[Quadriceps tendon insufficiency and rupture : Treatment options in total knee arthroplasty]

Pedicled Rectus Femoris Flap for Restoration of Suprapatellar Quadriceps Tendon and Defect Coverage after Multiple Reconstruction Attempts-A Case Report and Literature Review

There is no unified approach for restoring the suprapatellar quadriceps tendon and covering tissue defects simultaneously. In this case report, we present the pedicled myocutaneous rectus femoris flap as one effective approach in two cases with extensive loss or impairment of the suprapatellar muscle-tendon structures after trauma-related suprapatellar quadriceps tendon rupture and multiple reconstruction attempts. Additionally, we provide a literature review of the reconstructive use of the functional pedicled myocutaneous rectus femoris flap.

METHODS

Two male patients, 48 and 74 years old, with extensive loss or impairment of the suprapatellar muscle-tendon structures due to multiple reconstruction attempts, underwent restoration of the knee extension with a pedicled myocutaneous rectus femoris flap.

RESULTS

Three months after reconstruction, both patients were able to walk freely, unaided. After a six-month follow-up, the free passive mobility of the knee joint was restored, and the active extension of the knee joint was possible in both patients.

CONCLUSION

The authors conclude that the pedicled rectus femoris flap is a reliable method for the restoration of knee extension, with excellent functional results in cases of suprapatellar tendon lesions. Further to the functional restoration, this technique has the additional advantage of simultaneously achieving coverage of soft-tissue defects, while a direct closure of the donor site is possible. Elderly patients and patients with relevant comorbidities or multiple revisions may especially benefit from this technique.

Implantation of an attachment tube preserves knee extension after nonunion of Felix IV fracture: a case report

Background

While commonly utilized to fix tissue and muscles to megaprostheses to restore function and stability after tumor surgery, an attachment tube was used as a synthetic reconstruction of the knee joint’s extension mechanism after nonunion of Felix IV C fracture. Fixation of the tibial fragment, and therefore its osteointegration, is complicated after total knee arthroplasty, causing tibial tubercle dislocation.

Case presentation

A 61-year-old German patient presented to our clinic with Felix IV C fracture, persistent knee pain, and reduced knee extension strength. In this special case, mobilization and reattachment of the tibial tubercle was not possible because of necrosis and underlying tibial component. Therefore, we covered the defect with cement and used an polyethylene terephthalate tube for knee extension system augmentation. Follow-up after 10 months demonstrated a good clinical result.

Conclusion

The management of Felix IV C fractures is complicated by the underlying prosthesis resulting in redislocation of the fragment and persistent symptoms of pain and reduced functionality. We here present a new surgical technique to treat periprosthetic fracture complicated by tibial tubercle dislocation. Good clinical and radiologic results on follow-up after 10 months indicate the use of attachment tubes as a suitable surgical technique to restore knee joint extension and to reduce knee pain after dislocated Felix IV C fracture.