Simultaneous and spontaneous bilateral rupture of the patellar tendon in rheumatoid arthritis. A case report

Patellar Tendon Rupture During Postoperative Physiotherapy for Crouch Gait: A Case Report

INTRODUCTION

A 14-year-old adolescent girl with spastic diplegic cerebral palsy underwent bilateral distal femur extension osteotomy and patellar tendon plication. Two and a half months after surgery, during physiotherapy, she sustained mid-substance tear of the left patellar tendon. The girl was successfully managed with patellar tendon repair and augmentation with tensor fascia lata autograft.

CONCLUSION

Patellar tendon rupture during rehabilitative physiotherapy after patellar tendon plication surgery is rare. Postoperative protocols in patients with cerebral palsy are crucial and should progress gradually to improve knee range of motion. This report highlights that patellar tendon repair with fascia lata augmentation yields good outcome.

Simultaneous Bilateral Patellar Tendon Rupture: A Systematic Review

The extensor mechanism of the knee can be damaged due to various modes of injury, which, in most cases, will require urgent surgical intervention for repair. Single patellar tendon ruptures are uncommon, but simultaneous bilateral events are even rarer and have been scarcely reviewed in English literature. Research in this area is mainly confined to case series, with some literature reviews but no evidence of more substantial analysis. Therefore, this systematic review was done to analyse the existing literature on bilateral simultaneous patellar tendon ruptures and propose a systematic and standardised approach to diagnosing and managing these injuries. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search terms included 'bilateral patellar tendon rupture', 'bilateral', 'patellar', 'tendon' and 'rupture'. Three independent reviewers conducted searches in PubMed, OvidSP for Medline, Embase and the Cochrane Library using the same search strategy. The eligibility criteria included studies on bilateral concomitant patellar tendon rupture published in English. Bilateral simultaneous patellar tendon ruptures of traumatic and atraumatic origin in human patients were included. The study types comprised case reports and literature reviews. The key limitation of this study was the low number of patients covered by the eligible literature. Patellar tendon ruptures are a rare and scarcely documented injury, and there is a need for studies with a high level of evidence, especially regarding surgical treatment choice and methods, as well as post-operative management, which could potentially lead to improved outcomes in the management of this injury.

Complication after the reconstruction of the old patellar tendon rupture

Introduction. Chronic patellar tendon rupture (PTR) occurs rarely; its frequency and prevalence are unknown. There are very little data on the late patellar tendon reconstruction in rheumatoid arthritis and its complications. Case report. We presented a surgical repair of a PTR with early postoperative rupture of the contralateral patellar tendon for a 21-year-old woman with a past medical history of juvenile rheumatoid arthritis (treated with corticosteroids) who sustained initial injury 11 months prior to the presentation. The contralateral side was used for autograft harvesting. We used bone-tendon-bone (BTB) autograft and allografts followed by double-wire loop reinforcement and immediate postoperative mobilization. The patient was followed for 2 years, and the function of both knees was re-stored completely, with a full active range of motion. In this case, reconstruction of an 11-month-old chronic PTR (with complete resorption of the tendon and completely separated infrapatellar pads, complicated by the contralateral PTR) with BTB autograft and allografts and double wire loop reinforcement gave an excellent functional result. Two years after the surgical treatment, the extensor function of both knees was completely restored with a full range of movements. The patient reported satisfying outcomes and was able to return to all pre-injury activities without the assistance of orthopedic devices. Conclusion. This case report highlights the importance of the early diagnosis and describes operative techniques used in chronic PTR repair and treatments of the early postoperative complications such as rupture of the contralateral tendon.

Traumatic Rupture of the Patellar Tendon From the Tibial Tuberosity in an Adult: A Case Report

Patellar tendon ruptures from the tibial tuberosity are very uncommon. Various surgical techniques are described for patellar tendon ruptures from the tibial tuberosity. A 58-year-old male without any predisposing factors had pain and swelling in the right knee due to a road traffic accident. Tense swelling and ecchymosis were present around the right knee with a palpable defect over the patellar tendon and an inability to extend the right knee. An MRI report revealed avulsion of the distal patellar tendon from the tibial tubercle insertion and medial meniscus tear. Primary repair was done with a double-loaded suture anchor and augmentation was done by using a Gracilis tendon. After the months, the knee range of motion (ROM) of the patient reached up to 90 degrees, and there was no extension lag on straight leg raise. Hamstring augmentation with a primary repair is the safest and a good surgical option in elderly patients with patellar tendon ruptures from the tibial tuberosity.

