Spontaneous Tendon Rupture Research Articles

Presence of Bacteria in Spontaneous Achilles Tendon Ruptures

Background: The structural pathology of Achilles tendon (AT) ruptures resembles tendinopathy, but the causes remain unknown. Recently, a number of diseases were found to be attributed to bacterial infections, resulting in low-grade inflammation and progressive matrix disturbance. The authors speculate that spontaneous AT ruptures may also be influenced by the presence of bacteria. Hypothesis: Bacteria are present in ruptured ATs but not in healthy tendons. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients with spontaneous AT ruptures and patients undergoing anterior cruciate ligament (ACL) reconstruction were recruited for this study. During AT surgical repair, excised tendinopathic tissue was collected, and healthy tendon samples were obtained as controls from hamstring tendon grafts used in ACL reconstruction. Half of every sample was reserved for DNA extraction and the other half for histology. Polymerase chain reaction (PCR) was conducted using 16S rRNA gene universal primers, and the PCR products were sequenced for the identification of bacterial species. A histological examination was performed to compare tendinopathic changes in the case and control samples. Results: Five of 20 AT rupture samples were positive for the presence of bacterial DNA, while none of the 23 hamstring tendon samples were positive. Sterile operating and experimental conditions and tests on samples, controlling for harvesting and processing procedures, ruled out the chance of postoperative bacterial contamination. The species identified predominantly belonged to the Staphylococcus genus. AT rupture samples exhibited histopathological features characteristic of tendinopathy, and most healthy hamstring tendon samples displayed normal tendon features. There were no apparent differences in histopathology between the bacterial DNA–positive and bacterial DNA–negative AT rupture samples. Conclusion: The authors have demonstrated the presence of bacterial DNA in ruptured AT samples. It may suggest the potential involvement of bacteria in spontaneous AT ruptures.

Simvastatin and atorvastatin reduce the mechanical properties of tendon constructs in vitro and introduce catabolic changes in the gene expression pattern.

Treatment with lipid-lowering drugs, statins, is common all over the world. Lately, the occurrence of spontaneous tendon ruptures or tendinosis have suggested a negative influence of statins upon tendon tissue. But how statins might influence tendons is not clear. In the present study, we investigated the effect of statin treatment on mechanical strength, cell proliferation, collagen content and gene expression pattern in a tendon-like tissue made from human tenocytes in vitro. Human tendon fibroblasts were grown in a 3D tissue culture model (tendon constructs), and treated with either simvastatin or atorvastatin, low or high dose, respectively, for up to seven days. After seven days of treatment, mechanical testing of the constructs was performed. Collagen content and cell proliferation were also determined. mRNA levels of several target genes were measured after one or seven days. The maximum force and stiffness were reduced by both statins after 7 days (p<0.05), while the cross sectional area was unaffected. Further, the collagen content was reduced by atorvastatin (p = 0.01) and the cell proliferation rate was decreased by both types of statins (p<0.05). Statin treatment also introduced increased mRNA levels of MMP-1, MMP-3, MMP-13, TIMP-1 and decreased levels of collagen type 1 and 3. In conclusion, statin treatment appears to have a negative effect on tendon matrix quality as seen by a reduced strength of the tendon constructs. Further, activated catabolic changes in the gene expression pattern and a reduced collagen content indicated a disturbed balance in matrix production of tendon due to statin administration.

Spontaneous Rupture of Quadriceps Tendon: A Report of Two Cases and Review of the Literature

Abstract Introduction Spontaneous rupture of the quadriceps tendon is rare. A sudden snap in the knee and feeling of giving way and occasionally falling are associated with rupture of the tendon. Subsequently, the loss of extensor mechanism of the knee limits ambulation. The aim of this report is to highlight this rare entity and to demonstrate that simple tendon repair could also give good results. Presentation of case The two patients were middle aged who were apparently healthy with active lifestyles prior to their injuries. The first patient is a 61-year-old lady who was descending the staircase when she suddenly felt her knee gave way. She supported herself on the rail and subsequently started ambulating with a stick until presentation. The second patient is a 57-year-old male who was doing a pre-game work out in a lawn tennis court when he felt a sudden pull on his right knee and he slumped. After some weeks, his pain subsided but he noticed poor clearance during gait. A big defect, just above the patella was found in the usual position of the quadriceps tendon in each patient. Simple end-to-end tendon repairs were done for both patients with excellent restoration of the extensor mechanism. Discussion Spontaneous rupture of a strong tendon such as quadriceps is not common. The sudden episode of pain, knee swelling, a gap in the quadriceps and loss of knee extension make clinical diagnosis unmistakable. However, radiological exclusion of patella fracture is important. Conclusion Restoration of the extensor mechanism of the knee is a sine qua non for effective ambulation. The quadriceps pull would always create a gap in the tendon and healing is only possible by surgical apposition of the tendon ends and in our cases by direct suturing.

