02/22/2024] Open
Abstract
Background Ruptures of the quadriceps tendon present most frequently in older adults and individuals with underlying medical conditions. Purpose To examine the relationship between patient-specific factors and tear characteristics with outcomes after quadriceps tendon repair. Study Design Case-control study; Level of evidence, 3. Methods A retrospective review was conducted on all patients who underwent quadriceps tendon repair between January 1, 2016, and January 1, 2021, at a single institution. Patients <18 years and those with chronic quadriceps tendon tears (>6 weeks to surgery) were excluded. Information was collected regarding patient characteristics, presenting symptoms, tear characteristics, physical examination findings, and postoperative outcomes. Poor outcome was defined as a need for revision surgery, complications, postoperative range of motion of (ROM) <110° of knee flexion, and extensor lag of >5°. Results A total of 191 patients met the inclusion criteria. Patients were aged 58.5 ± 13.2 years at the time of surgery, were predominantly men (90.6%), and had a mean body mass index (BMI) of 32.2 ± 6.3 kg/m2. Patients underwent repair with either suture anchors (15.2%) or transosseous tunnels (84.8%). Postoperatively, 18.5% of patients experienced knee flexion ROM of <110°, 11.3% experienced extensor lag of >5°, 8.5% had complications, and 3.2% underwent revision. Increasing age (odds ratio [OR], 1.03 [95% CI, 1.004-1.07]) and female sex (OR, 3.82 [95% CI, 1.25-11.28]) were significantly associated with postoperative knee flexion of <110°, and increasing age (OR, 1.08 [95% CI, 1.04-1.14]) and greater BMI (OR, 1.14 [95% CI, 1.05-1.23]) were significantly associated with postoperative extensor lag of >5°. Current smoking status (OR, 15.44 [95% CI, 3.97-65.90]) and concomitant retinacular tears (OR, 9.62 (95% CI, 1.67-184.14]) were associated with postoperative complications, and increasing age (OR, 1.05 [95% CI, 1.02-1.08]) and greater BMI (OR, 1.08 [95% CI, 1.02-1.14]) were associated with risk of acquiring any poor outcome criteria. Conclusion Patient-specific characteristics-such as increasing age, greater BMI, female sex, retinacular involvement, and current smoking status-were found to be risk factors for poor outcomes after quadriceps tendon repair. Further studies are needed to identify potentially modifiable risk factors that can be used to set patient expectations and improve outcomes.
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Affiliation(s)
- Carlo Coladonato
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adeeb Jacob Hanna
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neel K. Patel
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John Hayden Sonnier
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory Connors
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew Sabitsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emma Johnson
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Donald W. Mazur
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shyam Brahmabhatt
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B. Freedman
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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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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Coladonato C, Perez AR, Sonnier JH, Looney AM, Delvadia BP, Okhuereigbe DO, Walia P, Tjoumakaris FP, Freedman KB. Similar Outcomes Are Found Between Quadriceps Tendon Repair With Transosseous Tunnels and Suture Anchors: A Systematic Review and Meta-Analysis. Arthrosc Sports Med Rehabil 2023; 5:100807. [PMID: 37868659 PMCID: PMC10585628 DOI: 10.1016/j.asmr.2023.100807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/31/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To evaluate the clinical outcomes and biomechanical performance of transosseous tunnels compared with suture anchors for quadriceps tendon repair. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was performed in April 2021 in the following databases: Cochrane Database of Systematic Reviews, PubMed (1980-2021), MEDLINE (1980-2021), Embase (1980-2021), and CINAHL (1980-2021). Level I-IV studies were included if they provided outcome data for surgical repair of the quadriceps tendon using transosseous tunnels or suture anchors with minimum 1-year follow-up. Biomechanical studies comparing transosseous tunnels and suture anchors were separately analyzed. Results The systematic search yielded 1,837 citations, 23 of which met inclusion criteria (18 clinical, 5 biomechanical). In total, 13 studies reported results for transosseous repair and 7 studies reported results for repair with suture anchors. There were results for 508 patients from clinical studies. The average postoperative Lysholm score ranged from 88 to 92 for suture anchor repairs and 72.8 to 94 for transosseous repairs with range of motion ranging from 117° to 138° and 116° to 135°, respectively. Synthesis of the biomechanical data revealed the mean difference in load to failure was not significant between constructs (137.21; 95% confidence interval -10.14 to 284.57 N; P = .068). Conclusions Transosseous and suture anchor techniques for quadriceps tendon repair result in similar biomechanical and postoperative outcomes. No difference between techniques in regard to ultimate load to failure among comparative biomechanical studies were observed. Level of Evidence Level IV, systematic review level III-IV studies.
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Affiliation(s)
- Carlo Coladonato
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Andres R. Perez
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - John Hayden Sonnier
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Austin M. Looney
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Bela P. Delvadia
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | | | - Pankhuri Walia
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Fotios P. Tjoumakaris
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kevin B. Freedman
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
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Alkhatatba M, Anaqreh Y, Essa SB, Alma’aiteh A, Ziad Audat H, Obeidat N, Ahmed M. Bilateral spontaneous quadriceps tendon rupture: a case report and literature review. SICOT J 2023; 9:31. [PMID: 37921612 PMCID: PMC10624162 DOI: 10.1051/sicotj/2023031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023] Open
Abstract
Bilateral spontaneous quadriceps tendon rupture is a rare condition characterized by the simultaneous tear of the fibrous tissue connecting the quadriceps muscle to the patella bone. Prompt diagnosis is crucial for appropriate treatment and optimal outcomes. We present a case of a 70-year-old male with bilateral knee pain and an inability to walk, resulting from a trivial fall. Despite initial misdiagnosis, a thorough evaluation, including physical examination and imaging, revealed bilateral quadriceps tendon rupture. Surgical repair was performed, followed by a comprehensive rehabilitation program. At the four-month follow-up, the patient showed significant improvement in pain and function. This article provides a comprehensive review of the existing literature on bilateral quadriceps tendon rupture, emphasizing the challenges in the diagnosis and management of this rare condition. Early diagnosis, prompt surgical intervention, and a tailored rehabilitation program are crucial for successful outcomes.
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Affiliation(s)
- Mohammad Alkhatatba
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Assistant Professor Division of Orthopedics, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology Irbid 22110 Jordan
| | - Yazan Anaqreh
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PGY-4 orthopedic resident Division of Orthopedics, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology Irbid 22110 Jordan
| | - Suhaib Bani Essa
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Assistant Professor Division of Orthopedics, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology Irbid 22110 Jordan
| | - Ala’a Alma’aiteh
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Department of Pediatric and Neonatology, Faculty of Medicine, Hashemite University Zarqa Jordan
| | - Hamzeh Ziad Audat
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Medical Student, Faculty of Medicine, Jordan University of Science and Technology Irbid 22110 Jordan
| | - Naser Obeidat
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Assistant Professor of Radiology, Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology Irbid 22110 Jordan
| | - Marwan Ahmed
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PGY-5 orthopedic resident Division of Orthopedics, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology Irbid 22110 Jordan
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Elicegui S, Stovak M, Dobrich J, Hodges JJ, Sekhon V, Dolan C. Traumatic Mid-substance Isolated Vastus Medialis Rupture in a Young Athlete: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00055. [PMID: 38134302 DOI: 10.2106/jbjs.cc.23.00422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
CASE This is the first documented case of an isolated traumatic vastus medialis rupture that occurred in a 14-year-old athlete after direct impact during play. Imaging confirmed a rare mid-substance rupture. The patient underwent conservative management with physical therapy augmented by blood flow restriction therapy (BFRT) and platelet-poor plasma (PPP) injection to regain full function. CONCLUSION Isolated quadriceps mid-substance tears are rare. Determining an appropriate treatment technique for mid-substance tears is complex. This case documents the use of nonoperative management with BFRT and PPP to achieve full recovery and early return to play in a young athlete.
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Affiliation(s)
| | - Mark Stovak
- University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Jordan Dobrich
- University of Nevada, Reno School of Medicine, Reno, Nevada
| | | | | | - Christopher Dolan
- University of Nevada, Reno School of Medicine, Reno, Nevada
- Great Basin Orthopaedics, Reno, Nevada
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Oliva F, Marsilio E, Migliorini F, Maffulli N. Chronic quadriceps tendon rupture: quadriceps tendon reconstruction using ipsilateral semitendinosus tendon graft. J Orthop Surg Res 2023; 18:355. [PMID: 37173685 PMCID: PMC10176907 DOI: 10.1186/s13018-023-03822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Ruptures of the quadriceps tendon (QTRs) are uncommon. If the rupture is not diagnosed, chronic ruptures may develop. Re-ruptures of the quadriceps tendon are rare. Surgery is challenging because of tendon retraction, atrophy and poor quality of the remaining tissue. Multiple surgical techniques have been described. We propose a novel technique in which the quadriceps tendon is reconstructed using the ipsilateral semitendinosus tendon.
