Suprapatellar Area Research Articles

Early Diagnosis of Acute Rupture of the Quadriceps Tendon by Arthrography

Arthrographic study of the knee was performed in six patients for diagnosis of acute rupture of the quadriceps tendon. All of the patients gave a history of attempting to recover from a fall. Pain and tenderness over the suprapatellar area were common findings in all patients. Four patients had a positive arthrogram demonstrating extravasation of the radiopaque material outside the knee along the quadriceps tendon. Of these four patients, two had complete loss of quadriceps function, but the other two were able to partially extend the knee when the gravity was eliminated. Two patients had negative arthrograms; both had loss of active extension of the knee against gravity but were able to extend the knee when the gravity was eliminated. All four patients with a positive arthrogram had rupture of the quadriceps tendon, which was demonstrated at the time of surgery. In one patient with a negative arthrogram, exploration of the knee revealed an intact extensor mechanism. Arthrography of the knee is an aid to the diagnosis of rupture of the quadriceps tendon and when indicated can be performed in the emergency room.

Radiographic diagnosis and accuracy in knee joint effusions.

Anteroposterior and lateral knee radiographs were obtained prior to arthrography in 200 patients. Presence and quantity of joint effusion were recorded, and radiologic criteria for the presence or absence of knee effusion were evaluated. Only the lateral projection was of value in assessing joint fluid. The fat pad separation sign was the most accurate indicator of fluid and effusions as small as 1-2 ml were recognized. There were accuracies of 88% in the diagnosis and 90% in the exclusion of knee effusions. Satisfactory lateral knee radiographs required radiologic demonstration of the entire suprapatellar area. Minimal knee flexion and a 5degrees cephalad angulation of the x-ray tube help in adequately visualizing this area.

The thinker's sign.

To the Editor: —Repeated pressure on and friction of the epidermis results in a characteristic hyperkeratotic plaque known as a callus. Production of these lesions requires chronic intermittent stimulation, such as might be a feature of certain occupations—hence, the well-known lesions on the shoulders of hod-carriers, the hands of mechanics, the lips of trumpeters, and the thumbs of leather buffers. There seems to be less appreciation of the fact that certain chronic disease states might result in the widespread adoption of characteristic postures, satisfying the mechanical requirements for callus formation, and consequently resulting in lesions as specific for the disease state as the lesions named are for the corresponding occupations. An example of just such an occurrence is herein described. Bilateral discrete calluses are frequently observed in the suprapatellar areas of patients suffering from chronic pulmonary disease with advanced respiratory insufficiency. The characteristic posture instinctively assumed by patients attempting to