Achilles Tendon Allograft with Semitendinosus Autograft Reinforcement Is a Successful Treatment for Chronic Patellar Tendon Rupture: Report of Two Cases

Rupture of the patellar tendon must be diagnosed urgently because reconstruction of the extensor mechanism produces better results when it is performed in acute conditions. Reconstruction of chronic extensor mechanism rupture on the contrary is very challenging. Several surgical techniques have been described using a variety of graft choices and fixation methods, but the optimal approach is still under debate. We report our experience of two cases of chronic patellar tendon rupture reconstruction using an Achilles tendon allograft reinforced by a vascularized ipsilateral semitendinosus tendon frame. The rapid functional recovery of the range of motion, only three months postoperatively, showed us that this reconstruction technique was effective.

Simultaneous Bilateral Rupture of the Patellar Tendon and Medial Collateral Ligament: A Case Report and Literature Review

Bilateral rupture of the patellar tendon is considered an uncommon and rare musculoskeletal injury. The association of this lesion with medial collateral ligament tear appears to be exceedingly rare. We present the case of a combined rupture of the medial collateral ligament (MCL) and the patellar tendon of both knees in a 48-year-old man, after falling 2 meters down an embankment. While there are numerous publications concerning associated MCL tears and other knee ligaments, a combination of MCL tear with a patellar tendon rupture is very rare. In addition, our case presents the first case recorded in the literature, involving both knees of a patient. The clinical case is described and discussed following a review of the literature. The symmetrical knee injury was treated with a primary direct repair of the MCL tears and using a suture anchor fixation of the patellar tendon ruptures, which was reinforced by a stainless steel wire and an autograft of the ipsilateral quadriceps tendon.

Revision Patellar Tendon Repair With Anchors, Allograft Augmentation, and Suspensory Fixation

Ruptures of the patellar tendon are rare but potentially devastating injuries reported to occur most commonly in active males in their third and fourth decades of life. Repair failure rates have been reported to range between 2% and 50% based on surgical technique used. There are several inherent challenges associated with revision patellar tendon repair, including quadriceps atrophy, contracture, tissue loss, excessive scarring, and improper patella height. There remains no consensus regarding ideal revision patellar tendon repair technique. The purpose of this Technical Note is to describe our preferred method for revision patellar tendon repair using suture anchors and allograft augmentation with adjustable loop suspensory fixation. On the basis of recent studies, we have carefully chosen our fixation and augmentation methods that have shown biomechanical promise, while allowing the surgeon to carefully titrate the patellar tendon length and accommodate for some patellar tendon tissue loss.

Bilateral patellar tendon rupture on lupus undergoing corticosteroids: a case report

BACKGROUND

Patellar tendon rupture is a rare condition, especially when it is bilateral. The most frequent associated pathologies are systemic lupus erythematosus, chronic renal failure, or treatments like corticosteroids. The aim of this case report is to draw attention to the non-specific clinical aspect of this condition, to recall its radiological signs, and highlight the diagnostic contribution of musculoskeletal ultrasound.

CASE PRESENTATION

A 39-year-old man was diagnosed with a systemic lupus erythematosus with cutaneous, pulmonary, cardiac, hematological, renal, and immunological manifestations. He was treated with high-dose corticosteroids. Within 3 months he presented with a total functional impotence of the knees. On physical examination, there was a gap in the right infrapatellar region, his patellae were abnormally ascended, and his left knee was swollen. Insall-Salvati ratio on knees conventional radiographies was 2.5 in the right and 2.25 in the left knee, assessing bilateral patella alta. Ultrasound revealed a complete and bilateral patellar tendon rupture. The treatment consisted in a surgical repair and physiotherapy. The patient was able to mobilize independently after 6 months.

CONCLUSIONS

Bilateral patellar tendon rupture is exceptional. Systemic lupus erythematosus and corticosteroids are among trigger factors. Careful examination of the patellae should be done in front of knee extension deficit. Ultrasound plays a determining role in the diagnosis.

