Quadriceps Tendon Rupture Research Articles

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.

Bilateral Quadriceps Tendon Repair with Suture Anchors: Case Series.

Bilateral and simultaneous quadriceps tendon rupture is rarely observed. This case series evaluates 3 patients with bilateral ruptures of the quadriceps tendon. The purpose of this case series is to display the effectiveness of the suture anchor surgical repair technique in these patients. Three obese male patients experienced some type of traumatic injury to the knee extensor mechanism, resulting in bilateral quadriceps tendon ruptures. Each of the patients was evaluated and given operative and nonoperative treatment options, and they all elected to undergo surgical tendon repair. Two double-loaded anchors were placed into the superior pole of the patella, allowing the tendons to be reduced back to their original positioning. Postoperatively, all patients were given the same guidelines for physical therapy, and their progress was monitored periodically. Each patient returned to his normal level of physical activity. Range of motion at the knee and weight bearing were reestablished in all 3 patients. These quadriceps tendon ruptures occurred in patients with a predisposition to injury as a result of excessive weight bearing. When addressing bilateral quadriceps tendon ruptures in this patient population, we found that a suture anchor-based construct allows for a secure repair, early initiation of physical therapy, and a noted improvement in pain scores on the Visual Analog Scale.

Role of MRI in Evaluation of Anterior Knee Pain

Abstract Background: MRI is well known for being particularly useful for scanning and detecting abnormalities in soft tissue structures like the cartilage tissues, tendons, and ligaments. Moreover, MRI can also aid in determining those patients with knee injuries who will require surgical intervention. MR imaging is recognized as a standard procedure and has replaced diagnostic arthroscopy as the primary diagnostic modality for many knee pathologies. Furthermore, MR images can be used to assess anatomic variants that may contribute to chronic patellar instability. Aim of Study: To go over several of the most common causes of Anterior Knee Pain (AKP), with emphasis on their MRI findings with the goal of allowing diagnosis that is more accurate and grading of some of the most common pathologies, for interpreting, reaching an efficient treatment and drastic improvement of this common complaint. Patients and Methods: This study included 25 patients (8 females and 17 males). Their ages ranging between 10-60 years (average age 30 years). All presented by anterior knee pain and were referred to Radiology Department of Ain Shams University Hospital or private centers for MRI examination after orthopedic consultation. This descriptive study was done to detect the role of MRI in the evaluation of anterior knee pain and apply advanced MRI techniques such as sagittal T2 mapping to visualize the articular cartilage of the knee. Most patients were subjected to MR imaging of the affected knee joints on high field strength scanners using Philips scanners Achieva or Intera (1.5T). Results: The present study revealed that 26% patellar tendon disorders which included (patellar Tendinopathy 21% and Osgood Schlatter disease 5%). Quadriceps tendon disorders represented 10% and they are including (Quadriceps Tendin-opathy 5% and Quadriceps tendon tear 5%). 69% of the sample size showed Patellar disorders represent and they are including (chondromalacia patella 32%, patellar instability 21%, transient patellar dislocation 11% and painful bipartite patella 5%). Hoffa's disease was demonstrated in 21% of the sample size and they are including (Hoffa impingement syndrome and Hoffa ganglion cyst), finally we have torn anterior horn of the lateral meniscus and they represent 5%. Conclusion: MRI is generally safe, accurate, and specific modality, which has been proven to be the modality of choice in the diagnosis of different knee pathologies that cause anterior knee pain in different age groups. Also it has a high specification in detecting the grades and types of some of these diseases or factors predispose to them as patella Alta and trochlear dysplasia.

Open tibia plateau fracture with intra-osseous dislocation of the patella and quadriceps tendon rupture: a case report

BackgroundBoth tibial plateau fractures and extensor apparatus injuries are serious injuries to the knee joint that generally do not occur in the same patient. We report a rare case of open tibial plateau fracture combined with quadriceps tendon rupture and complete displacement of the patella into the tibial plateau fracture.Case presentationThe case involved a male who was 19 years old who had been in a motorcycle accident. The patient was admitted to our department with an open tibial plateau fracture 3 h post-injury. X-ray showed a tibial plateau fracture and complete displacement of the patella into the tibial plateau. CT showed an avulsion fracture in the patella and tibial intercondylar eminence. Concomitant quadriceps tendon injury and both anterior and posterior cruciate ligament tibial insertion avulsion fractures were considered. The operative findings of emergency surgery confirmed our preoperative diagnosis. Single-stage quadriceps tendon repair and ORIF for the tibial plateau fracture were performed. Satisfactory restoration of function was acquired at the last follow up.ConclusionThe most difficult aspect of this case was the determination of the cause of the intra-osseous dislocation of the patella into the tibial plateau. The most likely mechanism of the injury may be that the patient experienced transient posterior dislocation of the knee during the injury. Rupture of the quadriceps tendon should be considered with posterior dislocation of the knee, and the patella was pushed into the tibial plateau fracture by force after the rupture of the quadriceps tendon.

