Acute Quadriceps Tendon Ruptures Research Articles

Quadriceps Tendon Ruptures in Middle-Aged to Older Patients: A Retrospective Study on the Preoperative MRI Injury Patterns and Mid-Term Patient-Reported Outcome Measures

(1) Quadriceps tendon rupture (QTR) is a rare pathology, usually occurring in elderly patients with comorbidities, requiring surgical therapy. The aim of this study was to analyze rupture patterns and concomitant injuries using preoperative magnetic resonance imaging (MRI) and to evaluate patient-reported outcome measures. (2) In this retrospective cross-sectional study, 113 patients with QTR were screened and rupture patterns/concomitant injuries (n = 33) were analyzed via MRI. Clinical outcome was assessed in 45 patients using the International Knee Documentation (IKDC) and Lysholm score with a mean follow-up of 7.2 (±5.0) years. (3) The evaluation of preoperative MRIs showed multiple ruptures of subtendons in 67% with concomitant knee injuries in 45%. The most common associated pathology detected using MRI was pre-existing tendinosis (31.2%). Surgical refixation demonstrated good results with a mean post-operative IKDC score of 73.1 (±14.1) and mean Lysholm score of 84.2 (±16.1). Patient characteristics and individual radiologic rupture patterns did not significantly affect the clinical outcome of patients. (4) Acute QTRs are complex injuries with common involvement of multiple subtendons. MRI imaging can be useful for achieving an accurate diagnosis as pre-existing tendinosis as well as concomitant injuries are common, and might be useful for providing an individual surgical strategy and improving outcomes.

Quadriceps Tendon Rupture with Avulsed Fracture of Patella and Resulting Patella Baja Deformity

Rupture of the quadriceps tendon is a rare injury. Predispositions such as recurrent microtrauma or degenerative changes are typically present. Clinical examination is typically sufficient to diagnose acute quadriceps tendon ruptures. People older than 40 with underlying medical issues are more likely to get quadriceps tendon ruptures. Early care improves the result and makes the damage debilitating. Radiographs and ultrasonography are frequently necessary for an early diagnosis when the traditional clinical signs are absent.

A Survey of Treatment Trends for Acute Quadriceps Tendon Ruptures Among North American Surgeons.

Background:To date, little clinical evidence exists to support a specific surgical technique or postoperative rehabilitation protocol for quadriceps tendon ruptures. With a lack of evidence-based superiority, assessment of clinical practices and surgeon preferences is pertinent.Purpose:To describe the current surgical technique and rehabilitation preferences among members of the Canadian Orthopaedic Association and American Orthopaedic Society for Sports Medicine pertaining to acute quadriceps tendon rupture.Study Design:Cross-sectional study.Methods:Orthopaedic staff members of the Canadian Orthopaedic Association and American Orthopaedic Society for Sports Medicine were invited to complete an internet-based survey composed of 26 questions assessing current trends in the management and rehabilitation of acute quadriceps tendon rupture. Survey questions were developed after a thorough review of current literature. Survey responses were analyzed and reported using descriptive statistics (absolute values, frequencies, and percentages) where appropriate. Statistical comparisons and contrasts between Canadian and American surgeons were made using chi-square analyses and Student t tests.Results:A total of 264 surgeons participated in the survey (136 Canadians; 128 Americans). Canadian surgeons were more likely to obtain a preoperative ultrasound as compared with Americans (43.0% vs 6.7%; P < .00001), while American respondents were more likely to obtain magnetic resonance imaging scans (65.8% vs 10.2%; P < .00001). The transosseous drill hole technique was the most commonly utilized (70.2%); the suture anchor technique was used 20.6% of the time. Canadian respondents trended toward a higher use of transosseous tunnels; however, this was not statistically significant (75.8% vs 64.2%; P = .068). American respondents were more likely to utilize suture anchors (27.5% vs 14.1%; P = .0096). Most respondents advanced range of motion goals stepwise in 2-week intervals of 30° (Canadians, 54.0% vs Americans, 58.5%; P = .3091); timing of range of motion initiation varied.Conclusion:Among North American surgeons who responded to this study, the transosseous technique was the most commonly used, and range of motion was generally advanced in a 2-week stepwise fashion. We found several differences in practice between Canadian and American respondents, including the type of preoperative imaging and the frequency of using the suture anchor technique.

Acute Quadriceps Tendon Rupture: Presentation, Diagnosis, and Management.

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.

V-Y turndown flap augmentation for acute quadriceps rupture after total knee arthroplasty: a prospective matched cohort study.