A high glucose level stimulate inflammation and weaken pro-resolving response in tendon cells - A possible factor contributing to tendinopathy in diabetic patients

BACKGROUND

Tendinopathy is a chronic disorder that affects a huge population, and is causing high socioeconomical impacts worldwide. Tendinopathy was reported to be more prevalent in diabetic patients, and chronic inflammation was proposed to play an important role in its development. It was also known that diabetic patients present in a pro-inflammatory state. There is a possibility that the high glucose environment in diabetic patients lead to chronic inflammation in the tendon, and eventually the development of tendinopathy. In this study, we would simulate the diabetic environment in an in vitro setup, to assess the effect of a high glucose level on cultured tendinopathic and healthy tendon derived stem cells (TDSCs) under inflammatory stress. We would first like to assess whether there are differences between the inflammatory response in tendinopathic and healthy TDSCs. We would then investigate whether a high glucose level may lead to changes in the inflammatory response in healthy tendon cells.

METHODS

Tendinopathic TDSCs were cultured from 2 torn rotator cuff tendons and 1 ruptured patellar tendon. Healthy TDSCs were cultured from 3 gender matched healthy hamstring tendons. Cells were stimulated by either 2ng/ml IL-1B for 24 hours, 11.1 mmol/L glucose for 24 hours, or both. mRNA was collected and processed for qPCR targeting B-actin, ALOX12, ALOX15, FPR1, FPR2, ChemR23, and COX2.

RESULTS

Upregulation of FPR1 (p=0.050) ChemR23 (p=0.050), ALOX15 (p=0.050) was significantly weakened when comparing tendinopathic and healthy TDSCs stimulated with IL-1b. The upregulation of ALOX15 (p=0.050), was significantly lower in stimulated healthy TDSCs in a high glucose environment when comparing with those stimulated under a regular glucose level. A high glucose level also induced upregulation of COX2 (p=0.046) in healthy TDSCs and tendinopathic TDSCs (p=0.050).

CONCLUSION

The results of this study provide a possible explanation to the increased risk to develop tendinopathy in diabetic patients. Chronic inflammation observed in tendinopathy may be due to the weakening of pro-resolving responses in tendinopathic TDSCs, and a high glucose environment may lead to chronic inflammation and ultimately tendinopathy by persistent stimulation and weakening of pro-resolving response in healthy TDSCs.

Proximal Patellar Tendon Repair: Internal Brace Technique With Unicortical Buttons and Suture Tape

Patellar tendon ruptures may be considerably limiting, especially in younger and highly active patients. These injuries ultimately result in a complete inability to maintain extension of the knee, thereby placing strict impediment on physical activity. As a result, a durable repair construct via surgery is necessary to allow patients to return to their preinjury activity level. Because of the inherent difficulty in maintaining patellar tendon position after repair, and to avoid failure of the tendon healing to the patella, we recommend using an internal brace construct. The construct uses bone tunnels in the patella and also cortical buttons on the tibia with suture tape whipstitched through the tendon. We feel that this provides an enhanced fixation construct. The purpose of this Technical Note is to describe our preferred method for proximal patellar tendon repair via an internal brace construct with unicortical buttons and suture tape.

Late reconstruction of the patellar tendon in rheumatoid arthritis using bone-patellar tendon-bone allograft

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A lady with rheumatoid arthritis had a chronic patellar tendon rupture.

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She underwent patellar tendon reconstruction with a massive BTB allograft.

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She now has an active range of motion between −20 and 120°.

Introduction

chronic patellar tendon rupture is rare and its incidence and prevalence are unknown. Furthermore, the data about late reconstruction of the patellar tendon in rheumatoid arthritis is limited. Such condition, if not managed properly, can substantially affect the patient's activities of daily living.

Case presentation

We report a case of chronic patellar tendon rupture in a 49 years old lady who has been suffering from rheumatoid arthritis for over 20 years. She presented with an inability to extend the right knee which started suddenly a year and a half ago without any history of trauma. She underwent reconstruction of the patellar tendon using a massive BTB allograft. Three years after surgery, the patient had an active range of motion between −20 and 120° and was walking normally without any external support.

