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Arnold EP, Sedgewick JA, Wortman RJ, Stamm MA, Mulcahey MK. Acute Quadriceps Tendon Rupture: Presentation, Diagnosis, and Management. JBJS Rev 2022; 10:01874474-202202000-00004. [PMID: 35130193 DOI: 10.2106/jbjs.rvw.21.00171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The incidence of quadriceps tendon rupture is estimated to be 1.37 cases per 100,000 people/year, with a predilection for these injuries in patients who are ≥40 years of age. » Quadriceps tendon ruptures are more likely to occur in the presence of preexisting comorbidities such as rheumatoid arthritis, systemic lupus erythematosus, gout, chronic kidney disease, secondary hyperparathyroidism, diabetes mellitus, and peripheral vascular disease. The most common mechanism of injury is a simple fall. » Magnetic resonance imaging is the gold-standard test for diagnosing quadriceps tendon ruptures, with a reported sensitivity, specificity, and positive predictive value of 1.0. » Complete tears require prompt surgical intervention; the most common technique is transosseous sutures passed through longitudinal patellar drill holes. Suture anchors have been proposed as an alternative method; they have shown superior biomechanical results in cadaveric models. » Early functional mobilization with full weight-bearing and progressive range-of-motion exercises is recommended for rehabilitation following injury.
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Affiliation(s)
- Evan P Arnold
- Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Ryan J Wortman
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Michaela A Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Elattar O, McBeth Z, Curry EJ, Parisien RL, Galvin JW, Li X. Management of Chronic Quadriceps Tendon Rupture: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202105000-00003. [PMID: 33956669 DOI: 10.2106/jbjs.rvw.20.00096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Chronic quadriceps tendon (QT) ruptures are uncommon injuries that present treatment challenges due to their complex nature and the limited evidence to guide management. » Timely diagnosis and surgical management of acute QT injury are imperative to optimize patient outcomes as delayed diagnosis leads to poorer results regardless of treatment modality. » Elements of chronic QT ruptures that may complicate surgical management include patient age, comorbidity, scar-tissue formation, amount of quadriceps muscle/ tendon retraction, and distalmigration of the patella with contraction of the tendon. » Treatment options for chronic QT ruptures include primary repair with or without vastus advancement, V-Y tendon lengthening with or without tissue augmentation, and autograft or allograft reconstruction.
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Affiliation(s)
| | | | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts
| | - Robert L Parisien
- University of Pennsylvania Medical School, Philadelphia, Pennsylvania
| | | | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts
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Simultaneous Bilateral Rupture of the Patellar Tendon and Medial Collateral Ligament: A Case Report and Literature Review. Case Rep Orthop 2020; 2020:8862600. [PMID: 33133714 PMCID: PMC7593758 DOI: 10.1155/2020/8862600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 01/16/2023] Open
Abstract
Bilateral rupture of the patellar tendon is considered an uncommon and rare musculoskeletal injury. The association of this lesion with medial collateral ligament tear appears to be exceedingly rare. We present the case of a combined rupture of the medial collateral ligament (MCL) and the patellar tendon of both knees in a 48-year-old man, after falling 2 meters down an embankment. While there are numerous publications concerning associated MCL tears and other knee ligaments, a combination of MCL tear with a patellar tendon rupture is very rare. In addition, our case presents the first case recorded in the literature, involving both knees of a patient. The clinical case is described and discussed following a review of the literature. The symmetrical knee injury was treated with a primary direct repair of the MCL tears and using a suture anchor fixation of the patellar tendon ruptures, which was reinforced by a stainless steel wire and an autograft of the ipsilateral quadriceps tendon.
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Abstract
Knee and leg injuries are extremely common presentations to the emergency department. Understanding the anatomy of the knee, particularly the vasculature and ligamentous structures, can help emergency physicians (EPs) diagnose and manage these injuries. Use of musculoskeletal ultrasonography can further aid EPs through the diagnostic process. Proper use of knee immobilizers can also improve long-term patient outcomes.