An Unexpected Smile

Question: A 79-year-old man with a history of diabetes and dyslipidemia experienced painful swelling in the left knee after falling onto the ground. He noticed that his dentures were missing after the fall; however, he could not recall whether he swallowed the dentures. Consequently, he was sent to the emergency department and diagnosed with a quadriceps tendon rupture and periosteal sleeve avulsion fracture of the left patella. A lateral view of the neck did not reveal any radiopaque lesion, and the prevertebral soft tissue thickness remained normal (Figure A).

A simultaneous bilateral quadriceps and patellar tendons rupture in patients with chronic kidney disease undergoing long-term hemodialysis: a case report

BackgroundThe incidence of rupture of the quadriceps or patellar tendon s is low, especially that of bilateral quadriceps tendon rupture, and it is generally considered a complication secondary to chronic systemic disorders. We report two rare cases of simultaneous bilateral tendon rupture affecting the extensor function of the knee in patients with chronic kidney disease who have been treated with long-term haemodialysis.Case presentationTwo young males with a history of chronic kidney disease who were being treated with long-term haemodialysis presented to our hospital with clinical signs of disruption of the extensor mechanism of the knee. One patient was diagnosed with bilateral quadriceps tendon rupture, and the other patient had bilateral patellar tendon rupture. They underwent surgical repair of the tendons, and their knees were actively mobilized during physiotherapy.ConclusionBilateral quadriceps or patellar tendons rupture is a rare occurrence in patients with chronic kidney disease who are being treated with long-term haemodialysis. Timely surgical treatment and scientific physiotherapy can lead to good recovery of knee joint function.

Disrupted quadriceps tendon post knee arthroplasty: A case series.

QTR (Quadriceps Tendon Rupture) occurs rarely after TKA (Total Knee Arthroplasty) but is a severe complication which has an association with morbidity and adverse outcomes. Rare literary evidence is available which deals with the complications. Delayed management may cause adverse outcomes so the focus is on the timely management of the disease; although, the diagnosis process is full of challenges because we expect weaker quadriceps after TKA as the surgical intervention violates quadriceps muscle. In case of postoperative trauma with the outcomes of weaker extensor weakness, a USG assessment is necessary to reduce the chances of prompt QTR performance after exclusion of the fracture. We have shared our experience about the treatment of four cases of QTR in the early postoperative time with focused efforts on prevention. We can reduce the chances of rupture with meticulous surgical approaches in the course of medial parapatellar method in order to preserve quadriceps integrity.

A case of total knee arthroplasty for SPONK with old quadriceps tendon rupture

A case of total knee arthroplasty for SPONK with old quadriceps tendon rupture

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

Rutura Crónica Bilateral do Tendão Quadricipital: Diagnóstico Tardio e Reparação Direta

A rutura bilateral do tendão quadricipital é uma lesão rara, não sendo muitas vezes diagnosticada na apresentação inicial.Apresenta-se o caso de um doente de 41 anos, género masculino, sem antecedentes médico-cirúrgicos ou medicação habitual, com diagnóstico tardio de rutura bilateral do tendão quadricipital (3 meses de evolução) após traumatismo de baixa intensidade. Foi submetido a reparação do tendão quadricipital com sutura transrotuliana e ancoragens à rótula bilateralmente. O pós-operatório decorreu sem intercorrências, tendo iniciado programa de reabilitação funcional com obtenção de arco de mobilidade de 0-120° aos 6 meses de seguimento.O diagnóstico de rutura bilateral do tendão quadricipital requer elevado grau de suspeição clínica pela sua raridade e variabilidade de apresentação. O tratamento precoce poderá estar associado a menor dificuldade cirúrgica e melhor resultado funcional. No presente caso foi possível a reparação direta com sutura transrotuliana do tendão e reforço de âncoras, com recuperação funcional sobreponível ao estado prévio ao traumatismo.