Discussion

When the primary repair of the patellar tendon is not possible, it is necessary to either repair with autologous augmentation or use a graft to reconstruct the tendon. We believe autografts may not be suitable in the presence of rheumatoid arthritis since the disease is associated with excessive levels of collagenase that could contribute to the degeneration of the tendons.

Conclusion

Late patellar tendon reconstruction in rheumatoid arthritis is a challenging procedure, and we believe it is best performed using an allograft to achieve the desired outcome.

Bilateral patellar tendon reconstruction using LARS ligaments: case report and review of the literature

Background

Acute bilateral patellar tendon rupture is a rare occurrence, with only 1 case reported in the English literature of a young, fit athlete with no regular medications. To our knowledge this is the first such case reported using a LARS reconstruction.

Case presentation

A 26-year-old otherwise well ex-olympic gymnast with bilateral acute on chronic patellar tendon rupture underwent reconstruction using LARS ligaments. At four years post-operatively he has maintained full range of motion and strength, without re-rupture or any evidence of synovitis.

Conclusion

The use of LARS ligament for reconstruction of the patellar tendon is a viable and effective option for rupture. It avoids donor site morbidity associated with autograft. Reconstruction of both patellar tendons simultaneously in a young, elite-level athlete has not previously been reported in the English-language literature.

Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone-induced tendinopathy

The present case emphasizes the importance of adhering to strict indications when prescribing fluoroquinolones. Although rare, drug‐induced tendinopathy is not confined to fluoroquinolones. The patient's and physician's awareness should be increased to reduce fluoroquinolones‐associated morbidity, particularly in patients with previously described risk factors.

Repair and augmentation of a spontaneous patellar tendon rupture in a patient with Ehlers-Danlos syndrome: a case report

INTRODUCTION

Disruption of the knee extensor mechanism is a serious disorder that requires prompt treatment. It often occurs in the form of a patellar tendon rupture. It may occur in association with systemic disease or after administration of corticosteroids or fluoroquinolones. These conditions can cause tendon weakness, and consequent ruptures usually require both repair and augmentation. This paper reports on repair and augmentation for treating patellar tendon rupture in patients with Ehlers-Danlos syndrome (EDS).

CASE REPORT

We report a patellar tendon rupture in a 27-year-old man with EDS, which occurred in the midsubstance of the patella. As the patient has tendon weakness, extensive repair will increase the risk of patella baja, and the use of end-to-end suturing technique alone will not be enough to prevent a rupture recurring; however, augmentation could be used to address the tendon weakness. Repair of the rupture and augmentation with hamstring tendon was performed. One year after the surgery, the patient was able to move his knee joint without pain and had an active range of motion of 0° (passive 20°)-145°. He was able to perform a straight leg raise without an extension lag.

CONCLUSIONS

Repair and augmentation with hamstring tendon was an effective treatment option for patellar tendon rupture in a patient with EDS.

Patellar tendon rerupture in a footballer: our personal surgical technique and review of the literature

Patellar tendon rerupture is a relatively uncommon condition that severely compromises the function of the extensor mechanism of the knee. Few cases described in the literature does not show a unique mode of treatment for this type of lesion. We report the case of a young athlete with traumatic patellar tendon rerupture. The first rupture was treated with the use of Statak anchors. Following a second rerupture incident as a result of a sporting accodent, the tendon was reconstructed with the use of an autologous graft tendon of semitendinosus and biological augmentation with gracilis tendon. For both tendons the distal insertion part was preserved to facilitate the healing process. The treatment was completed with the application of a neutralization cerclage wire and with local injection of plateket reach plasma (PRP). At 12 months follow up, a full recovery of the structure and function of the extensor mechanism was observed and the patient was able to resume normal sports competitive activity.