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.

Flexor Carpi Radialis to Palmaris Longus Tendon Transfer for Spontaneous Rupture of the Flexor Carpi Radialis Tendon-A Review of an Uncommon Finding and Surgical Technique for Operative Correction.

Spontaneous ruptures of the flexor carpi radialis tendon (FCR) are rare and associated with systemic inflammatory diseases, localized tendinopathy related to scaphotrapezial-trapezoidal arthritis, or chronic immunosuppression from corticosteroids. While most cases do not require operative intervention, some patients develop weakness, impaired range of motion, and persistent pain. Previously reported surgical options include synovectomy, tendon stump resection, and osteophyte removal. We describe a surgical technique for patients with persistent symptomatology following FCR rupture in which the FCR is transposed end-to-side to the palmaris longus tendon. Three cases using this technique are presented with follow-up of 4-9 months that were collected at Lenox Hill Hospital. All three patients did well regarding specific outcome measures: grip strength, range of motion, and functional activity. FCR transfer to palmaris is an alternative to other surgical options for the spontaneous rupture of the FCR tendon in patients who remain symptomatic despite a course of non-operative therapy.

Spontaneous flexor tendon rupture secondary to capitate non-union. A case report and review of literature

Rupture of the flexor digitorum profundus and superficialis tendons of the index finger secondary to non-union of the capitate has not yet been reported to our knowledge. We describe the case of a 48-year-old man with rupture of both flexor tendons of the index finger that occurred 15 years after a capitate fracture. The patient was completely asymptomatic before the rupture. Tendon reconstruction was performed using the palmaris longus. One year after surgery, the patient had acceptable range of motion and was pain-free.

Spontaneous Extensor Tendon Rupture in the Rheumatoid Wrist: Risk Factors and Preventive Role of Extended Tenosynovectomy.

Spontaneous extensor tendon rupture is often seen in rheumatoid arthritis (RA) patients, but the risk factors are not clearly defined. We therefore collected the data of RA patients with previous extensor tendon rupture and those with tenosynovitis and analyzed the relationship between extended tenosynovectomy and spontaneous extensor tendon rupture. We retrospectively reviewed 17 spontaneous extensor tendon rupture episodes in 15 RA patients and 14 tenosynovitis episodes that required tenosynovectomy in 12 RA patients from 1997 to 2013. Correlations between the incidence of tendon rupture, X-ray findings, and clinical findings in the affected wrists before tendon rupture were analyzed statistically using the test for proportion. The following parameters were significantly correlated with spontaneous extensor tendon rupture: disease duration longer than 8 years, persistent tenosynovitis longer than 1 year duration, and Larsen grade greater than 4 (P = 0.02, 0.03, and 0.01, respectively). Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray contributed to a higher spontaneous extensor tendon rupture rate among RA patients (P = 0.01, 0.05, and 0.03, respectively). Extended tenosynovectomy was performed on 14 wrists in 12 RA patients with persistent tenosynovitis longer than 6 months, and Larsen grade did not deteriorate in this group compared with those who did not undergo the surgery. No spontaneous extensor tendon rupture occurred following the surgery. Risk factors of spontaneous extensor tendon rupture included disease duration longer than 8 years, persistent tenosynovitis longer than 1 year, and wrist Larsen grade greater than 4. Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray indicated a higher probability of extensor tendon rupture. Rheumatologists should consult with hand surgeons promptly to preserve hand function before tendon rupture. Prophylactic extended tenosynovectomy surgery to prevent more severe damage of extensor tendon should be recommended in patients who had the above risk factors.

Spontaneous rupture of the Achilles tendon

Introduction: The Achilles tendon is the largest and most resistant tendon of the human body and the incidence of spontaneous rupture has increased in recent decades, especially because of the appearance and wide use of quinolones, which use is associated with this pathology. Objective: Case report of case of spontaneous rupture of the Achilles tendon in patients without predisposing risk factors. Method: case report based on the records of the patient and search in literature. Discussion: Spontaneous rupture of the Achilles tendon is more common in men aged between 30 and 50 years old and has an incidence of 1:100,000 in the general population. However, there is a rare entity, the spontaneous rupture of the Achilles tendon (RETA), which it is due to chronic inflammation of the tendon. Conclusion: Spontaneous rupture of the Achilles tendon is a rare entity, but should be suspected in patients who present acute pain condition or maybe worsened chronic pain, particularly when associated with the chronic use of corticosteroids or quinolones, or any of the cited predisposing factors.