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Affiliation(s)
- Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
| | - Emanuela Marsilio
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, E1 4DG, England
- School of Pharmacy and Biotechnology, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England
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Marty E, Genuario J, Aretakis A, Shinsako K, Frank RM. Left Knee Open Rectus Femoris Repair With Achilles Allograft Augmentation: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00017. [PMID: 36706196 DOI: 10.2106/jbjs.cc.22.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/10/2022] [Indexed: 01/29/2023]
Abstract
CASE We present a case of a 48-year-old man with a subacute tear of his left rectus femoris, repaired using Achilles tendon allograft. After fixation distally to the patella using suture anchors and a Krackow suture technique, the allograft was fixed proximally to the remnant rectus femoris tendon with multiple sutures in a variety of stitch configurations. The patient recovered excellently, regaining near-normal flexion and an intact straight leg raise without an extensor lag. CONCLUSION The literature regarding repair of subacute and chronic rectus femoris ruptures is limited. We provide an additional option for operative repair of subacute and chronic ruptures using Achilles tendon allograft.
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Affiliation(s)
- Eric Marty
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Duell B, Long MK, Divella M, Fogel J, Ruotolo C. Transosseous Repair With Nice Knot Augmentation Versus Knotless Suture Anchor Repair With Suture Tape for Quadriceps Tendon Rupture: A Cadaveric Study. Orthopedics 2022; 46:135-140. [PMID: 36508490 DOI: 10.3928/01477447-20221207-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Quadriceps tendon rupture is typically repaired using either transosseous tunnels or suture anchors. Recent literature has suggested that suture anchor repair is biomechanically superior to the use of transosseous tunnels. Augmentation of the transosseous technique with Nice knots may result in improved biomechanical properties as compared with a suture anchor construct. To compare biomechanical properties of a novel transosseous quadriceps tendon repair technique with Nice knot augmentation to those of knotless suture anchor repair, an artificial quadriceps tendon rupture was created in 10 matched pairs of cadaveric knees (n=20). Each cadaver was subjected to biomechanical testing to calculate the average ultimate load to failure, repair site gapping after early and late cyclic loading, and stiffness. Transosseous repair augmented with Nice knots as compared with knotless suture anchor repair had greater load to failure (mean±SD, 1489.5±297.6 N vs 717.7±191.4 N, P<.001), decreased gapping after early and late cyclic loading (cycles 1-20: mean±SD, 0.59±0.4 mm vs 2.1±1.2 mm, P=.008; cycles 21-250: mean±SD, 1.2±0.7 mm vs 3.9±1.7 mm, P=.002), and greater construct stiffness (mean±SD, 80.7±15.7 N/mm vs 44.4±13.4 N/mm, P=.001). The transosseous quadriceps tendon repair technique with Nice knot augmentation is biomechanically better than knotless suture anchor repair with regard to ultimate load to failure, gap formation after cyclic loading, and construct stiffness in cadaveric specimens. [Orthopedics. 202x;4x(x):xx-xx.].
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Performance Is Regained Within 2 Seasons After Quadriceps Tendon Tears in National Basketball Association Players. Arthrosc Sports Med Rehabil 2022; 4:e2073-e2078. [PMID: 36579031 PMCID: PMC9791805 DOI: 10.1016/j.asmr.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To characterize quadriceps tendon injuries over 30 National Basketball Association (NBA) seasons and assess the effects on player performance upon return to play. Methods Partial and complete quadriceps tendon tears in NBA players between the 1990-1991 and 2021-2022 seasons were queried from a publicly available database. The primary outcomes were changes in player performance statistics obtained from each player's preindex season and first 2 postindex seasons. These interseason changes were compared with the changes of a healthy control cohort. Each injured player was matched with 2 controls using position, career length and win shares by season. The secondary measure of this study was the rate of return to play. Results Nine quadriceps tendon tears (6 partial, 3 complete) were identified in NBA players. Seven (78%) of the players returned to play in NBA games, missing 50 ± 30 games and 214 ± 112 calendar days on average. Comparisons between these player's preindex and first postindex seasons revealed significant declines in games played (73.2 ± 6.6 vs 41.8 ± 10.8, P = .009) and minutes per game (27.2 ± 2.9 vs 23.0 ± 3.7, P = .042). When compared with controls, only the decrease in games played was significant (-31.3 ± 7.6 vs 1.4 ± 8.2, P = .004). These findings were consistent when comparing preindex and second postindex seasons (games played: 79.6 ± 1.9 vs -28.4 ± 5.4, P = .006; minutes per game: 29.3 ± 2.6 vs 51.2 ± 4.6, P = .003). All other player performance metrics including player efficiency rating returned to near-baseline levels in the first 2 seasons after injury. Conclusion NBA players with quadriceps tendon tears return to play in 78% of cases. These athletes achieved preinjury levels of performance within 1 to 2 seasons, but with reduced games played per season. Level of Evidence IV, therapeutic case series.
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Rocha de Faria JL, Laett CT, Gavilão UF, Carvalho MDB, Mozella ADP, de Sousa EB, Cossich VRA. Modified Pulvertaft on Weave Technique Restores Full Active Knee Extension in Patients With Large Chronic Quadriceps Tendon Rupture: A Case Series. Arthroscopy 2022; 38:2268-2277. [PMID: 35114346 DOI: 10.1016/j.arthro.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to investigate the clinical and functional outcomes, including maximal and explosive strength, after chronic quadriceps tendon rupture repair with Modified Pulvertaft on Weave (MPW) technique METHODS: Knee joint range of motion (ROM), patella height, thigh circumference, and Lysholm and International Knee Documentation Committee (IKDC) scores were assessed preoperatively and postoperatively. The knee extensors maximal (isokinetic peak torque and isometric maximal voluntary contraction (MVC) torque) and explosive strength-rate of torque development (RTD) early [RTD50 and RTD100] and late [RTD250]-were performed. We assessed the thigh circumference and vastus lateralis muscle thickness (MT) as indicators of quadriceps muscle mass, and the voluntary quadriceps activation using surface electromyography (EMG50). RESULTS Nine patients (mean age: 53 ± 11 years) took part in the study. We observed a significant increase in the knee active ROM and a decreased extension deficit (both, P < .001), but not for pain (P = .07), IKDC (P = .07), and Lysholm (P = .21) after the surgery. We did not observe a difference between involved (n = 8) and uninvolved (n = 10) limbs for ROM, thigh circumference, and MT. We observed differences for extensors peak torque, MVC torque, and late RTD (all, P < .05). However, we did not observe differences for early RTD and EMG50. Significant positive correlations were observed for RTD50 (ρ = .80) and RTD100 (ρ = .81) vs EMG50. Both the IKDC and Lysholm were better correlated with the early than with later RTD. CONCLUSIONS The MPW reestablished the active knee extension. The same level of quadriceps muscle mass was observed in both limbs, suggesting a lack of hypotrophy due to the injury. Although the involved limb had demonstrated lower knee extensors maximal strength, they demonstrate an equivalent early RTD when compared to the uninvolved limb. The early RTD seems to be better correlated with the patient's functionality than the later RTD and maximal strength. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
| | - Conrado Torres Laett
- Neuromuscular Research Laboratory, Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil; Biomechanics Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
| | - Ubiratã Faleiro Gavilão
- Neuromuscular Research Laboratory, Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil; Biomechanics Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
| | | | - Alan de Paula Mozella
- Knee Surgery Center, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
| | - Eduardo Branco de Sousa
- Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
| | - Victor Rodrigues Amaral Cossich
- Neuromuscular Research Laboratory, Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil; Biomechanics Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Research Division, National Institute of Traumatology and Orthopedic, Rio de Janeiro, Brazil
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Onggo JR, Babazadeh S, Pai V. Smaller Gap Formation With Suture Anchor Fixation Than Traditional Transpatellar Sutures in Patella and Quadriceps Tendon Rupture: A Systematic Review. Arthroscopy 2022; 38:2321-2330. [PMID: 35066110 DOI: 10.1016/j.arthro.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to compare the biomechanical properties between traditional transosseous tunnel and suture anchor technique repair for extensor mechanism ruptures and assess for differences in the mechanism of failure of both techniques. METHODS A multi-database search (PubMed, EMBASE, and Medline) was performed according to PRISMA guidelines on November 14, 2021. All articles comparing biomechanical properties of transpatellar and suture anchor technique for extensor mechanism ruptures were included. Abstracts, reviews, case reports, studies without biomechanical analysis, conference proceedings, and non-English language studies were excluded. Outcomes pursued included gap formation, load to failure, and mechanism of failure. Relevant data from studies meeting inclusion criteria were extracted and analyzed. Study methodology was assessed using the Methodological Index for Non-Randomized Studies score. RESULTS A total of 212 knees were biomechanically assessed, including 98 patella and 114 quadricep tendon ruptures. Five patellar tendon studies were included, and all of them reported significantly smaller gap formation in suture anchor group. Gap formation for suture anchors ranged from .9 mm to 4.1 mm, while that of transpatellar group ranged from 2.9 mm to 10.3 mm. One study reported a significantly higher load to failure in the suture anchor group, while the remaining four studies reported no significant difference. Load to failure for suture anchor ranged from 259 N to 779 N, while that of the transpatellar group ranged from 287 N to 763 N. The most common mechanism of failure was anchor pullout in suture anchor and knot failure in the transpatellar group. Five quadriceps tendon studies were included, and three studies reported statistically significant smaller gap formation in the suture anchor group. Gap formation for suture anchor ranged from 1.5 mm to 5.0 mm, while that of transpatellar group ranged from 3.1 mm to 33.3 mm. Two studies reported a significantly higher load to failure in the suture anchor group, while one study reported a higher load to failure in the transpatellar repair group. Load to failure for suture anchor ranged from 286 N to 740 N, while that of transpatellar group ranged from 251 N to 691 N. The most common mechanism of failure was suture failure in the suture anchor and knot failure in the transpatellar group. CONCLUSION Suture anchor fixation displays a better biomechanical profile than traditional transpatellar techniques in terms of smaller gap formations in the repair of both patella and quadriceps tendon injuries. Anchor pullout in suture anchor fixation was present mainly with the use of titanium anchors. CLINICAL RELEVANCE These findings above may result in better retention of tendon approximation in patella and quadriceps tendon fixation postoperatively, which may result in earlier recovery. Further randomized controlled clinical trials to compare these techniques are required.
