Quadriceps Rupture Research Articles

Adjustable Cortical Fixation Repair Is a Safe and Effective Technique for Quadriceps Tendon Rupture

To report the clinical outcomes of quadriceps tendon repair using adjustable cortical fixation devices at a minimum 2-year follow-up. A retrospective chart review identified patients who underwent quadriceps tendon repair using adjustable cortical fixation devices between January 2017 and March 2020. Patients with a partial tendon rupture were excluded. Demographic and injury-specific variables were gathered preoperatively and postoperatively from the electronic medical record and patient-reported outcomes (Lysholm Knee Questionnaire, Lower Extremity Functional Scale, and SF-12) were collected via telephone at a minimum of 2 years postoperatively. Fourteen quadriceps tendon repairs were included in a total of 13 patients. The average time to follow-up was 3.5 ± 1.2 years with a range of 1.9 to 5.7 years. The mean age of this cohort was 55.7 ± 11.6 years, and the mean body mass index was 32.9 ± 6.0. Ten injuries (71.4%) were sustained by mechanical fall, 2 patients (14.3%) suffered a direct blow to the knee, and 2 patients (14.3%) reported a noncontact injury mechanism. Thirteen quadriceps ruptures (13/14, 92.9%) underwent surgery within 10 days of their injury. One knee (7.1%) had a postoperative extensor lag of 5°, whereas another knee (7.1%) required a reoperation for manipulation under anesthesia and arthroscopic lysis of adhesions at 3 months' postoperatively. None of the included patients (0.0%) developed a tendon re-rupture, venous thromboembolism, delayed wound healing, surgical-site infection, neuropraxia or nerve injury, hardware irritation, patella fracture, or heterotopic ossification. In this study, adjustable cortical fixation was a safe and effective surgical technique for quadriceps tendon repair, with adequate restoration of quadriceps function and a low rate of adverse events at 2 years postoperatively. Level IV, therapeutic case series.

Quadriceps autograft is a viable graft choice for arthroscopic ACL reconstruction in patients over 50 years of age

PurposeThe purpose of this study was to evaluate the patient-reported outcomes, graft failure, quadriceps rupture and sports preference after arthroscopic ACL reconstruction in patients older than 50 years who underwent arthroscopic ACL reconstruction with a quadriceps tendon (QT) autograft.MethodsBetween 2010 and 2020, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction and a minimum of 2 years of follow-up were included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than a QT autograft, and patients with a contralateral knee injury or osteoarthritis (Ahlbäck stage 2 or higher) were excluded. A minimally invasive technique was used for QT autograft harvesting. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport.ResultsA total of 57 patients were included in the study. The mean age of the cohort was 54.9 ± 5.2 (range 50–75). Of the 57 reconstructions, 16 (28%) were isolated ACL reconstructions, while 41 (72%) were complex reconstructions (concomitant meniscus, cartilage and/or collateral ligament injuries). At the 2-year follow-up Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores (n.s.). No case of graft failure or quadriceps tendon rupture was reported. No significant difference was noted in the pre-injury and postoperative sports preference (n.s.) and all patients return to their desired sports activity.ConclusionArthroscopic ACL reconstruction by using QT autograft in highly active older patients provides satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity. QT autograft is a good graft option in patients older than 50 years.Level of evidenceLevel IV.

Transosseous Suture Fixation in Quadriceps Rupture: A Surgical Technique and a Case Report

Abstract Background: An important goal of surgical treatment of the quadriceps or patellar tendons is to provide sufficient strength for performing range-of-motion exercises soon after surgery. A popular treatment for repair of acute quadriceps tendon rupture is to insert sutures through patellar bone tunnels, which yields good to excellent results in most cases. Objective: We report the case of quadriceps tendon rupture in a young male, his radiological findings, intervention received, and the review of relevant literature as well as outcomes. Case Presentation: A 29-year-old obese man presented with a 10-day-old quadriceps rupture, which was repaired with transosseous patellar fixation. A 6-month follow-up revealed a satisfactory clinical and functional outcome. Discussion and Conclusion: Repair of acute quadriceps tendon tear repair by passing sutures through patellar bone tunnels is a popular and successful technique to preserve the knee extensor mechanism and to provide sufficient strength for range-of-motion exercises.