Bilateral Spontaneous Rupture of the Achilles' Tendon During Chemotherapy Treatment

Bilateral Spontaneous Rupture of the Achilles' Tendon During Chemotherapy Treatment

Spontaneous Achilles Tendon Rupture in a Patient with Ankylosing Spondylitis

Spontaneous Achilles Tendon Rupture in a Patient with Ankylosing Spondylitis

Bilateral Spontaneous Midsubstance Patellar Tendon Rupture after Bilateral Total Knee Arthroplasty.

Introduction:Patellar tendon rupture can occur due to multiple causes ranging from inflammatory pathologies to episodes of trauma. Extensor mechanism rupture is a rare complication of total knee arthroplasty (TKA). In most of these cases, the failure occurs as avulsion of patellar tendon from tibial tuberosity. We report a rare case with bilateral mid-substance patellar tendon rupture one month after bilateral total knee arthroplasty.Case Presentation:A 69-year-old male was operated for bilateral grade 4 osteoarthritis. On day 30 post-operative, he sustained bilateral patellar tendon rupture while getting up from toilet. He had a history of multiple steroid injections in the knee, which could have affected the tendon. The other etiologies could be inherent weakness of tendon due to diabetes and old age and micro-trauma/stretch associated with sudden correction of previous deformity by TKA. The management in our case was done by primary repair along with augmentation by autologous semitendinosus graft and suture anchor.Conclusion:The operating surgeon must be aware of the possibility of patellar tendon rupture following total knee arthroplasty. This will help the surgeon in early recognition and preparedness to handle such complications, should they arise. Surgeons may consider advising caution to both patient and rehabilitation team in cases with old age, chronic diabetes mellitus, and with a history of steroid injections.

Isolated spontaneous pectoralis minor tendon rupture in a patient with chronic renal failure

Isolated spontaneous pectoralis minor tendon rupture in a patient with chronic renal failure

A Rare Case of Bilateral Patellar Tendon Ruptures: A Case Report and Literature Review.

Bilateral patellar tendon ruptures are rare. The majority of case reports describing bilateral patellar tendon ruptures have occurred in patients with predisposing factors to tendinopathy. We describe a case of bilateral patellar tendon rupture sustained following minimal trauma by a patient with no systemic disease or history of steroid use. Due to the rarity of this injury, clinical suspicion is low. It is reported that 38% of patellar tendon ruptures are misdiagnosed initially. Therefore careful history taking and physical examination is integral in ensuring a diagnosis is achieved for early primary repair. We discuss the aetiology of spontaneous tendon rupture and report a literature review of bilateral patellar tendon ruptures.

Case report of a double spontaneous rupture: Quadriceps tendon and contralateral Achilles tendon

Uni- or bilateral quadriceps tendon ruptures are rare (1.37/100,000 person-years), those of the Achilles tendon are more common (21.5/100,000 person-years). To our knowledge, concomitant combination of these two ruptures has not been reported in the literature. This case reports a spontaneous rupture of quadriceps tendon and of Achilles contralateral tendon. 54 years, athletic patient without comorbidity, known for a ruptured left quadriceps tendon two years ago. During a ski descent, he presents a complete spontaneous rupture of the right quadriceps tendon and partial rupture of the left Achilles tendon, both repaired surgically. A stationary environment rehabilitation allowed a full recovery. Risk factors known in the literature for these tendon ruptures [1] , [2] (age, certain medications, anabolic steroids, certain systemic diseases, obesity, corticosteroid injections, static disorders in the knee or ankle, previous surgery) have not been found for this patient. The usually described triggers mechanisms could be found in this case (eccentric quadriceps contraction, sudden contraction of the sural triceps), occurring on tendons potentially weakened by repetitive microtrauma caused by intensive sport. However, this double spontaneous rupture and the previous rupture of the contralateral quadriceps tendon 2 years ago are suggestive of tendon abnormalities. In case of repetition, an histological analysis of the ruptured tendon could be achieved to assess the organization and structure of collagen fibers, tenocytes and microvascularization [3] . The search for a COL5A1 polymorphism also seems interesting because it has been associated with spontaneous tendon ruptures [3] , [4] .

Intratendinous ganglion cyst of the extensor digitorum longus tendon: A case report

IntroductionGanglion cysts are benign lesions, common in the hand and wrist. Intratendinous ganglion, however, are rare. We present the first reported case of an intratendinous ganglion cyst in an extensor digitorum longus (EDL) tendon of the foot. Case reportA 35-year old presented with a left-sided painful dorsolateral foot swelling. Ultrasound suggested a ganglion cyst in proximity to the EDL tendon of the 5th toe. Two distinct swellings were identified on surgical exploration, including a 6×1cm ganglion lying within the EDL tendon substance that had resulted in tendon splitting. The lesions were excised and EDL tendon repaired. Histological analysis confirmed that both lesions were ganglion cysts. Post-operative recovery was uneventful. DiscussionIntratendinous ganglion cysts are rare lesions that pose a unique set of diagnostic and treatment challenges. Unlike conventional ganglion, their diagnosis may not be possible until surgical exploration. They have been reported to increase the risk of spontaneous tendon rupture. As such, a lower operative threshold should be applied to prevent their progression. A high index of suspicion should be applied to any ganglion reported radiologically to be in close contact with tendons. If diagnosed upon surgical exploration, it is essential that the operating surgeon is prepared to appropriately modify the procedure to involve primary tendon repair, tendon transfer or tenodesis.