To evaluate the effectiveness of the quadriceps V-Y turndown augmentation for acute quadriceps tendon ruptures in the setting of TKA. Prospective cohort of 22 patients with quadriceps rupture after TKA were compared with 44 matched patients underwent TKA without quadriceps rupture. Quadriceps ruptures were treated within threeweeks after injury by suture augmented with Scuderi quadriceps V-Y turndown flap. Clinical evaluation was performed by the Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion. Patellar height was assessed by the Blackburne-Peel ratio. The mean follow-up was 3.3 (range, 3-4) years. At the final follow-up, there were significant improvements in mean KSS scores in both groups (p = 0.001). In the quadriceps group, the mean flexion for all patients, but one with arthrodesis for periprosthetic infection, was 100.1° (range, 90-110°) and mean extensor lag was 7.1° (range, 0-20°). There were significant differences between groups in KSS scores (p = 0.001). Active flexion (p = 0.020) and extension (p = 0.001) were significantly better in the control group. However, there was no significant difference in WOMAC scores (p = 0.252) or patient satisfaction (p = 0.352). There were no quadriceps reruptures. One patient with periprosthetic infection was treated with arthrodesis. The quadriceps V-Y turndown is an effective and safe procedure for quadriceps ruptures in the setting of TKA. Although the functional outcomes were lower than in TKA patients with no quadriceps rupture, the quality of life and satisfaction were successful in the TKA patients with quadriceps rupture.

Isokinetic Evaluation of Knee Strength and Endurance in Hemodialysis Patients Treated with the Transpatellar Tunnel Technique for Bilateral Spontaneous Quadriceps Tendon Ruptures.

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.

Acute quadriceps tendon rupture repaired by suture anchors and artificial ligament in 2 cases

Acute quadriceps tendon rupture repaired by suture anchors and artificial ligament in 2 cases

Better knee function after surgical repair of acute quadriceps tendon rupture in comparison to acute patellar tendon rupture

IntroductionThe purpose of this study was to determine if there is a difference in knee function between patients with quadriceps tendon rupture and patellar tendon rupture after acute surgical repair. Our hypothesis was that knee function would be similar between the two groups. MethodsThe study population included 24 patients; 13 patients suffered from quadriceps tendon rupture and 11 patients from patellar tendon rupture. All patients underwent acute surgical repair using heavy non-absorbable trans-osseous sutures; another non-absorbable suture, passed through both retinaculum and around the repaired tendon to augment the repair. Clinical evaluation was performed using the Lysholm, Kujala, and VAS scoring systems. In addition, radiographic evaluation to evaluate patellar height and patello-femoral joint arthritis using Iwano's classification was performed. ResultsThe average follow-up time was 70.5 months. All patients in the quadriceps tendon group had full range of knee motion while 3 patients (27%) in the patellar tendon group had reduced knee flexion. Patients in the quadriceps tendon group had a significantly higher Kujala score in comparison to the patellar tendon group (88 vs. 73 p=0.033). No significant differences were identified between the two groups according to the Lysholm scoring system. Patients in the quadriceps tendon group had significantly less pain according to VAS scale (1.2 vs. 3.5 p=0.012). Radiographic evaluation revealed that two patients from each group showed signs of grade II patello-femoral joint arthritis according to Iwano's classification. ConclusionAcute surgical repair of quadriceps tendon ruptures provides better knee function, in comparison to the surgical restoration of patellar tendon rupture. Level of evidenceLevel III, retrospective comparative study.

Acute quadriceps tendon rupture repaired by suture anchors: Outcomes at 7 years’ follow-up in 25 cases

IntroductionAcute 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. MethodsA 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. ResultsAt 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. ConclusionOutcomes 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 evidenceIV, retrospective cohort study.

Arthroscopic suture repair of acute quadriceps tendon ruptures

Acute quadriceps tendon ruptures disrupt the continuity of the extensor mechanism and must be treated surgically. Tendon reattachment with suture anchors has recently been shown to be biomechanically superior to reattachment through transosseous tunnels. In this context, arthroscopy is an interesting alternative. It can limit postoperative wound healing and infectious complications, while ensuring functional outcomes that are equivalent to standard techniques. The goal of this technical note is to describe an original, reproducible method for arthroscopic reattachment of the quadriceps tendon with suture anchors. Four patients were operated using this technique in a pilot study. No wound healing, infectious complications or re-tears were observed. At 6 months’ postoperative, the mean subjective IKDC score was 85.8/100.

Synthetic Mesh Augmentation of Acute and Subacute Quadriceps Tendon Repair.

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.