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Affiliation(s)
| | | | - Vishal Pai
- Box Hill Hospital, Melbourne, Victoria, Australia
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Rao S, Johnson EE, D’Amore T, Szeto S, Otlans P, Cohen SB. Outcomes After Repair of Quadriceps Tendon Rupture in Patients Aged 40 Years and Younger. Orthop J Sports Med 2022; 10:23259671221097107. [PMID: 35615753 PMCID: PMC9125636 DOI: 10.1177/23259671221097107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Injury to the quadriceps tendon is rare and most commonly occurs in
middle-aged men. Few reports are available regarding outcomes after
quadriceps tendon rupture in younger patients. Purpose/Hypothesis: To review the clinical outcomes of patients who underwent quadriceps tendon
repair at age ≤40 years. We hypothesized that this cohort would experience
better clinical outcomes in comparison to historical older controls. Study Design: Case series; Level of evidence, 4. Methods: Using an institutional database, we retrospectively identified patients who
underwent quadriceps tendon repair between January 2009 and December 2017.
Patients were included in the study if they were aged ≤40 years at the time
of surgery and had sustained an isolated, complete tendon rupture. Patient
and injury characteristics were recorded. Patients were contacted to
complete a custom survey, the 2000 International Knee Documentation
Committee (IKDC) form, the Lysholm scale, and the Tegner scale. Results: Included were 38 patients (86.8% male; mean age, 32.0 ± 6.9 years; age range,
15-40 years), with a mean follow-up of 5.9 ± 2.3 years (range, 2.4-11.3
years). At final follow-up, the mean IKDC score was 74.1 ± 22.6 (range,
26.4-100.0), and the mean Lysholm score was 85.4 ± 20.0 (range, 30-100),
which were similar if not inferior to historical controls of patients >40
years. Only 16 patients (42.1%) had unchanged or higher Tegner scores after
surgery, whereas 22 patients (57.9%) reported lower postoperative activity
level. Overall, 91.2% (31/34) of workers returned at a mean 3.9 months after
surgery, whereas 63% (12/19) of athletes were able to return to play at 8.8
months. At final follow-up, 12 patients (31.6%) reported persistent pain and
stiffness in their knees. Additionally, 3 patients (7.9%) reported pain
without stiffness, and 4 (10.5%) reported stiffness without pain. Patients
reporting pain or stiffness had significantly lower IKDC scores, Lysholm
scores, postoperative Tegner scores, and change in their Tegner score at
final follow-up in comparison to those who did not report pain or
stiffness. Conclusion: Although patients aged ≤40 years had satisfactory outcomes after quadriceps
tendon repair, this injury resulted in significant long-term sequelae in a
substantial percentage of patients, despite their youth. Further, this group
did not have better outcomes compared with historical controls aged > 40
years.
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Affiliation(s)
- Somnath Rao
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emma E. Johnson
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Taylor D’Amore
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stanley Szeto
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peters Otlans
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Steven B. Cohen
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Arnold EP, Sedgewick JA, Wortman RJ, Stamm MA, Mulcahey MK. Acute Quadriceps Tendon Rupture: Presentation, Diagnosis, and Management. JBJS Rev 2022; 10:01874474-202202000-00004. [PMID: 35130193 DOI: 10.2106/jbjs.rvw.21.00171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The incidence of quadriceps tendon rupture is estimated to be 1.37 cases per 100,000 people/year, with a predilection for these injuries in patients who are ≥40 years of age. » Quadriceps tendon ruptures are more likely to occur in the presence of preexisting comorbidities such as rheumatoid arthritis, systemic lupus erythematosus, gout, chronic kidney disease, secondary hyperparathyroidism, diabetes mellitus, and peripheral vascular disease. The most common mechanism of injury is a simple fall. » Magnetic resonance imaging is the gold-standard test for diagnosing quadriceps tendon ruptures, with a reported sensitivity, specificity, and positive predictive value of 1.0. » Complete tears require prompt surgical intervention; the most common technique is transosseous sutures passed through longitudinal patellar drill holes. Suture anchors have been proposed as an alternative method; they have shown superior biomechanical results in cadaveric models. » Early functional mobilization with full weight-bearing and progressive range-of-motion exercises is recommended for rehabilitation following injury.
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Affiliation(s)
- Evan P Arnold
- Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Ryan J Wortman
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Michaela A Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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15
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Birişik F, Ekinci M, Bayram S, Şahinkaya T, Ergin ÖN, Erşen A, Aşık M. Isokinetic Evaluation of Knee Strength and Endurance in Hemodialysis Patients Treated with the Transpatellar Tunnel Technique for Bilateral Spontaneous Quadriceps Tendon Ruptures. J Knee Surg 2022; 35:215-221. [PMID: 32838452 DOI: 10.1055/s-0040-1715100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are numerous surgical techniques described for treating acute quadriceps tendon rupture. We aim to evaluate the strength of the quadriceps tendon using isokinetic tests in hemodialysis patients treated with the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures. Additionally, functional and clinical results were investigated and compared with hemodialysis patients without a history of quadriceps tendon rupture. We retrospectively reviewed hemodialysis patients diagnosed with quadriceps tendon rupture who were operated between 2005 and 2015 at our institution. Eight patients with simultaneous bilateral quadriceps tendon rupture treated with the transpatellar tunnel technique (group 1; the operated group) and 10 patients with chronic renal failure without a history of quadriceps tendon rupture who underwent hemodialysis (group 2; the control group) were included in this study. The active range of motion (ROM), Lysholm and Tegner scores, knee flexor and extensor muscle strengths, and endurances were measured using an isokinetic dynamometer for each group and compared between the groups. The mean age was 44.6 and 40.2 years in groups 1 and 2, respectively. The mean follow-up was 58.6 (range, 24-140) months in group 1. The active ROM was 113.7 ± 9.7 degrees in group 1 and 130 ± 4.8 degrees in group 2 (p < 0.001). The mean Tegner score was not significantly different between the groups (1.87 ± 1.1 in group 1 vs. 2.6 ± 0.9 in group 2; p = 0.212). However, the Lysholm score was significantly higher in group 2 (93.2 ± 7.3 vs. 76.7 ± 13.8; p = 0.009). The mean extensor strength and endurance were significantly higher in group 2 than in group 1. The mean flexor strength and endurance were higher in group 1 than in group 2, but no significant difference was found. Although using the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures in hemodialysis patients can provide acceptable functional results, the ROM and strength particularly in extensor muscle might be significantly lower than control group. Level of evidence is Level III therapeutic case-control study.
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Affiliation(s)
- Fevzi Birişik
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Ekinci
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Türker Şahinkaya
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ömer Naci Ergin
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Erşen
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Aşık
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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16
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Miles R, Cruz C, Mannino BJ. Bilateral multipartite patellae avulsions associated with a unilateral quadriceps tendon rupture. BMJ Case Rep 2021; 14:e246902. [PMID: 34937756 PMCID: PMC8705064 DOI: 10.1136/bcr-2021-246902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/04/2022] Open
Abstract
Multipartite (or bipartite) patella is a developmental anomaly that occurs in 2%-6% of individuals. In 50%, the variant is bilateral. Multipartite patella is usually an asymptomatic condition. Quadriceps tendon rupture is also a rare entity occurring mostly in men aged >40 years and usually results from an acute eccentric quadriceps contracture. The authors present a case of a patient with bilateral multipartite patellae that sustained bilateral multipartite avulsions as well as an associated unilateral quadriceps tendon rupture. This constellation of injuries has never been reported in the literature. The patient was treated with excision of the multipartite patella fragments and quadriceps tendon repair on the side with the extensor mechanism disruption. He was treated non-operatively for the contralateral lower extremity multipartite patella avulsion. This report, along with a thorough review of the literature, serves to demonstrate the clinical and radiographic characteristics of this unusual injury.
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Affiliation(s)
- Rebecca Miles
- Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Christian Cruz
- Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Brian J Mannino
- Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
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17
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Belk JW, Lindsay A, Houck DA, Dragoo JL, Genuario JW, Mayer SW, Frank RM, McCarty EC. Biomechanical Testing of Suture Anchor Versus Transosseous Tunnel Technique for Quadriceps Tendon Repair Yields Similar Outcomes: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e2059-e2066. [PMID: 34977665 PMCID: PMC8689238 DOI: 10.1016/j.asmr.2021.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/25/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose To systematically review the literature to evaluate the biomechanical properties of the suture anchor (SA) versus transosseous tunnel (TO) techniques for quadriceps tendon (QT) repair. Methods A systematic review was performed by searching PubMed, the Cochrane Library, and Embase using PRISMA guidelines to identify studies that evaluated the biomechanical properties of SA and TO techniques for repair of a ruptured QT. The search phrase used was “quadriceps tendon repair biomechanics”. Evaluated properties included ultimate load to failure (N), displacement (mm), stiffness (N/mm), and mode of failure. Results Five studies met inclusion criteria, including a total of 72 specimens undergoing QT repair via the SA technique and 42 via the TO technique. Three of 4 studies found QTs repaired with SA to have significantly less elongation upon initial cyclic loading when compared to QTs repaired with the TO technique (P < .05). Three of 5 studies found QTs repaired with SA to have significantly less elongation upon final cyclic loading when compared to QTs repaired with the TO technique (P < .05). The pooled analysis from 4 studies reporting on initial displacement showed a statistically significant difference in favor of the SA group compared to the TO group (P = .03). The pooled analysis from studies reporting on secondary displacement and ultimate load to failure showed no significant difference between the SA and TO groups (P > .05). The most common mode of failure in both groups was suture slippage. Conclusion On the basis of the included cadaveric studies, QTs repaired via the SA technique have less initial displacement upon cyclic testing when compared to QTs repaired via the TO technique. However, final displacement and ultimate load to failure outcomes did not reveal differences between the two fixation strategies. Knot slippage remains a common failure method for both strategies.