Neglected Quadriceps Rupture Managed with Polypropylene Mesh and Collacure: A Case Report

Background: Quadriceps muscle rupture is second common cause of disrupted extensor mechanism by directly affect lower limb function by hinders knee extension drastically. Ideally, patient with quadriceps tendon rupture and undergo primary surgical repair in first 48–72 hours after injury to achieve good outcome then decrease morbidity and disability. Chronic untreated quadriceps tendon rupture with adverse progression of gap cause by muscle contraction, scarred muscle body, degenerative calcification, or decreased tendon end vascularity lead to pain in contraction, worsening morbidity and disability as well makes surgical repair more technically challenging. We report one case of chronic untreated quadriceps muscle rupture, our management, and outcomes. Clinical case: 27 years old male with right quadriceps rupture that occurred accidently while he was descending stairs. The patient then went to bonesetter and just went to the hospital after a long time of complaints of pain and are not getting better. In the right knee, the neglected quadriceps rupture was managed with polypropylene mesh and collacure to shorthen the gap. Discussion: Management goal is to reduce large gap at quadriceps tendon to reach both end of the muscle in tension free manner and not only increasing regeneration of tendon but also increasing the strength of the tissues after healing by polypropylene mesh and collacure. Conclusion: Quadriceps reconstruction with polypropylene mesh and collacure have a fair result for extensor mechanism. Further research is required to determine best approach to quadriceps reconstruction in reducing gap.

A case series of traumatic extensor mechanism rupture managed by extensor mechanism reconstruction using Z-plasty of Quadriceps tendon and autologus tendon graft augmentation

Extensor Mechanism Injuries of knee are rare. True incidence of traumatic Patellar tendon rupture is unknown but is third in sequence after neglected Patellar fracture and quadriceps tears. Often the diagnosis or treatment of such cases are delayed, hence the biggest challenge here is to the need to bridge the gap caused by the contracted quadriceps muscle or the patellar tendon. i.e. Patella baja in quadriceps rupture and Patella alta in patellar tendon rupture. The goal of treatment is to bring down the displaced fragment and maintain its position by lengthening the contracted tissue and restore the Extensor mechanism through a bone to bone or a tendon to bone repair. We have treated 2 cases of delayed presentation of Extensor mechanism Injuries. The first case was a 40-Y-M with patella non union and the second case a 35-Y-M was a Left tibial plateau fracture (type -2) with ruptured Patellar tendon and associated ligamentous injuries. Both the patient were managed by reconstructing the Extensor mechanism.

A rare case of patellar fracture with quadriceps tendon rupture

<p>Quadriceps tendon rupture is the rarest injury with an incidence of 1.37/1,00,000/year. A patellar fracture is the most common injury associated with extensor mechanism lag, but it is rarely found to have quadriceps rupture rather than patellar tendon rupture. Normally when patella fracture occurs the force is disseminated at the bone level rather than at the muscular level. In this case, the force has disseminated at both muscle and bone leading to fracture of patella and quadriceps tendon rupture. Here we report a case of patellar fracture along with quadriceps tendon rupture.<strong></strong></p>

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.

Posttraumatic Perfusion Analysis of Quadriceps, Patellar, and Achilles Tendon Regeneration With Dynamic Contrast‐Enhanced Ultrasound and Dynamic Contrast‐Enhanced Magnetic Resonance Imaging

The healing process of tendons after surgical treatment of tendon ruptures mainly depends on the perfusion of the tendon and its surrounding tissue. Dynamic contrast-enhanced ultrasound (DCE-US) and dynamic contrast-enhanced MRI (DCE-MRI) can provide additional information about the local microperfusion. In this pilot study, the feasibility of these techniques to assess the vascularization during tendon regeneration was evaluated. Between 2013 and 2015, 23 patients with surgical treatment of traumatic rupture of quadriceps, patellar, and Achilles tendons were involved. All patients received clinical follow-up examinations at 6, 12, and at least 52 weeks postoperatively. Dynamic contrast-enhanced US and DCE-MRI examinations were performed 6 and 12 weeks postoperatively. Dynamic contrast-enhanced US perfusion was quantified by the parameters peak enhancement, wash-in area under the curve, rise time, and initial area under the curve. Correlations between these parameters were examined via the Spearman rank correlation. The clinical and functional outcomes were assessed via the Lysholm Knee Score and Knee and Osteoarthritis Outcome Score at 12 and 52 weeks postoperatively. Fourteen patients with quadriceps (n = 8), patellar (n = 4) and Achilles (n = 2) tendon ruptures with complete follow-up were available. The microperfusion could be successful assessed. We could detect a strong correlation of DCE-US (peak enhancement) parameters with DCE-MRI (initial area under the curve) parameters after 6 and 12 weeks. In this pilot study, DCE-US was able to visualize the microperfusion of healing tendons with a strong correlation with DCE-MRI. Our initial results are in favor of DCE-US as a potential quantitative imaging tool for evaluating the vascularization in tendon regeneration as a complementary method.