Rehabilitation exercise program after surgical treatment of quadriceps tendon rupture: A case report

ObjectivesThis case report describes in detail the rehabilitation exercise program, provide post-operative therapeutic objectives/recommendations and to facilitate the return to a possible schedule of ADL and participation in sports after the surgical treatment of quadriceps tendon rupture. Also, the exact surgical technique is described. DesignA single case report. ParticipantThe patient was an active 53-year-old man who sustained this injury as a result of a sudden misstep with his left foot into a hole, while he was trekking across muddy countryside. Clinical examination of the knee revealed skin ecchymosis, swelling and tenderness over the distal thigh. Plain radiographs showed patella baja, and the scheduled magnetic resonance imaging (MRI) showed interrupted continuity of the quadriceps tendon and the patella. A diagnosis of quadriceps tendon rupture was made and the patient was scheduled to undergo surgical intervention the following day. Rehabilitation exercise programA well-structured rehabilitation exercise program was followed in order to ensure rapid recovery and good functional outcomes. His postoperative course progressed normally, demonstrating a return to the normal activities of daily living at 6 weeks, full active range of motion at 16 weeks, and return to sports recreational activities at 5 months. ConclusionsAn early surgical treatment and subsequently a well-structured rehabilitation exercise program have contributed to maximize the functional outcomes of the patient and provide a rapid and safe return to the activities of daily living (7th week) with participation in non-contact sports after the 18th week.

Massive Quadriceps Tendon Repair Using Suture Anchors: A Case Report and Literature Review

The quadriceps tendon is the largest tendon and a fulcrum for function of the most powerful muscles in the human body and has great influence on knee function and independent walking ability. A complete rupture of quadriceps tendon is rarely reported in patients without known co morbidities. In the present case was a 65-year-old male presented with severe pain and inability to extend his right knee after missing a step while walking in his compound. His physical examination revealed the presence of a suprapatellar gap and inability to extending his right knee. Knee X rays revealed a small avulsion fracture of the medial femoral condyle. The magnetic resonance imaging (MRI) also confirmed a diagnosis of complete rupture of his right quadriceps tendon at the insertion point. He denied having systemic disease or being on chronic steroid use. The patient underwent a successful operative repair of the tendon using two arthrex suture anchors. Intraoperatively we found that the right quadriceps had ruptured transversely at the tendon insertion. During the two-month follow-up after the surgery, the patient received a full rehabilitation with a satisfactorily outcome.

Comparing clinical and patient reported outcomes of suture anchor and transosseous repairs of quadriceps tendon rupture

Quadriceps tendon ruptures are relatively uncommon but severe injuries to the extensor mechanism are usually treated surgically. The purpose of this investigation was to compare the results following a standard transosseous (TO) repair to a suture anchor (SA) repair. A retrospective cohort was analyzed from a single institution with a total of 10 SA and 17 TO repairs meeting inclusion criteria. Average clinical follow up was 5.8 months and 15.2 months for the SA and TO groups, respectively. Re rupture rates were 9% and 13%, with total complication rates of 27% and 32% for the SA and TO groups, respectively. Knee flexion was 117° for SA repairs and 128° for TO repairs after a minimum of 3 months. Mean Lysholm scores were 63 and 72.8, recorded at a mean of 4.7 years and 5.5 years after the SA and TO repairs, respectively. Operative time was similar between both groups at 93 min and 90 min for the SA and TO groups, respectively. This study showed that the clinical results, re rupture rates, complications, and operative times were similar between suture anchor and transosseous repairs of the quadriceps tendon. Therefore both techniques are appropriate for the management of this debilitating injury.

Modified V-Y Turndown Flap Augmentation for Quadriceps Tendon Rupture Following Total Knee Arthroplasty

Quadriceps tendon rupture following total knee arthroplasty (TKA) is an infrequent but potentially devastating adverse event. Although uncommon, the long-term sequelae of this injury can result in permanent inability to walk. Despite the severity of this injury, there is no single accepted treatment, with various surgical methods producing mixed results. Therefore, the purpose of this study was to assess the efficacy of a modified V-Y turndown flap as a viable alternative method of treatment for this injury. Twenty-four quadriceps tendon ruptures in 23 patients (10 men and 13 women) who underwent TKA (8 primary and 15 revision), including 1 tendon rerupture, were treated with use of a modified V-Y turndown. The average patient age at the time of the V-Y flap repair was 61 years (range, 41 to 86 years). Knee Society scores, range of motion, strength, medical comorbidities, nature of the procedure (i.e., primary versus revision), and the ability to walk were all recorded before and after the quadriceps reconstruction, along with general satisfaction and adverse events following the procedure. Twelve patients (52%) had predisposing comorbidities, including obesity, diabetes, chronic dialysis, and steroid dependence. Prior to repair with the V-Y flap, none of the patients were able to walk independently, requiring either a wheelchair or walker. No patient had quadriceps strength greater than 3 (of 5), although all had full passive extension. Following the repair procedure, patients had significant (p < 0.0001) improvements in mean Knee Society knee score (88.7; range, 45 to 95) and mean strength (4.8; range, 3 to 5), and all were able to walk without assistive devices. Twenty knees exhibited active range of motion of 0° to 120°, whereas 4 had residual extensor lag of ≥5° (range, 5° to 35°). Major adverse events were limited to a single hematoma and an unacceptable extensor lag (35°) after repair. The modified V-Y quadriceps tendon turndown flap was a reliable alternative treatment for achieving restoration of the extensor mechanism after complete quadriceps tendon rupture following TKA. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Suture Anchor Repair of Quadriceps Tendon and Patellar Tendon Ruptures