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Affiliation(s)
- John W Belk
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Adam Lindsay
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Jason L Dragoo
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - James W Genuario
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Stephanie W Mayer
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
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18
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Synthetic Mesh Reconstruction of Chronic, Native Quadriceps Tendon Disruptions following Failed Primary Repair. Case Rep Orthop 2021; 2021:5525319. [PMID: 34567816 PMCID: PMC8457971 DOI: 10.1155/2021/5525319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/16/2021] [Indexed: 12/02/2022] Open
Abstract
Case Two patients presented with chronic knee extensor mechanism disruption after failed primary repairs. Both patients had minimal ambulatory knee function prior to surgical intervention and were treated with a synthetic mesh reconstruction of their extensor mechanism. Our technique has been modified from previously described techniques used in revision knee arthroplasty. At the one-year follow-up, both patients had improvement in their active range of motion and had returned to their previous activity. Conclusion Synthetic mesh reconstruction of chronic extensor mechanism disruption is a viable technique that can be utilized as salvage for the persistently dysfunctional native knee.
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19
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Elattar O, McBeth Z, Curry EJ, Parisien RL, Galvin JW, Li X. Management of Chronic Quadriceps Tendon Rupture: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202105000-00003. [PMID: 33956669 DOI: 10.2106/jbjs.rvw.20.00096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Chronic quadriceps tendon (QT) ruptures are uncommon injuries that present treatment challenges due to their complex nature and the limited evidence to guide management. » Timely diagnosis and surgical management of acute QT injury are imperative to optimize patient outcomes as delayed diagnosis leads to poorer results regardless of treatment modality. » Elements of chronic QT ruptures that may complicate surgical management include patient age, comorbidity, scar-tissue formation, amount of quadriceps muscle/ tendon retraction, and distalmigration of the patella with contraction of the tendon. » Treatment options for chronic QT ruptures include primary repair with or without vastus advancement, V-Y tendon lengthening with or without tissue augmentation, and autograft or allograft reconstruction.
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Affiliation(s)
| | | | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts
| | - Robert L Parisien
- University of Pennsylvania Medical School, Philadelphia, Pennsylvania
| | | | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts
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20
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Mehta AV, Wilson C, King TS, Gallo RA. Outcomes following quadriceps tendon repair using transosseous tunnels versus suture anchors: A systematic review. Injury 2021; 52:339-344. [PMID: 33041016 DOI: 10.1016/j.injury.2020.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/19/2020] [Accepted: 10/04/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Two major techniques are used to repair complete quadriceps tendon ruptures, transosseous tunnel (TT) and the suture anchor (SA). There are multiple studies comparing the biomechanical outcomes of repairs performed with TT or SA. Our purpose was to compare the clinical outcomes following quadriceps tendon repair using SA and TT fixation techniques. METHODS Three major search engines were used with predetermined keyword searches to perform a systematic review of literature. These studies were independently scanned by two reviewers using PRISMA criterion. All included studies had to include at least one of the following outcome measures: range of motion (ROM), Lysholm score, complications, and/or re-ruptures. RESULTS Using three major search engines, 1039 articles were identified. After removing duplicates and screening for inclusion, 49 articles were reviewed. Two independent reviewers searched the studies to meet the inclusion criteria, and eight studies were selected. These eight studies included 156 knees in the TT group and 54 knees in the SA group. The TT group had a significantly better ROM after QT repair (132.5° versus 127.0°, p = 0.02). There was no significant difference in Lysholm scores between the TT group (92.6) and SA group (91.0, p = 0.11). There were significantly more complications in SA groups (9.3% versus 1.3%, p = 0.013), but not a significant difference in re-rupture rate between those undergoing SA vs. TT repair (3.7% versus 0%, p = 0.065). The SA group had a significantly higher age at time of surgery (63.62 vs. 54.32) CONCLUSION: The current study suggests that, following quadriceps tendon rupture, there are no significant differences in functional outcome between TT and SA techniques. Those undergoing TT repair attained a statistically significantly greater final ROM but this difference may not be clinically relevant. There was a statistically significantly higher rate of post-operative complications using SA technique.
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Affiliation(s)
- Anuj V Mehta
- Penn State University College of Medicine, United States of America.
| | | | - Tonya S King
- Penn State University College of Medicine, United States of America
| | - Robert A Gallo
- Penn State University College of Medicine, United States of America; Penn State Hershey Medical Center, Department of Orthopaedics, United States of America
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21
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Rosteius T, Jettkant B, Brinkemper A, Rausch V, Lotzien S, Geßmann J, Schildhauer TA, Königshausen M. Long-term follow up of extensor tendon ruptures of the knee using electromyography and three-dimensional gait analysis. Knee 2021; 29:251-261. [PMID: 33676320 DOI: 10.1016/j.knee.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/09/2021] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to analyze the long-term outcomes of extensor tendon ruptures of the knee using exact measuring tools. METHODS The results of patients treated for extensor tendon rupture with a minimum follow up of 10 years were reviewed. Electromyography (EMG) and three-dimensional (3D) gait analyses were performed and compared with the healthy side of each patient and with the gait patterns of 20 healthy controls. Functional outcome scores were assessed using the Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS After a mean of 13.4 ± 3 years, 23 patients were available for follow up. The mean Lysholm score was 86.6, and the KOOS averaged 78.1. Gait analysis showed no major kinematic differences between these patients compared with healthy controls. In the squat test, the mean peak amplitude of the rectus femoris muscle was significantly smaller on the injured side than on the healthy side (140.21 ± 66.13 μV vs. 168.25 ± 91.77 μV; P = 0.01). The mean peaks of the vastus lateralis and medialis EMG signals were also lower on the injured side (P = 0.63; P = 0.08). Correspondingly, the thigh girth at 20 cm and 10 cm above the knee was significantly lower on the injured side. One patient had re-rupture after patella tendon repair. CONCLUSION At long-term follow up the patients reached good clinical outcomes and exhibited mainly physiological gait patterns after rupture of knee extensor tendons. However, the thigh muscles showed hypotrophy and a significantly smaller EMG signal amplitude during a high-intensity task on the formerly injured side.
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Affiliation(s)
- Thomas Rosteius
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Birger Jettkant
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | | | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
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22
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Hinckel BB, Baumann CA, Ejnisman L, Cavinatto LM, Martusiewicz A, Tanaka MJ, Tompkins M, Sherman SL, Chahla JA, Frank R, Yamamoto GL, Bicos J, Arendt L, Fithian D, Farr J. Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e20.00083. [PMID: 33986224 PMCID: PMC7537824 DOI: 10.5435/jaaosglobal-d-20-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
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Affiliation(s)
- Betina B Hinckel
- From the Oakland University, Rochester (Dr. Hinckel, and Dr. Cavinatto); Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak (Dr. Hinckel, Dr. Cavinatto), MI; the University of Missouri-School of Medicine, Columbia, MO (Mr. Baumann); the Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR (Dr. Ejnisman); the Shoulder and Elbow Surgery, Beaumont Orthopaedic Associates, Beaumont Health (Dr. Martusiewicz); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Tanaka); the Department of Orthopedic Surgery, TRIA Orthopedic Center, University of Minnesota, Gillette Children's Specialty Healthcare, MN (Dr. Tompkins); the Department of Orthopedic Surgery, Stanford University, CA (Dr. Sherman); the Rush University Medical Center, Chicago, IL (Dr. Chahla); the Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, Aurora, CO (Dr. Frank); the Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Yamamoto); CEGH-CEL, Instituto de Biociências, Universidade de São Paulo (Dr. Yamamoto); DASA Laboratories, Sao Paulo, Brazil (Dr. Yamamoto); the Michigan Orthopedic Surgeons, Fellowship Director William Beaumont Sports Medicine Fellowship, Assistant Professor Oakland University William Beaumont School of Medicine, MI (Dr. Bicos); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Arendt); the Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, CA (Dr. Fithian); and the Knee Preservation, Cartilage Regeneration and OrthoBiologics, Department of Orthopedic Surgery, Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, IN (Dr. Farr)
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23
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Wadhwani J, Vashishth S, Bansal H. Management of chronic quadriceps rupture with novel "chariot suture technique": A case report and review. J Clin Orthop Trauma 2020; 14:142-144. [PMID: 33680820 PMCID: PMC7919959 DOI: 10.1016/j.jcot.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022] Open
Abstract
Quadriceps tendon is one of the important segment of knee extensor mechanism. Acute ruptures are more common than chronic ruptures and have better outcomes. Chronic ruptures are rare with lot of surgical challenges including tendon retraction, fibrosis, degenerative calcification. We present a rare case of a 48 year old male diabetic patient with history of fall eight months ago and chief complaint of inability to actively extend his left knee. Diagnosis was made clinically and was confirmed radiologically with MRI. Surgical management was done with the use of novel "Chariot Suture Technique". It involves use of three Krakow whipstitches with Ethibond No. 5 suture across the distal ruptured end of quadriceps tendon and their intraosseous passage through patella in longitudinal fashion followed by tying knot at the distal pole of patella. The formation of Chariot makes the construct stable. At one year follow up patient was actively able to extend the knee with good range of motion. The technique is relatively cost effective, has no donor site morbidity, easy to learn and practice.