Bilateral Simultaneous Rupture of the Quadriceps Tendon in a Healthy Elderly Woman: A Case Report

Background: Quadriceps tendon ruptures are uncommon injury that affects middle-aged women, predominantly it affects middle aged men. However, the bilateral quadriceps tendon rupture is extremely rare in the absence of systemic disease. Subjects and Method: We reported a case of bilateral quadriceps tendon rupture in a healthy 65 year old female. She felt pain in both knees since 4 months before entering the hospital. Local physical examination on both knees reveal the loss of normal contour of rectus femoris, tenderness at superior pole patella the ruptur site, and palpable defect within 2 cm of superior pole patella. Patient unable to extend knee against resistance, and unable to perform straight leg raise. The patient was carried out a surgical repair with consent. Results: After the surgery both knees were immobilized with knee extension splint for 6 weeks. Patient evaluation revealed no pain and progressive recovery of muscular strength after four months and could be able to walk and returned to normal activity. Conclusion: Surgery is needed to repair quadriceps rupture. Keywords : Quadriceps tendon, quadriceps rupture, repair tendon. Correspondence: Pamudji Utomo. Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: utomodr@yahoo.com. Indonesian Journal of Medicine (2019), 4(1): 54-58 https://doi.org/10.26911/theijmed.2019.04.01.09

Primary repair for spontaneous quadriceps tendon rupture in patients with hemodialysis

Spontaneous quadriceps tendon rupture is not rare in patients with chronic renal failure needing dialysis due to the impaired collagen maturation in tendons. With transpatellar tunnel technique, the repair of the impaired tendon and successful healing are reported. The aim of this study is evaluate the functional results, strength and endurance of the quadriceps tendons after repair with transpatellar tunnel technique in hemodialysis patients with spontaneous quadriceps tendon ruptures. Primary repair with transpatellar tunnel technique is performed in 15 spontaneously ruptured quadriceps tendons of 9 patients with the mean age of 50,1 (6 bilateral, 3 unilateral ruptures). After a mean follow-up of 48.7 months, patients were evaluated with Lysholm score for functional evaluation. Isokinetic quadriceps strength and endurance measurements were performed with computerized dynamometer (CYBEX HUMAC–USA) and compared with a control group of 10 volunteers with chronic renal failure needing hemodialysis without quadriceps rupture history. The demographics of the study group and the control group were comparable in terms of age, body weight and dialysis year. 1 patient was deceased during follow-up due to end-stage renal failure. Of the 13 repairs evaluated, 1 repair failed after 3 months and needed revision surgery. Although at the latest follow-up all patients were doing active knee extension against gravity with their repaired quadriceps tendons and walk independently, the Lysholm score of the repair group (mean 75.3) was significantly lower than the control group (mean 93,2) (p: 0.009). The strength (peak torque) of the repaired quadriceps tendon was 43,6 Nm and was significantly lower than the control group (90,6 Nm) (p: 0.001). The endurance of the repaired tendon was also found to be significantly lower than the control group. 259 Nm and 625 Nm respectively (p: 0.001). Primary repair with transpatellar tunnel technique after spontaneous quadriceps ruptures in hemodialysis patients can provide acceptable functional results with active knee extension and independent walking ability. However the strength and endurance of the repaired tendon might be significantly lower than a impaired but unruptured quadriceps tendon.