A biomechanical comparison of patellar tendon repair materials in a bovine model

We evaluated the biomechanical properties of FiberWire (Arthrex, Inc, Naples, Florida), a new suture material, for both repair and augmentation as compared to standard Ethibond suture (Ethicon, Inc, Somerville, New Jersey), hypothesizing that primary repair and cerclage augmentation with the new suture material would have similar biomechanical properties as a standard repair with wire augmentation. Forty-five fresh bovine knees were placed in 3 groups of equal size: (1) #5 Ethibond tendon repair plus 18-gauge wire augmentation; (2) #5 FiberWire repair plus #5 FiberWire augmentation; and (3) #5 Ethibond repair plus #5 FiberWire augmentation. A straight static pullout test was performed, randomly alternating between the different groups. Gap formation was measured at the center of the repair by a metric ruler, with the examiner blinded to the developing force-tension readout. For each millimeter of gap formation (1-10 mm), the force on the repair was recorded, as well as the force at the ultimate failure of the repair, designated by breakage of any repair material. Analysis showed no significant difference between the standard Ethibond/wire repair and the FiberWire/FiberWire repair. The Ethibond/FiberWire repair was shown to be significantly weaker than the other 2 groups. Ultimate failure data indicated that the Ethibond/wire repair was significantly stronger than both other groups. No significant differences were found between the FiberWire/FiberWire repair and the Ethibond/FiberWire repair. Newer, stronger suture material for both primary repair and augmentation may provide equivalent biomechanical strength at clinically significant levels.

Extensor mechanism repair and reconstruction using Achilles tendon allograft after bilateral patellar tendon rupture in a patient with rheumatoid arthritis

Here we report spontaneous rupture of the bilateral patellar tendons in a 49-year-old man with rheumatoid arthritis. The ruptured tendons were sutured via bone tunnels using Krackow stitch, and the extensor mechanism of the knee was reinforced with three bundles of allograft Achilles tendons. The patient recovered well after operation. He could actively flex, extend the knees and carry out full-weight-bearing activities, and he resumed the former employment 6 months after the operation. Follow-up showed that the patient had satisfactory range of motion of the knees 1 year later.

Reconstruction of chronic patellar tendon tear with allograft in a patient with Ehlers-Danlos syndrome

Failure of repair of the patellar tendon is uncommon. It may occur in association with chronic systemic diseases or after administration of corticosteroid and quinolones. We report the reconstruction of the patellar tendon with allograft, after failed primary repair, of a 23-year-old young with Ehlers-Danlos syndrome.

Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation

Continuing progress in research in molecular biology and biomechanics has provided considerable new information and has given rise to new hypotheses in chronic tendinopathy. Overloading is still, however, crucial in the development of tendinopathy. Most of the histologic findings in tendinopathy represent chronic degeneration, regeneration, and microtears of the tendinous tissue. The prevailing opinion is that no histological evidence of acute inflammation has been documented, but in newer studies using immunohistochemistry and flow cytometry inflammatory cells have been detected. The existing data indicate that the initiators of the tendinopathic pathway include many proinflammatory agents (e.g. cytokines, prostaglandins, different growth factors, and neuropetides). Because of the complex interaction between the classic proinflammatory agents and the neuropeptides, it seems impossible and somewhat irrelevant to distinguish sharply between chemical and neurogenic inflammation. Furthermore, glucocorticoids are, at the moment, the most effective treatment in tendinopathy with regard to reduction of pain, tendon thickness, and neovascularization. This review indicates - despite a great deal of uncertainty regarding the concepts - that an inflammatory process may be related not only to the development of tendinopathy but also chronic tendinopathy. More attention should be directed towards the "tendinitis myth" in the future.

Bilateral patellar tendon ruptures: a missed diagnosis : case report and literature review

Knee extensor mechanism disruption is an unusual but serious emergency presentation. Rarely disruption can occur within the patellar tendon which is often associated with systemic diseases such as rheumatoid arthritis and systemic lupus erythematosus. Surgical management is required to repair the patellar tendon after clinical assessment and diagnosis. We describe the case of a 75-year-old man without any known predisposing systemic disease presenting on several occasions before accurate diagnosis and treatment. We include a literature review of similar cases and discuss the importance of missed diagnosis and underlying causes. A treatment algorithm to avoid missing similar injuries is also proposed.

Ultrasound appearance of tendon tears. Part 2: lower extremity and myotendinous tears

Traumatic tears of the musculotendinous complex at the lower limb are common in clinical practice but can be difficult to detect and to evaluate because of swelling and pain that can limit proper physical examination. They can affect sedentary subjects or active sports participants involved in amateur or professional activities. In the first group tendons are more commonly affected, while myotendinous tears are common in sports players. The aims of this review article are to review the aetiology and pathomechanism of the most common ruptures affecting the tendons and the main myotendinous junctions of the lower extremity and to describe their ultrasound findings as well as to correlate ultrasound appearance with that of the other imaging modalities.