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Affiliation(s)
- Jitendra Wadhwani
- Department of Orthopaedics, Pt.B.D.S. PGIMS, Rohtak, Haryana, India,Corresponding author. Department of Orthopaedics, Pt. B.D.S. PGIMS, 6/CH, Medical Enclave, PGIMS Campus, Rohtak, Haryana, 124001, India.
| | | | - Himanshu Bansal
- Department of Orthopaedics, Pt.B.D.S. PGIMS, Rohtak, Haryana, India
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24
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Bilateral Quadriceps Rupture in an Elite Weight Lifter: A Case Report and Review of Literature. Indian J Orthop 2020; 54:339-347. [PMID: 32399154 PMCID: PMC7205927 DOI: 10.1007/s43465-020-00051-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/12/2020] [Indexed: 02/04/2023]
Abstract
Simultaneous bilateral quadriceps tendon ruptures (QTR) are rare injuries in sportspersons; weightlifting, involving sudden eccentric contraction of the bilateral quadriceps, has the potential to cause this injury. We present a case of an elite weightlifter with bilateral quadriceps tear occurring during the "jerk" part of clean and jerk phase of weightlifting; single stage bilateral end to end repair was done, followed by 3 weeks of cast immobilisation. He then underwent a supervised rehabilitation protocol, leading to graduated strengthening of the muscles. He went back to competitive sport after 2 years and participated in a national championship after 5 years. Detailed questioning revealed a history of anabolic steroid use in the early phase of his career; a literature review showed only seven cases of this injury pattern in weightlifting/bodybuilding sports, and five of these seven had a definitive history of anabolic steroid use. Bilateral QTR may be a pointer to predisposing factors like use of steroids, which should be diligently identified. Good outcomes are possible after early surgical repair and rehabilitation, with high rates of return to sports.
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25
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Rocha de Faria JL, Barroso de Matos M, de Araújo Barros Cobra HA, Cavanellas N, Branco de Sousa E, Barretto JM, Guimarães JM. Surgical Treatment of Chronic Rupture of the Quadriceps Using a Modified Pulvertaft Weave Technique. Arthrosc Tech 2019; 8:e1163-e1169. [PMID: 31921591 PMCID: PMC6950773 DOI: 10.1016/j.eats.2019.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/08/2019] [Indexed: 02/03/2023] Open
Abstract
The extensor mechanism provides active knee joint extension and stability of the patellofemoral joint. Rupture of the quadriceps tendon, although uncommon, is therefore associated with impairment in knee joint stability and, thus, requires surgical repair. Although various techniques provide excellent clinical outcomes for acute rupture, treatment of chronic rupture remains clinically challenging. We describe our modified technique for quadriceps tendon repair using a semitendinosus tendon autograft, with suturing of the quadriceps tendon stump to the patella via transosseous sutures, wherein the use of allograft and anchors is avoided. Our modified Pulvertaft weave technique is simple and reproducible.
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Affiliation(s)
- José Leonardo Rocha de Faria
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, RJ, Brazil,Address correspondence to José Leonardo Rocha de Faria, M.D., Knee Surgery Center, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Av Brasil, 500, São Cristovão, CEP 20940-070, Brazil.
| | - Murilo Barroso de Matos
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, RJ, Brazil
| | | | - Naasson Cavanellas
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, RJ, Brazil
| | - Eduardo Branco de Sousa
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, RJ, Brazil
| | - João Mauricio Barretto
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, RJ, Brazil
| | - João Matheus Guimarães
- Trauma Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, RJ, Brazil
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Hasenoehrl T, Palma S, Keilani M, Reschl M, Vekszler G, Ambrozy C, Plesser S, Hajdu S, Crevenna R, Widhalm HK. Gait analysis and body composition after treatment of quadriceps tendon ruptures showed equal results independent of suture anchor or transosseus repair technique used: a pilot study. Disabil Rehabil 2019; 42:3833-3837. [DOI: 10.1080/09638288.2019.1611951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Timothy Hasenoehrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefano Palma
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Reschl
- Department of Orthopaedics and Trauma Surgery, Division of Trauma-Surgery, Medical University of Vienna, Vienna, Austria
- Department of Orthopedics and Traumatology, LK Baden-Mödling-Hainburg, Baden, Austria
| | - Gyoergy Vekszler
- Department of Trauma Surgery and Sports Traumatology, Danube Hospital, Vienna, Austria
| | - Clemens Ambrozy
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Plesser
- Department of Orthopaedics and Trauma Surgery, Division of Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopaedics and Trauma Surgery, Division of Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Kurt Widhalm
- Department of Orthopaedics and Trauma Surgery, Division of Trauma-Surgery, Medical University of Vienna, Vienna, Austria
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Lucattelli E, Delcroix L, Baldrighi C, Tanini S, Innocenti M. Quadriceps tendon reconstruction using a fascia lata included in a reverse‐flow anterolateral thigh flap. Microsurgery 2019; 39:642-646. [DOI: 10.1002/micr.30420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/10/2018] [Accepted: 12/12/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| | - Luca Delcroix
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| | - Carla Baldrighi
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| | - Sara Tanini
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| | - Marco Innocenti
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
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Plesser S, Keilani M, Vekszler G, Hasenoehrl T, Palma S, Reschl M, Crevenna R, Hajdu S, Widhalm HK. Clinical outcomes after treatment of quadriceps tendon ruptures show equal results independent of suture anchor or transosseus repair technique used - A pilot study. PLoS One 2018; 13:e0194376. [PMID: 29554109 PMCID: PMC5858832 DOI: 10.1371/journal.pone.0194376] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/01/2018] [Indexed: 11/24/2022] Open
Abstract
Biomechanical studies have shown the use of suture anchors (SA) to be superior to the traditional transosseous sutures (TS) in the repair of quadriceps tendon rupture (QTR). This study aimed to analyze and compare the functional outcomes of patients treated for quadriceps tendon ruptures using suture anchors or transosseous sutures. Patients having undergone suture anchor repair or transosseous suture repair for quadriceps tendon rupture between 2010 and 2015 at one of the two participating hospitals were included. Patients from site A underwent TS repair (TS group) while patients from site B underwent SA repair (SA group). Exclusion criteria included previous or concomitant injuries of the involved knee, penetrating injuries and pre-existing neurological conditions. Clinical outcome was assessed by subjective scores (Lysholm and Tegner Scores, International Knee Documentation Committee (IKDC) Score, Visual Analog Scale (VAS) for pain), quadriceps isokinetic strength testing, Insall-Salvati Index (ISI), and physical examination. Non-parametrical statistical analysis was conducted using the Mann-Whitney U test. Twenty-seven patients were included in the study of which 17 patients (63%) were available for follow-up (SA group: 9, TS group: 8). All patients were male with a mean age of 62.7 (SD: 8.8) and 57.9 (SD: 12.7) years for the SA group and TS group, respectively. The groups did not differ in terms of demographic characteristics. No clinically significant differences were identified between the two groups. There were no re-ruptures in either group. Treatment of quadriceps tendon rupture using suture anchors provides a clinically valid alternative treatment to the gold-standard transosseous suture repair.
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Affiliation(s)
- Stefan Plesser
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Gyoergy Vekszler
- Department of Trauma Surgery and Sports Traumatology, Danube Hospital, Vienna, Austria
| | - Timothy Hasenoehrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefano Palma
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Reschl
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Hajdu
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
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Soong JW, Silva AN, Andrew TH. Disruption of quadriceps tendon after total knee arthroplasty: Case report of four cases. J Orthop Surg (Hong Kong) 2018; 25:2309499017717206. [PMID: 28699406 DOI: 10.1177/2309499017717206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Quadriceps tendon rupture after total knee arthroplasty (TKA) is a rare but dire complication. It is associated with adverse outcomes and morbidities. Studies on such complications are scarce in the literature. In this study, we share our experience in the management of four patients who sustained quadriceps tendon rupture in the early postoperative period. Efforts should be focused on prevention. Meticulous surgical techniques during the medial parapatellar approach to preserve the integrity of quadriceps can reduce the risk of rupture. The importance of prompt diagnosis is emphasized as delayed treatment may lead to poor outcomes. However, making a diagnosis can be challenging, as worsening of the quadriceps strength after TKA is expected because of the surgical approach that violates the quadriceps muscle. In an event of postoperative trauma with resultant extensor weakness, an ultrasound evaluation to exclude a quadriceps tendon rupture should be promptly performed after a fracture is excluded.