Chronic Quadriceps Tendon Rupture After Total Knee Arthroplasty Augmented With Synthetic Mesh

Tear of the quadriceps tendon after revision or primary total knee arthroplasty is a rare complication, but when it occurs, this injury has serious functional consequences. In complete tears, the outcome of direct repair is unpredictable, and several authors recommend that the suture should be reinforced. Several techniques have been described, including the use of autografts, allografts, and synthetic mesh. The goal of this study was to assess the outcomes of a reconstruction technique augmented with synthetic mesh. A retrospective study was performed involving 3 patients who had chronic partial quadriceps tendon tear after total knee revision. In 2 cases, proximal quadriceps release was performed. When conservative management failed, surgical reconstruction with suture reinforced with synthetic mesh was attempted. The knee was immobilized in full extension for 6 weeks after the surgical procedure. A minimum follow-up of 12 months was required to assess results. All reconstructions showed clinical success at a mean follow-up of 19 months. Mean Knee Society Score improved from 55.7 to 87.3, with average postoperative extensor lag of 3.3° (range, 0°-10°). The mean visual analog scale pain score was 2.3 (range, 0-4). No complications were reported. Synthetic mesh has previously been shown to be an effective treatment for patellar tendon repairs after total knee replacement, but there have been few articles on quadriceps rupture. Surgical reconstruction with synthetic mesh is a viable option that provides good functional outcomes in chronic quadriceps tendon rupture after total knee arthroplasty. [Orthopedics. 2017; 40(1):38-42.].

Surgical Treatment of Neglected Traumatic Quadriceps Tendon Rupture with Knee Ankylosis.

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.

Polypropylene mesh augmentation for complete quadriceps rupture after total knee arthroplasty

IntroductionPolypropylene mesh has previously been shown to be an effective treatment for failed patellar tendon repairs after total knee arthroplasty (TKA), but there have been few reports of this synthetic mesh used in complete quadriceps rupture after TKA. MethodsWe retrospectively reviewed seven consecutive cases in six patients with complete quadriceps tears after TKA who had their quadriceps tendon repaired with suture and polypropylene mesh augmentation. All but two patients had previously failed primary suture repair. Patient outcomes were evaluated using the Knee Society Score. Standardized anterior-posterior (AP), lateral and merchant radiographs were evaluated preoperatively and at final follow-up. ResultsSeven knees in six patients were evaluated with a mean follow-up of 34±10 (range 24 to 49months) months. There were only four clinical successes defined as an extensor lag less than 30°. Of the functioning knees at final follow-up (n=5) the overall extensor lag in this group did significantly improve from 50±13° to 20±15° (range 5 to 40°) (p=.01). Mean postoperative flexion at final follow-up was 115±8°. Mean Knee Society Score for function improved from 20±30 to 45±54 (p=.03) as did the mean Knee Society Score for pain (44±18 vs. 74±78, p=.02). DiscussionPolypropylene mesh offered limited postoperative functional results when used as an augment to the multiply operated knee that sustains a complete quadriceps rupture after TKA, but did allow for significant improvement in postoperative pain outcomes. Level of EvidenceIV

Total Knee Arthroplasty Complicated by Partial Quadriceps Tendon Rupture: A Case Report

Disruption of the extensor mechanism after total knee arthroplasty is a rare but serious complication. It may involve the patellar tendon, patella or quadriceps tendon. Quadriceps tendon ruptures are less common and relatively few reports in the literature have addressed this complication. In particular, treatment guidelines for management of partial quadriceps rupture after total knee arthroplasty are lacking. Herein, we present the surgical technique and outcome of a patient with traumatic partial quadriceps tendon rupture after total knee arthroplasty using FiberTape and double figure of eight technique plus augmentation with TissueMend. J Med Cases. 2014;5(1):18-20 doi: http://dx.doi.org/10.4021/jmc1603w

Total Knee Arthroplasty Complicated by Partial Quadriceps Tendon Rupture: A Case Report

Disruption of the extensor mechanism after total knee arthroplasty is a rare but serious complication. It may involve the patellar tendon, patella or quadriceps tendon. Quadriceps tendon ruptures are less common and relatively few reports in the literature have addressed this complication. In particular, treatment guidelines for management of partial quadriceps rupture after total knee arthroplasty are lacking. Herein, we present the surgical technique and outcome of a patient with traumatic partial quadriceps tendon rupture after total knee arthroplasty using FiberTape and double figure of eight technique plus augmentation with TissueMend. J Med Cases. 2014;5(1):18-20 doi: http://dx.doi.org/10.4021/jmc1603w

