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Chraibi O, Messoudi A, Lamris MA, Rajaallah A, Rahmi M, Rafai M. Floating patella: Ipsilateral and simultaneous rupture of the quadriceps and patellar tendons in a young individual (a surgical case report). Int J Surg Case Rep 2024; 116:109429. [PMID: 38422749 PMCID: PMC10944125 DOI: 10.1016/j.ijscr.2024.109429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The phenomenon of a floating patella or ipsilateral bifocal rupture of the extensor apparatus is an extremely rare injury, with few cases reported in the literature. The aim of this case study is to report an unprecedented event: the simultaneous trans-tendinous rupture of both quadriceps and patellar tendons in a young adult without predisposing factors, emphasizing the need for awareness in diagnosis and management, and suggesting a new avenue for research in prevention and rehabilitation. CASE PRESENTATION We report the case of a 35-year-old patient with no significant medical history, who experienced this injury following a sudden start in a sprint without prior warm-up. The clinical examination revealed a swollen, painful knee with active extension deficit, patellar ascent, and a sub patellar hiatus. Magnetic Resonance Imaging (MRI) confirmed a trans-tendinous rupture of both the patellar and quadriceps tendons. CLINICAL DISCUSSION Tendon repair was performed using end-to-end sutures and a figure-8 reinforcement with the semitendinosus tendon, along with gracilis plastie to strengthen the patellar tendon repair. This methodological approach is discussed in the context of its effectiveness and potential implications for future surgical management of similar injuries. CONCLUSION After a 12-month follow-up, the patient exhibited highly satisfactory results, resuming both professional and sporting activities. To our knowledge, this is the first published case of a trans-tendinous rupture of the extensor apparatus tendons. This observation serves as a reference in understanding the mechanism and surgical management of such lesions, emphasizing the need for further research and clinical vigilance in similar cases.
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Affiliation(s)
- Omar Chraibi
- Orthopedics and Traumatology Surgery, CHU Ibn Rochd, 32 pavilion, Casablanca, Morocco
| | | | - Mohamed Amine Lamris
- Orthopedics and Traumatology Surgery, CHU Ibn Rochd, 32 pavilion, Casablanca, Morocco.
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Tavares BADP, Antunes LC, Guerrero SJS, de Faria ÂJN, Carvalho RA, Amorim RD. Quadricipital Tendon Simultaneous Bilateral Tear in a Patient with Type-II Diabetes Mellitus after Low-energy Trauma: Case Report. Rev Bras Ortop 2024; 59:e136-e138. [PMID: 38524704 PMCID: PMC10957280 DOI: 10.1055/s-0040-1722584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/14/2020] [Indexed: 10/21/2022] Open
Abstract
Simultaneous bilateral rupture of the quadricipital tendon is an extremely rare lesion. We report a case of this injury after low-energy trauma in a patient with type-II diabetes mellitus. Both knees were surgically approached in the same surgical procedure. Early rehabilitation is essential for the adequate functional recovery of the knee. The aim of the present report was to describe an atypical case of this type of injury after minimal trauma, as well as to detail the surgical technique used to treat it.
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3
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Fernandes A, Rufino M, Hamal D, Mousa A, Fossett E, Cheema KS. Simultaneous Bilateral Patellar Tendon Rupture: A Systematic Review. Cureus 2023; 15:e41512. [PMID: 37426403 PMCID: PMC10327612 DOI: 10.7759/cureus.41512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/11/2023] Open
Abstract
The extensor mechanism of the knee can be damaged due to various modes of injury, which, in most cases, will require urgent surgical intervention for repair. Single patellar tendon ruptures are uncommon, but simultaneous bilateral events are even rarer and have been scarcely reviewed in English literature. Research in this area is mainly confined to case series, with some literature reviews but no evidence of more substantial analysis. Therefore, this systematic review was done to analyse the existing literature on bilateral simultaneous patellar tendon ruptures and propose a systematic and standardised approach to diagnosing and managing these injuries. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search terms included 'bilateral patellar tendon rupture', 'bilateral', 'patellar', 'tendon' and 'rupture'. Three independent reviewers conducted searches in PubMed, OvidSP for Medline, Embase and the Cochrane Library using the same search strategy. The eligibility criteria included studies on bilateral concomitant patellar tendon rupture published in English. Bilateral simultaneous patellar tendon ruptures of traumatic and atraumatic origin in human patients were included. The study types comprised case reports and literature reviews. The key limitation of this study was the low number of patients covered by the eligible literature. Patellar tendon ruptures are a rare and scarcely documented injury, and there is a need for studies with a high level of evidence, especially regarding surgical treatment choice and methods, as well as post-operative management, which could potentially lead to improved outcomes in the management of this injury.