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Affiliation(s)
- J W Soong
- 1 Singapore General Hospital, Singapore, Singapore
| | - A N Silva
- 1 Singapore General Hospital, Singapore, Singapore
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Abstract
Acute knee pain is a frequently encountered problem in the clinical settings. In 2003, American Orthopedic Association recorded that 19.4 million people visited a physician because of a knee problem. Knee pain due to injuries is increasing even among the older population, as a greater number of persons are participating in recreational activities. The quadriceps tendon rupture is not a common condition among acute causes of knee pain. However, it can be quite debilitating. The usual clinical presentation includes a middle-aged person presenting with a history of fall accompanied by swelling and inability to extend the knee. Providers who are faced with this clinical situation should be able to recognize this condition sooner than later. It is very important that precise clinical decisions be made, so as to achieve best outcomes. This article reviews the etiology, epidemiology, clinical presentation, differential diagnosis, and management of quadriceps tendon rupture.
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Affiliation(s)
- Subhadra Nori
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, USA.,Department of Rehabilitation Medicine, Queens Health Network, Elmhurst and Queens Hospital Centers, USA
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Torkaman A, Yousof Gomrokchi A, Elahifar O, Barmayoon P, Shojaei SF. Simultaneous bilateral rupture of patellar tendons in diabetic hemodialysis patient: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2018; 9:306-311. [PMID: 30197779 PMCID: PMC6121341 DOI: 10.22088/cjim.9.3.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bilateral rupture of the patellar tendon is a very rare injury, which takes place in relation to chronic systemic diseases. These injuries are known causes. Some of these causes are particular in patellar tendon rupture and another are in quadriceps tendon rupture. CASE PRESENTATION 70-year-old diabetic man with simultaneous bilateral patellar tendon disruption of proximal insertion without trauma, receiving long-term hemodialysis. CONCLUSIONS In the present study, we report a case of patellar tendon rupture that has two differences with literature: first, renal failure is a known risk factor for quadriceps tendon rupture, and secondly, the prevalent age of patellar tendon rupture is less than 40 years. Clinical picture, diagnosis, pathogenesis and treatment are discussed. Finally, the literature is reviewed based on previous studies.
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Affiliation(s)
- Ali Torkaman
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Yousof Gomrokchi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Elahifar
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pooyan Barmayoon
- Firoozgar Clinical Research and Development Center, (FCRDC) , Iran University of Medical Sciences, (IUMS) , Tehran, Iran
| | - Seyedeh Fahimeh Shojaei
- Firoozgar Clinical Research and Development Center, (FCRDC) , Iran University of Medical Sciences, (IUMS) , Tehran, Iran
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Amini MH. Quadriceps Tendon Repair Using Knotless Anchors and Suture Tape. Arthrosc Tech 2017; 6:e1541-e1545. [PMID: 29354471 PMCID: PMC5709721 DOI: 10.1016/j.eats.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/12/2017] [Indexed: 02/03/2023] Open
Abstract
Repair of a torn quadriceps tendon is necessary to restore the extensor mechanism of the knee. Traditional repair involves transosseous sutures tied over bone bridges on the inferior pole of the patella. Suture anchor repair has been shown to be stronger than transosseous repair and facilitates a smaller incision. Suture tape can improve the strength of the suture-tendon interface, and when combined with knotless anchors, leads to a stronger repair construct than even traditional suture anchors and surgeon-tied knots. Here we describe our technique of quadriceps tendon repair using suture tape and knotless anchors.
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Affiliation(s)
- Michael H. Amini
- Address correspondence to Michael H. Amini, M.D., Southwest Orthopaedic Surgery Specialists, 7520 N Oracle Rd, Ste 200, Tucson, AZ 85704, U.S.A.Southwest Orthopaedic Surgery Specialists7520 N Oracle RdSte 200TucsonAZ85704, U.S.A
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Abstract
Epidemiologic data show that the number of middle aged (>40 yr) and elderly (>65 yr) individuals continues to increase steadily, creating an expanding need for sports medicine care. Management of injuries in this subset of patients is expanding well beyond sustaining a patient's ability to perform activities of daily living. In fact, many older individuals increasingly expect to maintain reasonably high activity levels throughout their lifespan as well as after musculoskeletal injury. While a number of the emerging physiologic benefits of physical activity in older patients have been outlined, no recent review has outlined the current best surgical techniques, rehabilitation protocols, and return-to-sport recommendations for older athletes after soft-tissue repair or reconstruction as well as joint replacement. The goal of orthopaedic care in the elderly patient is shifting from simple pain relief toward return to athletic activity.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
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Surgical Treatment for Failure of Repair of Patellar and Quadriceps Tendon Rupture With Ipsilateral Hamstring Tendon Graft. Sports Med Arthrosc Rev 2017; 25:51-55. [PMID: 28045874 DOI: 10.1097/jsa.0000000000000138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tears of the patellar and quadriceps tendon are common in the active population, especially in athletes. At present, several techniques for surgical repair and reconstruction are available. When reruptures occur, a reconstruction is mandatory. In the present paper, we describe a surgical technique for patellar and quadriceps tendon reconstruction using ipsilateral hamstring autograft. After routine hamstring tendon harvesting, the tendon ends are prepared using a whip stitch. A transverse tunnel is drilled in the midportion of the patella, the hamstring graft is passed through the patella, and firmly secured to the patellar tunnel openings with sutures. The details of the technique are fully described. Autologous ipsilateral hamstring tendon grafts provide a secure sound means to manage these challenging injuries.
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Brossard P, Le Roux G, Vasse B. Acute quadriceps tendon rupture repaired by suture anchors: Outcomes at 7 years' follow-up in 25 cases. Orthop Traumatol Surg Res 2017; 103:597-601. [PMID: 28373140 DOI: 10.1016/j.otsr.2017.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/07/2017] [Accepted: 02/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute quadriceps tendon rupture is rare. The gold-standard repair technique is transosseous patellar suture. Biomechanical studies have validated the use of anchors as an alternative. The present study sought to report long-term clinical and radiological results in a series of acute quadriceps tendon rupture repaired with anchors. The study hypothesis was that results are comparable to those of the gold-standard technique. METHODS A retrospective continuous study included 25 knees with acute quadriceps tendon rupture, operated on by a single surgeon between 2007 and 2013: 22 patients; 17 males, 5 females; mean age, 64 years (range: 52-87 years). Modified Bunnell suture was performed, using either 2 anchors (19 knees) or 3 anchors (6 knees). Anchors were positioned under 20° flexion. The factors studied were: active range of motion, muscle strength, patient satisfaction, Lysholm score, return to work, and the radiological behavior of the anchors. RESULTS At a mean follow-up of 7 years (range: 3-9 years), all but 1 patient had 0° active extension. Mean active flexion was 128° (range: 110-150°), and mean muscle strength was 4.9/5. Mean Lysholm score was 92. Subjective results proved satisfactory or very satisfactory in 23 cases. Working patients returned to work at a mean 4.2 months. There were no cases of anchor migration or of re-rupture. One poorly tolerated anchor was ablated at 2 years, without functional impact. CONCLUSION Outcomes with anchors were comparable to those of the gold-standard technique. Anchors allow immediate rehabilitation, without risk of anchor migration. The technique provided satisfactory functional recovery. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- P Brossard
- Service d'orthopédie et de traumatologie, centre hospitalier de La Rochelle, 17019 La Rochelle, France
| | - G Le Roux
- Service d'orthopédie et de traumatologie, centre hospitalier de La Rochelle, 17019 La Rochelle, France
| | - B Vasse
- Service d'orthopédie et de traumatologie, centre hospitalier de La Rochelle, 17019 La Rochelle, France.
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- 18, rue de Bellinière, 49800 Trélazé, France
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36
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Agu TC. Spontaneous rupture of quadriceps tendon: A report of two cases and review of the literature. APOLLO MEDICINE 2017. [DOI: 10.1016/j.apme.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kindya MC, Konicek J, Rizzi A, Komatsu DE, Paci JM. Knotless Suture Anchor With Suture Tape Quadriceps Tendon Repair Is Biomechanically Superior to Transosseous and Traditional Suture Anchor-Based Repairs in a Cadaveric Model. Arthroscopy 2017; 33:190-198. [PMID: 27514943 DOI: 10.1016/j.arthro.2016.06.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties of a knotless suture anchor with suture tape quadriceps tendon repair technique with transosseous and suture anchor repair techniques. METHODS Twenty matched pairs of cadaveric knees underwent a quadriceps tendon avulsion followed by repair via the use of transosseous tunnels with #2 high-strength sutures, 5.5-mm biocomposite fully threaded suture anchors with #2 high-strength sutures, or 4.75-mm biocomposite knotless suture anchors with suture tape. Ten knees were repaired via transosseous repair and 10 via fully threaded suture anchor repair, and their matched specimens were repaired with suture tape and knotless anchors. Biomechanical analysis included displacement during cyclic loading over 250 cycles, construct stiffness, ultimate load to failure, and failure mode analysis. RESULTS Compared with transosseous repairs, quadriceps tendons repaired with knotless suture tape demonstrated significantly less displacement during cyclic loading (cycles 1-20 3.6 ± 1.3 vs 6.3 ± 1.9 mm, P = .003; cycles 20-250 2.0 ± 0.4 vs 3.1 ± 0.9 mm, P = .011), improved construct stiffness (67 ± 25 vs 26 ± 12 N/mm, P = .001), and greater ultimate load to failure (616 ± 149 vs 413 ± 107 N, P = .004). Our repair technique also demonstrated improved biomechanical parameters compared with fully threaded suture anchor repair in initial displacement during cyclic loading (cycles 1-20 3.0 ± 0.8 vs 5.1 ± 0.9 mm, P < .001), construct stiffness (62 ± 20 vs 28 ± 10 N/mm, P = .001) and ultimate load to failure (579 ± 129 vs 399 ± 87 N, P = .006). CONCLUSIONS Repair of quadriceps tendon ruptures with this knotless suture anchor with suture tape repair technique is biomechanically superior in cyclic displacement, construct stiffness, and ultimate load to failure compared with transosseous and fully threaded suture anchor techniques in cadaveric specimens. CLINICAL RELEVANCE The demonstration that our repair technique is biomechanically superior to previously described techniques in a cadaveric setting suggests that consideration should be given to this technique.