Les tendons : lésions traumatiques

In the recent years there has been an increase in the number of tendon tears (TT) seen in routine daily outpatient practice secondary to the increasing popularity of sport activities. Tears require early diagnosis to ensure proper treatment and reduce functional impairment. Since local pain, edema and reflex muscle contraction can significantly limit the usefulness of clinical examination, imaging is usually required to confirm the clinical diagnosis, differentiate between partial and complete tear, and localize the retracted tendon stump. Several imaging modalities can be used in the evaluation of TT. Ultrasound is an efficient, dynamic, low cost and non invasive modality that is being increasingly utilized in the evaluation of the musculoskeletal system. It is well accepted by the acutely injured patient. The aim of this review article is to describe the ultrasound findings of the most common tendon tears.

Bilateral patellar tendon rupture in a child: a case report

Patellar tendon rupture in children is very rare. When it occurs, patellar tendon is usually ruptured either from the upper end as a sleeve fracture of the patella or from lower end as an avulsion fracture of the tibial tuberosity. In this report, we present the case of an otherwise healthy 9-years-old boy who had subsequent bilateral patellar tendon ruptures through the midparts, which has not been published previously in the literature. Treatment was performed with primary end-to-end repair, reinforcement with cerclage wires and fresh-frozen achilles tendon augmentation for both sides.

Ultrasound of tendon tears. Part 1: general considerations and upper extremity

The role of ultrasound (US) in assessing musculoskeletal disorders is persistently increasing because of its low cost, readiness, noninvasiveness, and possibility of allowing a dynamic examination. Secondary to increased sport practice, tendon tears are more frequently observed in daily medical practice. They deserve early diagnosis to allow proper treatment that can limit functional impairment. The aim of this review article is twofold: to illustrate the US appearance of normal tendons and to describe the US findings of the most common tendon tears.

Bilateral patellar tendon rupture without predisposing systemic disease or steroid use: a case report and review of the literature

Simultaneous bilateral patella tendon ruptures are very rare injuries of the knee extensor complex often associated with systemic disorders such as lupus erythematosus or rheumatoid arthritis. We describe the case of a 34-year-old man without concomitant systemic disease or steroid use and provide the most comprehensive review of the German and English literature. Furthermore, we discuss the predisposing factors and causal mechanisms as well as current diagnostic procedures and treatment options. In the literature review, only a few patients without systemic disorder or steroid medication present with potential predisposing factors that may be responsible for degenerative changes of the patella tendon, weakening its stability. In addition, in most of these cases, it remains difficult to explain the bilateral and simultaneous nature of this injury.

Rupture of the Achilles and patellar tendons

Certain similarities can clearly be appreciated between Achilles and patellar tendon ruptures. Both are strong tendons that transmit force bridging at least one joint of the lower limb. When healthy, both require massive forces to be disrupted, and both can be weakened through certain systemic disease processes, steroids, and fluoroquinones. Both allow for a variety of innovative management possibilities that ultimately lend themselves to individual surgical preference. We feel that, although surgical management plays an important role in restoring continuity in knee extension and in plantar flexion, functional outcome inevitably relies on patient motivation and a well-established physiotherapy regime. Sports physicians should be able to identify both conditions early in their presentation, but still hold a high index of suspicion for these problems in athletes who have an acute exacerbation of ongoing tendinopathy.

Traumatic bilateral concurrent patellar tendon rupture: an alterative fixation method

A 37-year-old healthy Chinese man with traumatic bilateral concurrent patellar tendon rupture is presented. This is the 19th case reported in the literature. Sports-related activities are the most common cause of injury. The mechanism of rupture is forceful contraction of quadriceps muscle on a partially flexed knee. Previous surgical treatments have potential problems. Soft tissue anchors were used for restoration of the patellar continuity. Improved surgical techniques and excellent functional results are expected.

Outcomes following repair of quadriceps tendon ruptures

OBJECTIVES

The purpose of this study was to examine critically the outcomes of patients sustaining a quadriceps tendon rupture and to compare outcomes in patients with bilateral simultaneous ruptures versus a unilateral rupture.