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Affiliation(s)
- Moira Davenport
- Department of Emergency Medicine, Allegheny General Hospital, Temple University School of Medicine, 320 East North Avenue, Pittsburgh, PA 15212, USA.
| | - Matthew P Oczypok
- Department of Emergency Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
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Ibounig T, Simons TA. Etiology, Diagnosis and Treatment of Tendinous Knee Extensor Mechanism Injuries. Scand J Surg 2016; 105:67-72. [PMID: 26271663 DOI: 10.1177/1457496915598761] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/17/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Quadriceps and patella tendon ruptures are uncommon injuries often resulting from minor trauma typically consisting of an eccentric contraction of the quadriceps muscle. Since rupture of a healthy tendon is very rare, such injuries usually represent the end stage of a long process of chronic tendon degeneration and overuse. This review aims to give an overview of the current understanding of the pathophysiology, diagnostic principles, and recommended treatment protocols as supported by the literature and institutional experience. MATERIAL AND METHODS A non-systematic review of the current literature on the subject was conducted and reflected against the current practice in our level 1 trauma center. RESULTS AND CONCLUSION Risk factors for patella and quadriceps tendon rupture include increasing age, repetitive micro-trauma, genetic predisposition, and systemic diseases, as well as certain medications. Diagnosis is based on history and clinical findings, but can be complemented by ultrasound or magnetic resonance imaging. Accurate diagnosis at an early stage is of utmost importance since delay in surgical repair of over 3 weeks results in significantly poorer outcomes. Operative treatment of acute ruptures yields good clinical results with low complication rates. Use of longitudinal transpatellar drill holes is the operative method of choice in the majority of acute cases. In chronic ruptures, tendon augmentation with auto- or allograft should be considered. Postoperative treatment protocols in the literature range from early mobilization with full weight bearing to cast immobilization for up to 12 weeks. Respecting the biology of tendon healing, we advocate the use of a removable knee splint or orthotic with protected full weight bearing and limited passive mobilization for 6 weeks.
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Affiliation(s)
- T Ibounig
- Töölö Hospital, Helsinki University Central Hospital, HUS, Helsinki, Finland
| | - T A Simons
- Töölö Hospital, Helsinki University Central Hospital, HUS, Helsinki, Finland
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Rosso F, Bonasia DE, Cottino U, Dettoni F, Bruzzone M, Rossi R. Patellar tendon: From tendinopathy to rupture. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:99-107. [PMID: 29264248 PMCID: PMC5730651 DOI: 10.1016/j.asmart.2015.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/07/2015] [Accepted: 07/03/2015] [Indexed: 01/08/2023]
Abstract
Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on the aetiology, diagnosis, and treatment of both patellar tendinopathy and rupture. We report the conservative treatments proposed for patellar tendinopathy and the surgical techniques described for its rupture.
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Affiliation(s)
- Federica Rosso
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico Hospital, Via Zuretti, Torino, Italy
| | - Umberto Cottino
- Department of Orthopedics and Traumatology, University of Study of Torino, Via Po 8, Torino, Italy
| | - Federico Dettoni
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Matteo Bruzzone
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy.,Department of Orthopaedics and Traumatology, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico Hospital, Via Zuretti, Torino, Italy
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Teber MA, Oğur T, Bozkurt A, Er B, Turan A, Gülbay M, Akdağ İ. Real-time sonoelastography of the quadriceps tendon in patients undergoing chronic hemodialysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:671-677. [PMID: 25792583 DOI: 10.7863/ultra.34.4.671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study aimed to compare sonoelastographic findings for the quadriceps tendon in patients with chronic renal failure who were in a dialysis program to findings in a control group. METHODS Fifty-three randomly allocated patients (mean age, 54.3 years; range, 27-86 years) with chronic renal failure who were in a dialysis program 3 days a week between January and May 2012 were included. The measurements were performed in both knees of 53 patients undergoing dialysis and 25 individuals in the control group. The tendons were classified as follows: type 1, very stiff tissue (blue); type 2, stiff tissue (blue-green); and type 3, intermediate tissue (green-yellow) according to color mapping. RESULTS The mean quadriceps tendon thicknesses in the patient group were 4.9 mm (range, 1.9-6.5 mm) for the right knee and 4.9 mm (1.4-6.5 mm) for the left knee; the values in the control group were 5.4 mm (3.6-7.0 mm) for the right knee and 5.4 mm (3.4-7.0 mm) for the left knee. The mean elasticity scores in the patient group were 3.14 (1.03-5.23) for the right knee and 3.33 (1.29-5.00) for the left knee; in the control group, the values were 3.79 (1.73-5.23) and 3.69 (1.23-5.53) for the right and left knees, respectively (right knee, P = .025; left knee, P = .018; Mann-Whitney U test). The quadriceps tendons were significantly thinner in the patient group (right knee, P = .054; left knee, P = .015; Mann-Whitney U test). CONCLUSIONS Quadriceps tendons in patients with chronic renal failure are thinner and have lower elasticity scores compared to controls.