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Affiliation(s)
- Michael C Kindya
- Department of Orthopaedic Surgery, SUNY Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | | | - Angelo Rizzi
- Department of Orthopaedic Surgery, SUNY Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - David E Komatsu
- Department of Orthopaedic Surgery, SUNY Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - James M Paci
- Department of Orthopaedic Surgery, SUNY Stony Brook University Medical Center, Stony Brook, New York, U.S.A..
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39
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Pengas IP, Assiotis A, Khan W, Spalding T. Adult native knee extensor mechanism ruptures. Injury 2016; 47:2065-2070. [PMID: 27423309 DOI: 10.1016/j.injury.2016.06.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 02/02/2023]
Abstract
Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery. Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.
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Affiliation(s)
- I P Pengas
- UHCW (University Hospitals of Coventry & Warwickshire NHS Trust), United Kingdom.
| | - A Assiotis
- ST5 NW London Rotation, St Marys Hospital, United Kingdom.
| | - W Khan
- Division of Trauma & Orthopaedics, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom.
| | - T Spalding
- UHCW (University Hospitals of Coventry & Warwickshire NHS Trust), United Kingdom.
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40
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Morrey MC, Barlow JD, Abdel MP, Hanssen AD. Synthetic Mesh Augmentation of Acute and Subacute Quadriceps Tendon Repair. Orthopedics 2016; 39:e9-13. [PMID: 26709558 DOI: 10.3928/01477447-20151218-02] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/04/2015] [Indexed: 02/03/2023]
Abstract
Quadriceps tendon rupture is an uncommon injury. To date, surgical results have been less than favorable. A novel repair technique that uses Marlex mesh (C R Bard, Murray Hill, New Jersey) has been developed. Use of this repair may allow earlier range of motion and functional restoration of extension. The authors sought to evaluate the technical feasibility, durability, and postoperative function of this repair. This study retrospectively analyzed 8 knees (7 patients) operated on with this technique from 1990 to 2011. Mean follow-up was 9 years. Average age at the time of injury was 69 years. Mean operative time was 130 minutes. No perioperative complications occurred, no patients had clinical evidence of failure, and no patients required subsequent reoperation. Mean flexion at final follow-up was 100°. Of the 8 knees, 7 knees had no extensor lag at final follow-up. Marlex mesh augmentation for quadriceps tendon ruptures has promising clinical results, despite significant comorbidities. The results showed that the technique was feasible, with low cost and reasonable operative time. The clinical results were durable, with no intraoperative complications, no re-ruptures, rare extension lag, and good range of motion. Therefore, synthetic mesh augmentation is a feasible option in acute quadriceps tendon ruptures.
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Abstract
Patellar and quadriceps tendon ruptures are relatively common injuries. Rupture of the knee extensor mechanism may occur because of a forceful eccentric contraction of the quadriceps against a resisted flexed knee, though atraumatic cases have also been described. Patients at higher than normal risk for knee extensor mechanism rupture include those with systemic co-morbidities, fluoroquinolone use, and chronic tendinopathy. Early operative treatment and mobilization of acute extensor mechanism ruptures has proven effective, and numerous techniques have been described. A 46-year-old male on anastrozole therapy simultaneously ruptured his left patellar and right quadriceps tendons during a deadlift attempt. Diagnosis was by history and physical examination. Repair of both injuries was performed 5 days after injury. Described within and shown in the accompanying video is a standard technique for primary repair using Krackow stitches through the ruptured tendon that are passed through patellar bone tunnels and tied over a bone bridge. The finer points of this technique are emphasized. Also included is a technique to augment the standard repair with a figure-of-8 stitch passed through additional oblique patellar bone tunnels. The mechanical advantage of the adjuvant figure-of-8 stitch provides additional compression, which nicely reapproximates the tendon edges.
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42
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Lee SH, Song EK, Seon JK, Woo SH. Surgical Treatment of Neglected Traumatic Quadriceps Tendon Rupture with Knee Ankylosis. Knee Surg Relat Res 2016; 28:161-4. [PMID: 27274474 PMCID: PMC4895089 DOI: 10.5792/ksrr.2016.28.2.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/24/2015] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
Quadriceps tendon rupture is an uncommon injury. This disabling condition is the result of direct or indirect trauma. It requires surgical repair to avoid poor outcomes in cases of neglected or chronic rupture. In most acute cases, simple tendon suture or reinsertion is suitable for an extensor mechanism reconstruction of the knee joint. However, chronic lesions often require a tendon graft or flap reconstruction. We report a case of a 15-year-old male who was diagnosed with a chronic quadriceps rupture with a patellar superior pole fracture. We performed quadriceps reconstruction using tibialis anterior allograft tendon and additional screw fixation to reconstruct the extensor mechanism and recover knee joint range of motion to prevent a high-level functional restriction. The treatment was difficult and limited due to neglect for 9-months that led to ankylosis accompanied with nonunion of tibial fracture. Our surgical treatment using allograft tendon resulted in a very good outcome after 30 months of follow-up.
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Affiliation(s)
- Seung-Hun Lee
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Eun-Kyoo Song
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Seong-Hwan Woo
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
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Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques. Arthroscopy 2016; 32:1117-24. [PMID: 26895785 DOI: 10.1016/j.arthro.2015.11.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 09/24/2015] [Accepted: 11/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical fixation strength of suture anchor and transosseous tunnel repair of the quadriceps tendon in a standardized cadaveric repair model. METHODS Twelve "patella-only" specimens were used. Dual-energy X-ray absorptiometry measurement was performed to ensure equal bone quality amongst groups. Specimens were randomly assigned to either a suture anchor repair of quadriceps tendon group (n = 6) or a transosseous tunnel repair group (n = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 0.1 mm/s up to 100 N after which cyclic loading was applied at a rate of 1 Hz between magnitudes of 50 to 150 N, 50 to 200 N, 50 to 250 N, and tensile load at a rate of 0.1 mm/s until failure. Outcome measures included load to failure, displacement at 1st 100 N load, and displacement after each 10th cycle of loading. RESULTS The measured cyclic displacement to the first 100 N, 50 to 150 N, 50 to 200 N, and 50 to 250 N was significantly less for suture anchors than transosseous tunnels. There was no statistically significant difference in ultimate load to failure between the 2 groups (P = .40). Failure mode for all suture anchors except one was through the soft tissue. Failure mode for all transosseous specimens but one was pulling the repair through the transosseous tunnel. CONCLUSIONS Suture anchor quadriceps tendon repairs had significantly decreased gapping during cyclic loading, but no statistically significant difference in ultimate load to failure when compared with transosseous tunnel repairs. Although suture anchor quadriceps tendon repair appears to be a biomechanically superior construct, a clinical study is needed to confirm this technique as a viable alternative to gold standard transosseous techniques. CLINICAL RELEVANCE Although in vivo studies are needed, these results support the suture anchor technique as a viable alternative to transosseous repair of the quadriceps tendon.
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Quadriceps tendon repair using hamstring, prolene mesh and autologous conditioned plasma augmentation. A novel technique for repair of chronic quadriceps tendon rupture. Knee 2015; 22:664-8. [PMID: 26003216 DOI: 10.1016/j.knee.2015.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/28/2015] [Accepted: 04/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several techniques have been described for the primary repair of quadriceps tendon ruptures but there is a paucity of literature on operative management of chronic/recurrent quadriceps tendon ruptures. We describe a novel technique for the revision of quadriceps tendon ruptures which uses hamstring, prolene mesh and autologous conditioned plasma augmentation. METHODS Our patient was an independently mobile, active 61 year-old man who sustained staggered, bilateral quadriceps tendon ruptures. He had two failed direct repairs on the left side. The patient was unable to actively extend his knee. On the third attempt, despite maximising quadriceps tendon length using the Codivilla technique the gap remained significant. The left and right semitendinosus and left gracilis tendons were thus harvested and used to augment our repair. A prolene mesh, sized to fit the whole length quadriceps tendon and patella, was then secured to the repair to reinforce it. The repair site was finally injected with autologous conditioned plasma. RESULTS Satisfactory post-operative outcomes were achieved. The patient was pain-free and able to maintain straight leg raise with a 10 degrees extensor lag at his four months review in clinic. CONCLUSIONS We were able to achieve a stable construct with combination of both well-established and novel tendon lengthening techniques, in addition to mesh and biological augmentation. In our experience this surgical procedure is suitable for the treatment of a large tendon gap defect and will withstand high force transmission.