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Affiliation(s)
- André Fernandes
- Trauma and Orthopaedics, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, GBR
| | - Mariana Rufino
- Respiratory Medicine, Wirral University Teaching Hospital NHS Foundation Trust (WUTH), Wirral, GBR
| | - Divakar Hamal
- Anesthesiology, Hull University Teaching Hospital, Hull, GBR
| | - Amr Mousa
- Surgery, The Hillingdon Hospital NHS Foundation Trust, London, GBR
| | - Emma Fossett
- Trauma and Orthopaedics Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
| | - Kamalpreet S Cheema
- Trauma and Orthopaedics Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
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Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10061011. [PMID: 35742062 PMCID: PMC9222654 DOI: 10.3390/healthcare10061011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Osgood-Schlatter disease is the most common osteochondritis of the lower limb in sport-practicing children and adolescents. Its manifestation usually coincides with the appearance of the secondary ossification center of the tibia and is linked to the practice of sports with an explosive component. In the present study, a review of the factors related to its appearance, diagnosis and treatment was carried out. Its appearance seems to be multifactorial and related to multiple morphological, functional, mechanical and environmental factors. Given all the above, risk factor reduction and prevention seem the most logical strategies to effectively prevent the appearance of the condition. In addition, it is essential to create prevention programs that can be objectively assessed and would allow to stop the progress of the pathology, particularly in those sports where high forces are generated on the insertion zone of the patellar tendon at sensitive ages. More studies are needed to clarify which type of treatment is the most appropriate—specific exercises or the usual care treatment.
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5
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Murphy SM, McAleese T, Elghobashy O, Walsh J. Bilateral patellar tendon rupture following low-energy trauma in a young patient without predisposing risk factors. Trauma Case Rep 2022; 40:100643. [PMID: 35677801 PMCID: PMC9168684 DOI: 10.1016/j.tcr.2022.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/19/2022] Open
Abstract
We describe the case of a 25 year old male who presented with a bilateral patellar tendon ruptures without any of the identified risk factors for tendon injuries. Our patient is the youngest adult reported to date with confirmed bilateral, unprovoked, patellar tendon ruptures. We accompany our case with an up-to-date literature review on this topic. A degree of clinical suspicion is required for emergency room physicians as well as orthopaedic surgeons assessing such patients to avoid missing bilateral injuries. Point of care ultrasound may be utilised when there is doubt regarding the diagnosis. Prompt surgical management and a specific rehabilitation programme are both required to ensure maximum recovery of these patients.
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Beirut port explosion: unusual presentation of bilateral blast-related extensor mechanism rupture. Skeletal Radiol 2021; 50:1479-1483. [PMID: 33506315 DOI: 10.1007/s00256-020-03707-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/27/2020] [Accepted: 12/27/2020] [Indexed: 02/02/2023]
Abstract
Industrial disasters related to high-order explosives result in characteristic injuries that are seldom seen among civilians. Survivors of these disasters often present with injuries of the musculoskeletal system. Awareness of explosion and blast injuries for healthcare providers who care for civilians is important considering the possibility of such events as demonstrated in the past two decades, including the Boston Marathon bombing in 2013 and the explosion of the port of Tianjin, China, in 2015. We report an unusual presentation of isolated bilateral rupture of the knee extensor mechanism in a 46-year-old healthy male, with history of anabolic androgen steroid (AAS) use. He was standing 1.5 miles from the site of the site of explosion of the port of Beirut on August 4, 2020. We discuss the imaging appearance of this injury, the different mechanisms of blast-related injuries, the role of possible underlying pathology, and the management of this patient.