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Affiliation(s)
- Mehmet A Teber
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey.
| | - Törel Oğur
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - Alper Bozkurt
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - Bülent Er
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - Aynur Turan
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - Mutlu Gülbay
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - İbrahim Akdağ
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
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Pires e Albuquerque R, Campos ALS, dos Santos Neto JF, Karam E, Neves JG, Di Tullio P, Giordano V, do Amaral NP. Análise radiográfica de fatores predisponentes às rupturas tendinosas do mecanismo extensor do joelho. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Pires e Albuquerque R, Campos ALS, dos Santos Neto JF, Karam E, Neves JG, Di Tullio P, Giordano V, do Amaral NP. Radiographic analysis of factors predisposing toward tendon tears in the knee extensor mechanism. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2014; 49:374-8. [PMID: 26229830 PMCID: PMC4511568 DOI: 10.1016/j.rboe.2014.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 10/10/2013] [Indexed: 11/16/2022]
Abstract
Objectives Methods Results Conclusion
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Affiliation(s)
| | | | | | - Evaldo Karam
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro do Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - José Guilherme Neves
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro do Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - Paulo Di Tullio
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro do Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro do Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - Ney Pecegueiro do Amaral
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro do Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
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Perfitt JS, Petrie MJ, Blundell CM, Davies MB. Acute quadriceps tendon rupture: a pragmatic approach to diagnostic imaging. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1237-41. [DOI: 10.1007/s00590-013-1307-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 08/21/2013] [Indexed: 11/24/2022]
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Abstract
Both magnetic resonance imaging (MRI) and sonography are well suited to tendon imaging. A normal tendon on MRI demonstrates low signal intensity and on sonography, an echogenic fibrillar pattern. MRI is considered the imaging gold standard, providing an anatomic overview and excellent soft tissue contrast. Sonography is a more rapidly performed examination; it has greater resolution than that of MRI; it allows dynamic evaluation of tendons and muscles; and it can guide percutaneous therapeutic procedures. Moreover, the advent of sonographic extended-field-of-view imaging allows the demonstration of the entire length of a tendon, matching MRI’s ability to display a large anatomic region. Sonography should best be considered a focused examination, concentrating on the area of pain and clinical suspicion of pathology, whereas MRI can provide a global assessment of the region of concern. Both modalities demonstrate high accuracy for abnormalities of various tendons. This article reviews normal tendon anatomy and its imaging appearance, as well as the imaging appearances of tendon degeneration and tear.