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Sellei RM, Bauer E, Hofman M, Kobbe P, Lichte P, Garrison RL, Pape HC, Horst K. Reconstruction of a quadriceps tendon tear using Polyvinylidene fluoride sutures and patellar screw fixation: A biomechanical study. Knee 2015; 22:535-41. [PMID: 26004197 DOI: 10.1016/j.knee.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/19/2015] [Accepted: 04/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute quadriceps tendon tears are infrequent injuries requiring surgical treatment. Improved stability after surgical repair may allow for earlier weight-bearing and range of motion. Therefore, a new implant was tested and compared with the "gold standard", using transosseous sutures. METHODS Quadriceps tendon tears were constructed using a cadaveric model of 12 fresh matched-pair specimens (aged 61-97; mean age: 82 years). The biomechanical testing compared non-absorbable suture anchors (Polyvinylidene fluoride) versus transosseous absorbable sutures (Polydioxanon). Following anatomic reconstruction, the repaired specimens were loaded until they failed (testing machine: Hounsfield H10KM, Redhill, United Kingdom; maximum force: 1000 N; load speed: 25 mm/min; maximum test length: 150 mm; pre-load: 5 N). Values for load until tear displacement, maximum load until complete failure of the construct (pullout or breakage of the sutures or anchors) and stiffness of the reconstruction were recorded. RESULTS The stiffness found in the Polyvinylidene fluoride reconstruction (mean 9.83 N/mm) (standard deviation (SD) 7.75) showed a significant increase compared to the Polydioxanon reconstruction (mean 6.66 N/mm (SD 3.32); P=0.045). Transosseous fixation showed comparable results to the suture anchor system. There was no significant difference found in the maximum load to tear displacement (PVDF: 290.88 N (SD 106.01) vs. PDS: 266.75 N (SD 82.61); P=0.358). CONCLUSIONS Using the Polyvinylidene fluoride thread showed comparable results to the established method in reconstruction of ruptured quadriceps tendon. Stiffness of the Polyvinylidene fluoride thread reconstruction was even greater than Polydioxanon thread. CLINICAL RELEVANCE Improved stiffness may facilitate healing and is suggested as clinical relevance in reconstruction.
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Affiliation(s)
- R M Sellei
- Department of Orthopaedic Trauma, Sana Klinikum Offenbach, Germany.
| | - E Bauer
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | - M Hofman
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | - P Kobbe
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | - P Lichte
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | | | - H C Pape
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | - K Horst
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
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Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:85-92. [PMID: 26441330 DOI: 10.1007/s00590-015-1710-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Quadriceps tendon avulsions are typically treated by reattaching the tendon through bone tunnels, with or without tendon or hardware augmentation. The operated knee joint can be moved right away; however, tendon grafting or tension banding will be required to protect the repair, and the hardware must be removed later on. The goal of this study was to evaluate the clinical and functional outcomes when suture anchors are used to reattached torn quadriceps tendon, and also to assess tendon healing using MRI. MATERIALS AND METHODS Thirteen consecutive patients with avulsed quadriceps tendons were operated and then followed prospectively. The surgical technique consisted of tendon reattachment using at least three anchors, in addition to intratendinous weaving of the sutures. Weight bearing was allowed while using a splint. Rehabilitation was initiated immediately after surgery according to a set protocol. RESULTS Eleven patients were followed for a mean of 14.7 months. Two retears occurred in patients who did not wear the splint. Eighty-two per cent of patients were satisfied or very satisfied with the outcome. The mean knee flexion was 124.5°. All patients were able to return to their pre-injury activity levels. The mean time for clinical and functional recovery was 3 months. MRI performed 6 months after the surgical repair revealed good tendon healing. DISCUSSION This was the first prospective study performed on quadriceps avulsion patients undergoing suture anchor repair. Prior clinical case reports have shown that this method leads to predictable clinical and functional results. Our results were comparable to those in published cases. CONCLUSION The procedure is simpler when only suture anchors are used. Tendon healing was observed on MRI in all cases. This simple, reproducible technique is free of the drawbacks associated with the typical repair augmentation.
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Ibounig T, Simons TA. Etiology, Diagnosis and Treatment of Tendinous Knee Extensor Mechanism Injuries. Scand J Surg 2015; 105:67-72. [PMID: 26271663 DOI: 10.1177/1457496915598761] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/17/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Quadriceps and patella tendon ruptures are uncommon injuries often resulting from minor trauma typically consisting of an eccentric contraction of the quadriceps muscle. Since rupture of a healthy tendon is very rare, such injuries usually represent the end stage of a long process of chronic tendon degeneration and overuse. This review aims to give an overview of the current understanding of the pathophysiology, diagnostic principles, and recommended treatment protocols as supported by the literature and institutional experience. MATERIAL AND METHODS A non-systematic review of the current literature on the subject was conducted and reflected against the current practice in our level 1 trauma center. RESULTS AND CONCLUSION Risk factors for patella and quadriceps tendon rupture include increasing age, repetitive micro-trauma, genetic predisposition, and systemic diseases, as well as certain medications. Diagnosis is based on history and clinical findings, but can be complemented by ultrasound or magnetic resonance imaging. Accurate diagnosis at an early stage is of utmost importance since delay in surgical repair of over 3 weeks results in significantly poorer outcomes. Operative treatment of acute ruptures yields good clinical results with low complication rates. Use of longitudinal transpatellar drill holes is the operative method of choice in the majority of acute cases. In chronic ruptures, tendon augmentation with auto- or allograft should be considered. Postoperative treatment protocols in the literature range from early mobilization with full weight bearing to cast immobilization for up to 12 weeks. Respecting the biology of tendon healing, we advocate the use of a removable knee splint or orthotic with protected full weight bearing and limited passive mobilization for 6 weeks.
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Affiliation(s)
- T Ibounig
- Töölö Hospital, Helsinki University Central Hospital, HUS, Helsinki, Finland
| | - T A Simons
- Töölö Hospital, Helsinki University Central Hospital, HUS, Helsinki, Finland
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Cetinkaya E, Aydin CG, Akman YE, Gul M, Arikan Y, Aycan OE, Kabukcuoglu YS. A rare knee extensor mechanism injury: Vastus intermedius tendon rupture. Int J Surg Case Rep 2015; 14:186-8. [PMID: 26298093 PMCID: PMC4573616 DOI: 10.1016/j.ijscr.2015.07.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 11/30/2022] Open
Abstract
The first case of isolated rupture of vastus intermedius tendon in the literature. Partial quadriceps tendon rupture can be treated by conservative therapy.
Introduction Quadriceps tendon injuries are rare. There is a limited number of studies in the literature, reporting partial quadriceps tendon ruptures. We did not find any study reporting an isolated vastus intermedius tendon injury in the literature. Presentation of case A 22 years old professional rugby player with the complaints of pain in the right lower limb, decreased range of motion in right knee and a mass in the mid-anterior of the right thigh applied following an overloading on his hyperflexed knee during a rugby match. T2 sequence magnetic resonance images revealed discontinuity in the vastus intermedius tendon and intramuscular hematoma. The patient has been conservatively treated. Discussion Quadriceps tendon ruptures generally occur after the 4th decade in the presence of degenerative changes. Our case is a young professional rugby player. Isolated vastus intermedius tendon rupture is unusual. Conservative treatment is performed as the intermedius tendon is in the deepest layer of the quadriceps muscle. Conclusion We report the first case of isolated rupture of the vastus intermedius tendon in the literature and we claim that disorder may be succesfully treated with conservative treatment and adequate physiotheraphy.
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Affiliation(s)
- Engin Cetinkaya
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Canan Gonen Aydin
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Yunus Emre Akman
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Murat Gul
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Arikan
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Osman Emre Aycan
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
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Arthroscopic quadriceps tendon repair: two case reports. Case Rep Orthop 2015; 2015:937581. [PMID: 25815224 PMCID: PMC4359866 DOI: 10.1155/2015/937581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/08/2015] [Indexed: 01/17/2023] Open
Abstract
Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.
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Benyass Y, Chafry B, Koufagued K, Bouabid S, Chagar B. [Traumatic rupture of the quadriceps tendon: a report of 3 cases]. Pan Afr Med J 2015; 22:343. [PMID: 26985261 PMCID: PMC4779624 DOI: 10.11604/pamj.2015.22.343.8272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/25/2015] [Indexed: 11/23/2022] Open
Abstract
Les ruptures traumatiques du tendon quadricipital sont rares, elles surviennent préférentiellement après 40 ans, suite à un traumatisme indirect chez le sportif (flexion contrariée du genou) ou traumatisme banal chez le sédentaire. La tendinopathie préexistante est fréquente. La rupture est le plus souvent totale et siège au corps du tendon 60% des cas ou décallotement quadricipital au bord supérieur de la rotule (40% des cas). Le diagnostic est essentiellement clinique. Les examens complémentaires (échographie et imagerie par résonance magnétique) sont utiles et appuient le diagnostique, mais sont souvent faussement rassurants hormis la radiographie qui montre une rotule basse. Le traitement essentiellement chirurgical associé à la rééducation fonctionnelle donne des résultats largement meilleurs. Le délai d'intervention est un facteur pronostic très important. Les auteurs rapportent 03cas de rupture de tendon quadricipital. L’âge moyen est de 50ans. Ils ont été traités chirurgicalement et revus régulièrement, avec un recul de 16 mois pour apprécier l’évolution. Les résultats ont été très bons chez 02 cas et bon chez 01 cas. L'amélioration a été très nette selon les critères: marche, douleur et reprise d'activité physique.
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Affiliation(s)
- Youssef Benyass
- Service de Traumatologie-Orthopédie II, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Bouchaib Chafry
- Service de Traumatologie-Orthopédie II, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Kaldadak Koufagued
- Service de Traumatologie-Orthopédie II, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Salim Bouabid
- Service de Traumatologie-Orthopédie II, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Belkacem Chagar
- Service de Traumatologie-Orthopédie II, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
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