Purpose: To document patient-reported function, range of motion (ROM), and failure rate of a surgical technique for repairing quadriceps tendon (QT) and patellar tendon (PT) ruptures with suture anchors. Methods: Consecutive patients 18 years of age or older who had isolated QT or PT ruptures treated with suture anchor repair between 2004 and 2014 were identified. Patients were included if preoperative and minimum 6-month postoperative International Knee Documentation Committee (IKDC) scores and/or minimum 8-week postoperative ROM had been collected. The effects of patient age, interval between injury and surgery, and length of follow-up period on postoperative IKDC scores were analyzed with Pearson correlation. Results: QT repair was performed in 36 patients with a mean postoperative IKDC score of 66.9 and mean ROM of 0 to 116 degrees. PT repair was performed in 27 patients with a mean postoperative IKDC score of 64.4 and mean ROM of 0 to 117 degrees. The failure rate of the 63 suture anchor repairs was 4.8%. There was no significant correlation between IKDC score and either increasing age (r=−0.23, P=0.15), increasing interval between injury and surgery (r=0.12, P=0.46) or length of follow-up period (r=0.07, P=0.67). No significant difference in IKDC score was found between knot-tied and knotless suture anchor repairs (P=0.4). Conclusions: Suture anchor repair of QT and PT ruptures results in full active extension and a low failure rate, but IKDC scores indicate continued functional deficits in most patients. Level of Evidence: Level IV—therapeutic.

Simultaneous quadriceps and contralateral patellar tendon ruptures in a patient with chronic renal failure following electric shock; a case report and review of the literature

Abstract Bilateral extensor tendon ruptures of the knee are not uncommon. However, simultaneous ruptures of the patellar tendon (PT) and contralateral quadriceps tendon (QT) are relatively rare injuries. These ruptures are frequently associated with chronic renal failure and minor trauma. However, they can occur spontaneously in healthy individuals. In this case report, a 43-year-old male with chronic renal failure who sustained bilateral extensor tendon ruptures (right knee: QT rupture, left knee: PT rupture) following an alternating current electrical shock was reported. To our knowledge, simultaneous quadriceps and contralateral patellar tendon rupture following an electric shock have not been reported yet. Etiology, mechanism of injury and treatment options of this rare injury are discussed together with a thorough literature review.

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

Purpose: Suture anchor repair is a fairly new surgical technique for quadriceps tendon ruptures. It is supposed to be superior to the standard transosseus sutures because of biomechanical superiority and – due to a less invasive surgery – earlier rehabilitation onset. This study focused on analyzing functionality of the quadriceps muscle during gait as well as body composition between a suture anchor and a transosseus suture repair group and is the first study that undertook systematic gait analyses in this patient population. Materials and methods: Seventeen patients who underwent either suture anchor (9 subjects) or transosseus suture repair surgery (8 subjects) at two different trauma surgery centers between 2010 and 2015 were included. Gait analysis was performed with a three dimensional motion capture system (Vicon) and body composition was assessed with bioelectrical impedance analysis (Nutribox). Parametrical statistical analyses were conducted using independent t-tests. Results: No statistically significant differences were found in any outcome parameter of gait analysis or body composition measurement. Conclusion: Suture anchor repair shows equal results to transosseus suture repair technique regarding gait quality and body composition. Implications for rehabilitation In a long term follow-up suture anchor repair shows similar results to the transosseus suture technique regarding body composition and musculus quadriceps function in gait. Without the implementation of an appropriate rehabilitation protocol incorporating the earlier load-carrying capacity, early biomechanical advantages of suture anchor technique over transosseus sutures might vanish over time. The decision which surgery technique might be best for the individual patient, should not be based on the expectation that suture anchor repair alone without considering appropriate rehabilitation would lead to long term functional advantages over transosseus suture technique.