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Affiliation(s)
| | - Theodore T. Miller
- Address correspondence to Theodore T. Miller, MD, FACR, 535 East 70th Street, New York, NY 10021 (e-mail: )
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Pires E Albuquerque R, Prado J, Hara R, Ferreira E, Schiavo L, Giordano V, Amaral NPD, Barretto JM. EPIDEMIOLOGICAL STUDY ON TENDON RUPTURES OF THE KNEE EXTENSOR MECHANISM AT A LEVEL 1 HOSPITAL. Rev Bras Ortop 2012; 47:719-23. [PMID: 27047890 PMCID: PMC4799490 DOI: 10.1016/s2255-4971(15)30028-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 02/07/2012] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to review the epidemiological aspects of tendon ruptures of the knee extensor apparatus at a level 1 hospital. METHODS We retrospectively analyzed 76 lesions of the knee extensor apparatus that were treated surgically at the Miguel Couto Municipal Hospital between March 2004 and March 2011. We took into consideration age, sex, trauma mechanism, anatomical classification of the lesion, affected side, comorbidities and associated lesions. RESULTS Among the patients studied, 68 were male and the mean age was 36 years. Regarding the trauma mechanism, 62 lesions occurred due to direct trauma; the right side was affected in 21 cases; eight presented comorbidities and four presented associated lesions. CONCLUSION The majority of the patients were male, at an economically active age (young people), and were victims of direct trauma. Ruptures of the patellar ligament were the most frequent lesions. Associated lesions were rare and comorbidities were infrequent in our sample.
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Affiliation(s)
- Rodrigo Pires E Albuquerque
- Master's degree and Doctor's degree in Medicine; Coordinator, Knee Surgery Department, Professor Nova Monteiro Orthopedics and Traumatology Clinic, Hospital Municipal Miguel Couto (SOT-HMMC) - Rio de Janeiro, RJ, Brazil
| | - Juliano Prado
- Collaborating doctor at the SOT-HMMC - Rio de Janeiro, RJ, Brazil
| | - Rafael Hara
- Collaborating doctor at the SOT-HMMC - Rio de Janeiro, RJ, Brazil
| | - Evaldo Ferreira
- Collaborating doctor at the SOT-HMMC - Rio de Janeiro, RJ, Brazil
| | - Leonardo Schiavo
- Collaborating doctor at the SOT-HMMC - Rio de Janeiro, RJ, Brazil
| | - Vincenzo Giordano
- Master's degree in Medicine; Coordinator, Medical Residency Program of the SOT-HMMC - Rio de Janeiro, RJ, Brazil
| | | | - João Mauricio Barretto
- Master's degree and Doctor's degree in Medicine; Head, Orthopedics Clinic, Santa Casa da Misericórdia do Rio de Janeiro - Rio de Janeiro, RJ, Brazil
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Abstract
The knee plays a significant role in ambulation and the activities of daily living. During the course of these activities and its role in weight bearing, the knee is susceptible to a variety of different forces and the emergency physician should be familiar with the diagnosis and treatment of the injuries that result. In addition to following basic trauma protocols, thorough neurovascular and musculoskeletal examinations should be performed and supplemented with appropriate imaging. Emergency physicians should also consider recent developments in knee anatomy and function when evaluating the patient with an acutely injured knee.
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Affiliation(s)
- Moira Davenport
- Department of Emergency Medicine, Allegheny General Hospital, Drexel University College of Medicine, 320 EN Avenue, Pittsburgh, PA 15212, USA.
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Trobisch PD, Bauman M, Weise K, Stuby F, Hak DJ. Histologic analysis of ruptured quadriceps tendons. Knee Surg Sports Traumatol Arthrosc 2010; 18:85-8. [PMID: 19672579 DOI: 10.1007/s00167-009-0884-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 07/24/2009] [Indexed: 12/14/2022]
Abstract
Quadriceps tendon ruptures are uncommon injuries. Degenerative changes in the tendon are felt to be an important precondition for rupture. We retrospectively reviewed 45 quadriceps tendon ruptures in 42 patients. Quadriceps tendon ruptures occurred most often in the sixth and seventh decade of life. Men were affected six times as often as women. A tissue sample from the rupture-zone was obtained in 22 cases and histologic analysis was performed. Degenerative changes were present in only 14 (64%) of the 22 samples. We observed an increasing ratio of degenerative to nondegenerative tendons with increasing patient age. Our data suggests that quadriceps tendon rupture, especially in younger patients, can occur in the absence of pathologic tendon degeneration.