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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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8
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Massey PA, Myers M, McClary K, Brown J, Barton RS, Solitro GF. Biomechanical Analysis of Patellar Tendon Repair With Knotless Suture Anchor Tape Versus Transosseous Suture. Orthop J Sports Med 2020; 8:2325967120954808. [PMID: 33062760 PMCID: PMC7536376 DOI: 10.1177/2325967120954808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patellar tendon ruptures have routinely been repaired with transosseous suture tunnels. The use of knotless suture anchors for repair has been suggested as an alternative. PURPOSE To compare the load to failure and gap formation of patellar tendon repair at the inferior pole of the patella with knotless suture anchor tape versus transosseous sutures. A secondary objective was to investigate whether either technique shows an association between bone density and load to failure. STUDY DESIGN Controlled laboratory study. METHODS A total of 20 human tibias with attached patellar and quadriceps tendons were sharply incised at the bone-tendon junction at the inferior pole of the patella. A total of 10 tendons were repaired using 2 knotless suture anchors in the inferior pole of the patella and a single suture tape with 2 core sutures. The other 10 tendons were repaired using No. 2 suture passed through 3 transosseous tunnels. A distracting force was then applied through the suture in the quadriceps tendon. Gap distance through load cycling at the repair site and maximum load at repair failure were then measured. Bone density was measured using computed tomography scanning. RESULTS No difference was found in the mean load to failure of knotless patellar tendon repair versus transosseous suture repair (367.6 ± 112.2 vs 433.9 ± 99 N, respectively; P = .12). After 250 cycles, the mean repair site gap distance was 0.85 ± 0.45 mm for the knotless patellar tendon repair versus 2.94 ± 2.03 mm for the transosseous suture repair (P = .03). A small correlation, although not statistically significant, was found between bone density and load to failure for the knotless tape repair (R 2 = 0.228; P = .66). No correlation was found between bone density and load to failure for the transosseous repair (R 2 = 0.086; P = .83). CONCLUSION Suture tape repair with knotless anchors for repair of patellar tendon rupture has comparable load to failure with less gap formation than transosseous suture repair. There is a small correlation between bone density and failure load for knotless anchor repair, which may benefit from further investigation. CLINICAL RELEVANCE Using knotless suture anchors for patellar tendon rupture repair would allow for a smaller incision, less dissection, and likely shorter operating time.
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Affiliation(s)
- Patrick A. Massey
- Department of Orthopaedic Surgery, Louisiana State University
Health, Shreveport, Louisiana, USA
| | - Mitchell Myers
- Department of Orthopaedic Surgery, Louisiana State University
Health, Shreveport, Louisiana, USA
| | - Kaylan McClary
- Department of Orthopaedic Surgery, Louisiana State University
Health, Shreveport, Louisiana, USA
| | - Jimmy Brown
- Department of Orthopaedic Surgery, Louisiana State University
Health, Shreveport, Louisiana, USA
| | - R. Shane Barton
- Department of Orthopaedic Surgery, Louisiana State University
Health, Shreveport, Louisiana, USA
| | - Giovanni F. Solitro
- Department of Orthopaedic Surgery, Louisiana State University
Health, Shreveport, Louisiana, USA
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9
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Moy A, Song E, Wallace SJ, Teixeira R, Torres D. Simultaneous Bilateral Patellar Tendon Rupture in a Young Adult Male: A Case Report and Review of the Literature. Cureus 2020; 12:e10649. [PMID: 33133819 PMCID: PMC7586418 DOI: 10.7759/cureus.10649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A bilateral patellar tendon rupture is extremely rare and has only been documented in case reports. Although the etiology remains unknown, predisposing factors include steroid usage, systemic diseases, and tendinopathies. In the present case, a healthy 33-year-old male with a prior history of bilateral patellar tendonitis and a diagnosis of Osgood-Schlatter disease during adolescence experienced simultaneous bilateral patellar tendon rupture after playing volleyball. He underwent bilateral patellar repair without complications. In the absence of trauma, spontaneous bilateral patellar tendon ruptures are associated with several predisposing factors, including systemic diseases, prior corticosteroid or fluoroquinolone usage, and history of tendinopathy. Injuries can be classified based on the location of the rupture. Bilateral patellar tendon ruptures can be misdiagnosed due to the rarity of cases and the lack of a normal comparative knee. Radiographic techniques can aid in the diagnosis, leading to early surgical treatment and improved outcomes. Early diagnosis and prompt surgical repair contribute to good functional outcomes in this potentially debilitating injury pattern.