DESIGN

Retrospective review.

SETTING

Patients were treated at a Level I trauma center.

PATIENTS/PARTICIPANTS

Fifty-one quadriceps tendon ruptures in thirty-nine patients were evaluated. A mean four-year follow-up (range 13 to 204 months) was available for forty-eight tendon ruptures.

INTERVENTIONS

All patients except one were treated with operative repair of the quadriceps tendon rupture(s).

MAIN OUTCOME MEASUREMENTS

Patients were assessed by physical examination, Lysholm and Tegner scores, a functional questionnaire, quadriceps isokinetic testing, and radiographs.

RESULTS

A statistically greater number of patients in the bilateral simultaneous rupture group had a systemic illness associated with tendon rupture (p = 0.014). This result did not adversely affect outcome as compared with patients with unilateral ruptures. Mean range of motion was 123 degrees in injured knees. Eighty-four percent of working patients returned to their previous occupations. More than half the patients, however, in general the most active, could no longer participate in their preinjury recreational activities. Fifty-three percent of unilateral rupture patients had persistent quadriceps strength deficits (>20 percent) in the injured extremity. Both quadriceps and hamstring isokinetic testing correlated significantly with Lysholm and Tegner scores.

CONCLUSIONS

Most patients with bilateral simultaneous and unilateral tendon repairs can expect a good range of motion and return to their previous occupation, but many have persistent weakness and difficulty returning to higher level sporting activities.

Bilateral infrapatellar tendon rupture in a patient with jumper's knee

This is the fourth case report of bilateral infrapatellar tendon rupture as a result of indirect trauma in a patient without systemic disease. This is the only report we have found of jumper's knee leading to simultaneous infrapatellar tendon ruptures.

Bilateral simultaneous rupture of the patellar tendon. Case report and review of the literature

A case of bilateral simultaneous rupture of the patellar tendon due to apicitis patellae is presented. Clinical picture, diagnosis, pathogenesis and treatment are discussed. In addition, the literature on the subject is reviewed.

Jumper's Knee

Jumper's knee is a common manifestation seen in the athletic population, resulting from overuse of the knee extensor mechanism. The purpose of this article is to review the literature associated with jumper's knee, in the hope that it may benefit the physical therapist's understanding and management of this condition. The pertinent anatomical, biomechanical, and physiological aspects will be briefly reviewed. Clinical findings, methods of conservative treatment, and a proposed method of prevention will be presented. J Orthop Sports Phys Ther 1989;11(4):137-141.

Tendon rupture in systemic lupus erythematosus

Tendon rupture in SLE is a rare but potentially disabling complication. The etiology of tendon rupture is not well understood, but in some cases it is secondary to trauma and in others it is related to inflammatory changes in and around the tendon as a result of the underlying disease process. Corticosteroid therapy may also be responsible for tendon rupture in some patients. Therapy must be individualized depending on the site of rupture.

[Bilateral spontaneous rupture of the patellar tendon in systemic lupus erythematosus. A case report and review of the literature]

A rupture of the patella ligament occurs after acute trauma or if there are factors that could have predisposed to the rupture like former injuries or operations of the knee or systemic diseases. If symptoms like loss of active extension, no patella tendon reflex, and a proximally displaced patella in radiograph appear in cases of those diseases, it should be thought of the rare rupture of the patella ligament. It will be treated operatively by suture of the tendon supporting by a wire, applying a cast for six to eight weeks and following physical therapy.

Successive ruptures of the ligamenta patellarum in a young Nigerian: a case report

A 34-year-old Nigerian man had successive ruptures of the ligamenta patellarum repaired 2 years after the first injury. One knee was injured at a soccer match, the other 5 months later subsequent to a minor fall. There was no evidence of systemic disease. In spite of delay in effecting treatment, the outcome was satisfactory.

Infrapatellar tendon ruptures

This is a retrospective study of 23 infrapatellar tendon ruptures in 22 patients seen at Henry Ford Hospital from 1969 to 1980. Two of the patients had a systemic disease known to predispose to tendon ruptures, while the remainder of the tendon ruptures occurred in otherwise normal individuals as the result of either repetitive or isolated trauma.