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Affiliation(s)
- Per David Trobisch
- BG-Traumacenter, Eberhard-Karls University Tuebingen, Schnarrenbergstr 95, 72076 Tuebingen, Germany.
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Affiliation(s)
- David J Hak
- Department of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.
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Neubauer T, Wagner M, Potschka T, Riedl M. Bilateral, simultaneous rupture of the quadriceps tendon: a diagnostic pitfall? Report of three cases and meta-analysis of the literature. Knee Surg Sports Traumatol Arthrosc 2007; 15:43-53. [PMID: 16951978 DOI: 10.1007/s00167-006-0133-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 02/22/2006] [Indexed: 12/18/2022]
Abstract
Bilateral, simultaneous quadriceps tendon rupture (QTR) represents a rare entity and delay in establishing the correct diagnosis is not uncommon. Another three cases are reported here and in all the correct diagnosis was missed initially. A review of the English and German literature retrieved 105 cases of bilateral, simultaneous QTR and in 32 patients (30.5%) the correct diagnosis was established with delay. In 28 cases--representing 25 men (89.3%) and 3 women (10.7%)--sufficient data was available for further analysis. In the majority of patients (n = 19/28; 67.9%) rupture was associated with trauma, while no trauma was reported in 9/28 cases (32.1%). No direct correlation between age and the kind of rupture form (traumatic/spontaneous) could be detected (P = 0.35). Most partients (n = 18/28; 64.3%) presented risk factors associated with QTR and obesity (n = 6/28; 21.4%) was most frequently encountered. A direct association between the rate of risk factors and the rupture form was not seen (P = 0.5). Overall diagnostic delay lasted 64.7 days on an average (traumatic ruptures 67.7 days/spontaneous ruptures 58.7 days) with this period being longer than 2 weeks in 51.9% and longer than 3 months in 33.3% of patients. Delay varied distinctly in different medical institutions as this period lasted in hospital departments 93.9 days, in ambulances 24 days and in General Practitioners 7.6 days on an average. Initially 25 incorrect diagnoses were established in 21/28 (75%) patients, while 7/28 cases (25%) were discharged initially without any diagnosis. Clinical examination revealed most often palpable suprapatellar gaps (n = 17/24) and effusions (n = 13/24), while the classic trias of painful swelling, suprapatellar gap and loss of knee extension was found in only 58.3% of reported patients (n = 14/24). The correct diagnosis of bilateral QTR was established in 60.7% (n = 17/28) by history and clinical examination alone. In 10.7% (n = 3/28) clinical suspect was supported by sonography and in 14.3% (n = 4/28) by MRT; in 14.3% (n = 4/28) the correct diagnosis represented a by chance finding during diagnostic or operative procedures of other indication. In 52 tendons detailed information about repair was provided and most often transosseous fixation (n = 30/52; 57.7%) and direct repair (n = 14/52; 26.9%) were used, while a tenoplasty was performed in only 15.4% (n = 8/52). Only 34.6% of patients (n = 9/26) with follow-up data (n = 26/28) reported a full recovery with a trend that early surgical repair (limit 2 weeks) improves the final outcome.
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Affiliation(s)
- T Neubauer
- Department of Traumatology, Wilhelminenspital der Stadt Wien, Montleartstrasse 37, 1160 Vienna, Austria.
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Ochman S, Langer M, Petersen W, Meffert RH, Tillmann B, Raschke MJ. [Rupture of the quadriceps tendon. Diagnosis and treatment of a rare injury]. Unfallchirurg 2005; 108:436-44. [PMID: 15931530 DOI: 10.1007/s00113-005-0957-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Rupture of the quadriceps tendon is a rare knee injury. In most cases the tendon ruptures spontaneously without adequate trauma in patients older than 40 years with degenerative changes of the tendon. Suture repair is the only treatment option for acute complete, older ruptures and partial ruptures that do not heal after nonoperative treatment. The type of repair depends on the time of diagnosis and localisation of the rupture. The functional outcome depends on timely repair and early initiation of knee movement and strengthening therapy.
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Affiliation(s)
- S Ochman
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster.
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