Endoscopic Resection of Gouty Tophus of the Patellar Tendon

Tophaceous deposition of tendon can result in spontaneous patellar tendon rupture. Surgical therapy may be needed to control symptoms and prevent tendon rupture. Open debridement of the lesion requires a lengthy incision over the lesion; this may result in symptomatic scar adhesion of the patellar tendon or an unhealed wound with persistent tophaceous discharge. Moreover, the other part of the patellar tendon cannot be examined through the incision. We describe a technique for endoscopic resection of a gouty tophus of the patellar tendon. It has the advantage of small incisions away from the lesion and tendon and minimizes wound problems. The whole patellar tendon can be examined endoscopically.

Spontaneous Achilles Tendon Rupture in a Patient with Undergoing Long-Term Haemodialysis: a Case Report and Literature Review

Chronic kidney disease and hemodialysis are well known risk factors for tendon rupture, although this is a rare situation. The present case was a 70-year old male who presented with a sudden onset of painful disability in the left posterior ankle. This occurred while he was climbing the stairs. A physical examination and imaging resulted in a diagnosis of Achilles tendon rupture. The patient had received regular haemodialysis for 12 years. He developed secondary hyperparathyroidism as excepted sequelae of end stage renal disease. Following surgical repair, physiotherapy and management of associated risk factors, the patient regained full active mobility.

Late spontaneous rupture of extensor pollicis longus tendon after blunt trauma with no residual fracture

Spontaneous rupture of extensor pollicis longus tendon was first reported by Dupley in 1876. This rupture has been reported after distal radius fracture (Colles fracture), rheumatoid arthritis, steroid injections or systemic steroid treatment, and occupational tenosynovitis. The main etiologies of this rupture are the fracture of the tendon over the irregular bone surface following the fracture or inflammatory processes as in rheumatoid arthritis. Most ruptures are usually found at Lister’s tubercle. Some authors suggested ischemic etiology in the cases following wrist trauma with no residual fracture. We describe a case of rupture of the extensor pollicis longus tendon 1 month after a blunt wrist trauma with no residual fracture. The rupture was at the myotendinous junction (MTJ). To highlight on this rupture, we believed it was caused from both vascular and mechanical factors. The mechanical factor was the position of the myotendinous junction under the extensor retinaculum. The vascular factor was the nature of the myotendinous junction being the most sensitive to ischemia. Level of Evidence: Level V, diagnostic study.

Evaluation of absorbable and nonabsorbable sutures for repair of achilles tendon rupture with a suture-guiding device.

The purpose of this study was to compare the functional and clinical results of Achilles tendon repairs with an Achilles tendon suture-guiding device using nonabsorbable versus absorbable sutures. We hypothesized that the absorbable suture would have clinical results comparable to those of the nonabsorbable suture for Achilles tendon repair with an Achilles tendon suture-guiding system. From January 2010 to September 2013, 48 consecutive patients who had sustained a spontaneous rupture of the Achilles tendon underwent operative repair with an Achilles tendon suture-guiding device using 2 different suture types. All ruptures were acute. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The average age of the patients was 38 years (range, 28-50 years). Functional outcome scores and complications were evaluated. All patients had an intact Achilles repair after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot clinical outcome scores were 98 (range, 90-100) in the nonabsorbable suture group and 96.8 (range, 87-100) in the absorbable suture group. All patients returned to their previous work. The absorbable suture group had fewer postoperative complications (0%) than the nonabsorbable suture group (12.5%) (P < .05). Use of an absorbable suture in the treatment of Achilles tendon repair by an Achilles tendon suture-guiding system was associated with a lower incidence of suture reaction; however, functionally the results were not notably different from those using a traditional nonabsorbable suture. We conclude that repair with absorbable sutures is appropriate for Achilles tendon ruptures. Level II, prospective comparative study.

Quinolone induced tendon rupture: a case series

Spontaneous rupture of tendons is a rare condition and mostly it is associated with fluoroquinolones or steroid use. Here we present three interesting cases of tendon ruptures [two cases of achilis tendon rupture and one case of long head of biceps tendon rupture] and investigated their etiologic factors. All the ruptures occurred after minimal stress on the tendons few days after initiation of quinolone therapy, leading to our diagnose of quinolone induced ruptures. Here we highlight the literature review showing association between this class of drug and tendon rupture and its possible mechanism.