Metaphyseal Fixation Using Highly Porous Cones in Revision Total Knee Arthroplasty: Minimum Two Year Follow Up Study

BackgroundHighly porous metaphyseal cones have been introduced to restore metaphyseal integrity for improved cement interdigitation to achieve durable fixation in revision total knee arthroplasty (TKA). The purpose of this study is to review the survivorship, clinical results, and complications of revision TKA using highly porous 3-dimensionally printed titanium metaphyseal cones. MethodsThis is a review of 62 revision TKAs using metaphyseal tibial cones, with 15 cases utilizing both tibial and femoral cones. The mean age of the patients was 66 years (range 32-84) who had a mean follow-up of 27 months (range 24-34). There were 38 women and 24 men, who had a mean body mass index of 33 (range 18.3-62). ResultsRevision-free survival of the cones was 90.2%. If infection was excluded, survivorship was 100%. There were no cases of aseptic loosening. The mean Knee Society Score improved from 51 points preoperatively to 80 points at the time of latest follow-up. The mean Knee Society Functional Score improved from 48 points preoperatively to 68 points. A total of 15 of the 62 patients (24%) required additional surgery: 10 (16%) for infection, 3 (5%) for contracture, 1 for patellar subluxation, and 1 for quadriceps tendon rupture. ConclusionMetaphyseal fixation is important for survivorship in revision TKA which can be challenging due to cancellous and structural bone loss encountered at the time of revision. Prosthetic joint infection continues to be the leading cause of failure in revision TKA. The use of highly porous titanium metaphyseal cones produced from 3-dimensionally printed technology used in this study demonstrated excellent short-term results with no cases of aseptic loosening. Further follow-up is required to determine if these results can be durable over a longer period.

The increasing incidence of surgically treated quadriceps tendon ruptures

PurposeDue to increased life expectancy and a more active life style of the older people, we hypothesised that the incidence of quadriceps tendon rupture (QTR) is higher than previously reported. The objective of this nationwide population-based study was to investigate the annual incidence of QTR in patients who underwent operative treatment in Finland between 1997 and 2014.MethodsThe Finnish National Hospital Discharge Register was searched for all adult patients who had undergone surgical treatment for QTR during the study period. Population-based annual incidence and incidence trends for surgically treated QTR were calculated.ResultsDuring the study period, 1343 QTR surgeries were performed. Of these, 90% were performed on male patients. The incidence of QTR increased by 411% from 0.55 to 2.82 per 100,000 person-years from 1997 to 2014. The average yearly increase in the number of surgeries was 9.0%. In male patients, the incidence of QTR increased by 490% and in female patients by 121%. The mean age of the male patients increased during the study period from 50 to 59 years.ConclusionsBased on the data from the Finnish National Hospital Discharge Register, the annual incidence of QTR increased by over 400% during the 18-year study period. The average age of the patients also increased. Because QTR is only very rarely treated without surgery, the results of our study can be considered to be a reliable estimate of the increase in the incidence of this condition. There is an urgent need to establish the risk factors associated with QTR and to also establish the optimal surgical technique.Level of evidenceIV.

Polyethylene terephthalate tape augmentation as a solution in recurrent quadriceps tendon ruptures.

Quadriceps tendon rupture is a severe and demanding problem in knee surgery, especially when it is recurrent and when elderly patients are involved. It can have a devastating impact when it is a complication following knee arthroplasty. There are many procedures for dealing with this problem, but none of them offer reliable results. The most popular methods of treatment are traditional transosseous sutures and suture anchors, often in combination with semitendinosus augmentation. In cases of osteoporotic bone or hamstring insufficiency, these solutions are not appropriate. One way to manage quadriceps tendon rupture is to use polyethylene terephthalate tape (poly tape) as scaffolding for tissue ingrowth. Because of its structure, poly tape provides adequate strength and allows early mobilization. Besides being durable, multifilament high tenacity polyethylene terephthalate is flexible. Poly tape augmentation is particularly recommended in the following cases: recurrent rupture of the quadriceps tendon; extensor apparatus damage following total knee arthroplasty (TKA); delayed diagnosis of quadriceps tendon rupture; and in elderly patients (with weak bones and poor ligament quality). The surgical technique is simple and the procedure has a low complication rate. There have been many studies confirming the security of polyethylene terephthalate use in the human body. There is also a great deal of evidence concerning tissue ingrowth in the mesh structure of poly tape. Allergic reactions and inflammatory responses are rare.