Acute quadriceps tendon ruptures: A series of 50 knees with an average follow-up of more than 6 years

IntroductionQuadriceps tendon ruptures are rare and mainly affect patients over 40 years of age who have a systemic disease. The aim of this study was to evaluate the functional and radiological outcomes following surgical repair of acute quadriceps tendon ruptures. MethodsThis retrospective study included 68 knees in 65 patients (three women, 62 men), having an average age of 55.2 ± 13.9 years. The Lysholm and Tegner scores, patient satisfaction, range of motion and X-rays were evaluated. ResultsFifty knees were evaluated with a mean follow-up of 76±67 months (12–253months). The average Lysholm score was 93.7±10 (range 56–100, median 99) and 49 of 50 knees (98%) had good or very good subjective results. The average Tegner score was 3.4±1.6 (range 1–9, median 4). At the last follow-up, the average active flexion was 133°±10.8° (range 110°–150°, median 130°). Minor or moderate patellofemoral osteoarthritis was found in 24% of knees, but this was attributed to the surgery or initial injury in only 8% of cases. For 97% of active patients, the surgical repair allowed them to return to work in their pre-injury occupations. ConclusionQuadriceps tendon ruptures have a good prognosis if they are diagnosed quickly. Treatment consists of surgery and postoperative immobilization for at least 6 weeks. An intensive rehabilitation protocol is also needed to recover good knee function. Level of evidenceLevel IV. Retrospective study.

Acute quadriceps tendon rupture: a pragmatic approach to diagnostic imaging

Quadriceps tendon ruptures are uncommon injuries, occurring most frequently in males over 40 years and associated with obesity, renal failure and steroids. Literature states that ultrasonography and magnetic resonance imaging have a role in diagnosis. We discuss the contrasting advantages and disadvantages of each imaging modality and establish their diagnostic value. A closed loop audit cycle was performed over 68 months by reviewing all patients presenting with a suspected acute quadriceps tendon ruptures to a Teaching Hospital. Sixty-six patients were included in the study; 4/47 patients in the initial audit period were inaccurately diagnosed, either clinically or by ultrasonography, leading to surgical exploration identifying an intact quadriceps tendon. This highlighted the need for improved pre-operative diagnosis and a recommendation to increase the use of magnetic resonance imaging. In the second cycle, the use of magnetic resonance imaging increased from 4 to 42% (p = 0.0004) and misdiagnosis fell from 4/47 (9%) to 1/19 (5%). Ultrasonography was shown to be highly sensitive (1.0) but the specificity of this modality was only 0.67 with a positive predictive value of 0.88. Magnetic resonance imaging displayed a sensitivity of 1.0, a specificity of 1.0 and a positive predictive value of 1.0. We propose that all patients who have a suspected quadriceps tendon rupture after clinical examination and radiography should either proceed directly to magnetic resonance imaging or be initially assessed by ultrasound, and in those with positive findings, a supplementary magnetic resonance imaging to eliminate false positive diagnoses.

A new technique for repair of quadriceps tendon rupture by transpatellar PDS cerclage

Quadriceps tendon ruptures are relatively unusual injuries caused by direct or more frequently indirect trauma. Since complete ruptures lead to loss of active extension of the knee joint, operative treatment is usually indicated. Several techniques are described in the literature. However, relatively little is known about the functional outcome after operative treatment of acute quadriceps tendon ruptures. We present a new operative technique using a 1.3-mm PDS cord passed through a transverse drill hole in the proximal pole of the patella. We operated ten consecutive cases of complete quadriceps tendon ruptures with the technique described between January 2000 and June 2003. Eight of ten patients were evaluated after a mean follow-up time of 38 months by physical examination, IKDC Subjective score, Lysholm and Tegner score as well as an isokinetic test of the quadriceps strength. No complications were noted in this period. The average postoperative scores were 87 (IKDC), 98 (Lysholm), and 4.5 (Tegner). Isokinetic testing showed an average of 25% quadriceps strength deficit. The operative treatment of complete quadriceps tendon ruptures using a PDS cord through a drill hole in the patella is a safe and effective technique permitting functional postoperative treatment.

Ultrasonography as a reliable diagnostic tool in old quadriceps tendon ruptures: a prospective multicentre study

Quadriceps tendon rupture is an uncommon injury. In the majority of cases, predispositions as recurrent microtrauma or degenerative changes are present. The diagnosis of acute quadriceps tendon ruptures can usually be made by clinical examination. Ultrasonography has been shown as a reliable, inexpensive and easily available diagnostic tool to confirm the diagnosis. In this study, we evaluated the clinical value of ultrasonography for establishing diagnosis of old quadriceps tendon ruptures. In the prospective time period of 6 years (01/1998-12/2003), the delayed diagnosis of quadriceps tendon rupture was established in six patients with seven cases of old ruptures (one bilateral rupture). The mean age was 50.2 (SD+/-16.9) years in one woman and five men. The mean interval from trauma until diagnosis was 15.2 (SD+/-7.1; range 8-24) weeks. In all cases, ultrasonography represented a reliable and sensitive tool for establishing diagnosis of old quadriceps tendon rupture. We therefore recommend the use of ultrasonography in the diagnostic work up of cases with knee trauma and potential involvement of tendon injuries.