Bilateral Quadriceps Rupture: Results With and Without Platelet-rich Plasma

This article presents a 46-year-old man with bilateral atraumatic quadriceps rupture that occurred while he was descending stairs. The patient underwent surgery the day after the accident. In the left knee, quadriceps reinsertion was performed using a conventional technique. In the right knee, platelet-rich plasma (PRP), both in its liquid and semisolid patterns, was added intraoperatively. Ultrasonography and magnetic resonance imaging evaluations were performed 1, 6, and 24 months postoperatively. At 6 and 24 months postoperatively, clinical and functional evaluations also were performed. Clinical examination showed no differences between the knees, and functional scores were the same for both knees. Ultrasonographic evaluation showed bilateral persistent tendon thickening and gross echotexture abnormalities, with no side-to-side differences. Magnetic resonance imaging showed signals of vascularized granulation tissue in both knees, which was more evident in the right (PRP) knee at 1 month postoperatively, along with a better signal of scar tissue in the right knee at 6 and 24 months postoperatively. The use of PRP yielded no better clinical or functional results than the lack of its use. However, a more intense and significant reparative healing process occurred where the PRP was used, thus suggesting a more rapid completion of the healing process, although this effect seems to remain only a radiographic finding with no clinical correlation.

Horizontal intra-articular patellar dislocation resulting in quadriceps avulsion and medial patellofemoral ligament tear

Intra-articular patellar dislocations are rare. We present a 13-year-old boy who sustained a complete horizontal intra-articular patellar dislocation following blunt trauma to the flexed knee. Closed reduction was unsuccessful and open reduction indicated a repairable quadriceps avulsion and medial patellofemoral ligament tear. He is the youngest patient to sustain a quadriceps rupture and the only patient to sustain a medial patellofemoral ligament tear to date. His flexed knee and the horizontally positioned patella (seen on lateral radiograph) were indicative of a complete rotational injury with extensor mechanism involvement. Open reduction allowed for the repair of both injuries and a favorable outcome.

Solid Organ Transplant Patients Experience High Rates of Infection and Other Complications After Total Knee Arthroplasty

Survival after solid organ transplants in the United States is increasing, and there is a need to understand the complications in knee arthroplasty patients who underwent organ transplantation. A retrospective study was conducted from 1993–2008 on 19 patients (23 knee arthroplasties) with previous successful solid organ transplants. Eleven knee arthroplasties were performed after renal transplantation, and 12 after nonrenal solid organ transplant (seven liver, four heart, one lung). Complications occurred in 9/23 patients (39.1%) and infections occurred in 4/23 patients (17.3%). Of the infected knees, two had MRSA, one had MSSA, and one Escherichia coli. Noninfectious complications (5/24, 21.7%) include aseptic loosening, quadriceps rupture, femoral fracture, hemarthrosis, and arthrofibrosis. All patients with complications were on immunosuppressant medications at the time of arthroplasty. There was a significantly higher rate of infection in the renal group compared to the non-renal group (P = 0.022). There was also a higher overall complication rate in the renal group however this did not reach significance.

Repair of Ruptured Neglected Quadriceps Tendon after Manipulation of Stiff Knee

We report the case of 28 year old male patient who suffered quadriceps rupture following manipulation of the stiff knee. We treated the patient with V-Y plasty procedure which is an uncommon procedure with successful results. The final range of motion was 90 degrees with 10 degrees of extensor lag.

Management of extensor mechanism rupture after TKA

Disruption of the extensor mechanism in total knee arthroplasty may occur by tubercle avulsion, patellar or quadriceps tendon rupture, or patella fracture, and whether occurring intra-operatively or post-operatively can be difficult to manage and is associated with a significant rate of failure and associated complications. This surgery is frequently performed in compromised tissues, and repairs must frequently be protected with cerclage wiring and/or augmentation with local tendon (semi-tendinosis, gracilis) which may also be used to treat soft-tissue loss in the face of chronic disruption. Quadriceps rupture may be treated with conservative therapy if the patient retains active extension. Component loosening or loss of active extension of 20° or greater are clear indications for surgical treatment of patellar fracture. Acute patellar tendon disruption may be treated by primary repair. Chronic extensor failure is often complicated by tissue loss and retraction can be treated with medial gastrocnemius flaps, achilles tendon allografts, and complete extensor mechanism allografts. Attention to fixing the graft in full extension is mandatory to prevent severe extensor lag as the graft stretches out over time.