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Affiliation(s)
- Adrian Moy
- Orthopedic Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Ethan Song
- Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Sean J Wallace
- Department of Surgery - Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA
| | - Robert Teixeira
- Department of Surgery - Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA
| | - Daniel Torres
- Department of Surgery - Division of Orthopedic Surgery, Lehigh Valley Health Network, Allentown, USA
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10
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Bilateral patellar tendon rupture on lupus undergoing corticosteroids: a case report. BMC Musculoskelet Disord 2020; 21:477. [PMID: 32693777 PMCID: PMC7372875 DOI: 10.1186/s12891-020-03513-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patellar tendon rupture is a rare condition, especially when it is bilateral. The most frequent associated pathologies are systemic lupus erythematosus, chronic renal failure, or treatments like corticosteroids. The aim of this case report is to draw attention to the non-specific clinical aspect of this condition, to recall its radiological signs, and highlight the diagnostic contribution of musculoskeletal ultrasound. CASE PRESENTATION A 39-year-old man was diagnosed with a systemic lupus erythematosus with cutaneous, pulmonary, cardiac, hematological, renal, and immunological manifestations. He was treated with high-dose corticosteroids. Within 3 months he presented with a total functional impotence of the knees. On physical examination, there was a gap in the right infrapatellar region, his patellae were abnormally ascended, and his left knee was swollen. Insall-Salvati ratio on knees conventional radiographies was 2.5 in the right and 2.25 in the left knee, assessing bilateral patella alta. Ultrasound revealed a complete and bilateral patellar tendon rupture. The treatment consisted in a surgical repair and physiotherapy. The patient was able to mobilize independently after 6 months. CONCLUSIONS Bilateral patellar tendon rupture is exceptional. Systemic lupus erythematosus and corticosteroids are among trigger factors. Careful examination of the patellae should be done in front of knee extension deficit. Ultrasound plays a determining role in the diagnosis.
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Hosur Ravishankar V, El Abed K, Ahmad R. Ossified proximal patellar tendon rupture. BMJ Case Rep 2020; 13:13/7/e235143. [PMID: 32675119 DOI: 10.1136/bcr-2020-235143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Extensor mechanism injuries are not uncommon in young active individuals. Patellar tendon is a part of extensor mechanism of the knee which is commonly ruptured due to forced eccentric contraction against flexed knee. There have been reports of pathological changes in the patellar tendon which eventually lead to the rupture. The common pathologies include hypoxic tendinopathy, mucoid degeneration, calcific tendinopathy and tendolipomatosis. We report a rare case of ossified proximal patellar tendon rupture in a fit and active skittle player, who sustained indirect injury to knee while playing soccer. The rupture was confirmed on examination and radiographs. We discovered intraoperatively that the ruptured proximal patellar tendon was ossified which was sequentially repaired with two Krackow sutures, JuggerKnot suture anchor and finally augmented with Leeds Keio tape. Postoperatively, a knee brace was used to immobilise in knee extension with progressive increase in range of motion. This report supports the pool of evidence suggestive of patellar tendon pathology in causing ruptures.
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Affiliation(s)
| | | | - Riaz Ahmad
- Orthopaedics, Weston General Hospital, Weston-super-Mare, UK
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12
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Surgical Treatment for Chronic Rupture of the Patellar Tendon Performed in 2 Stages. Arthrosc Tech 2019; 9:e159-e166. [PMID: 32021790 PMCID: PMC6993262 DOI: 10.1016/j.eats.2019.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/13/2019] [Indexed: 02/03/2023] Open
Abstract
Patellar tendon rupture is an uncommon but disabling lesion. It usually occurs in men younger than 40 years, through direct or indirect trauma. Obtaining satisfactory results with treatment of chronic injuries and re-ruptures in which the patella retracts owing to quadriceps contraction is a challenge. This is of major concern especially in cases in which the patella cannot be positioned in its anatomic position when distal traction is performed. In these cases, V-Y stretching of the quadriceps can be performed in an attempt to perform reconstruction in 1 stage. Instead, a 2-stage procedure can be chosen, in which the first stage relies on patellar trans-skeletal traction to achieve distalization of the patella. In 1981, a technique for the treatment of chronic injuries of the patellar tendon in 2 stages was described. In that procedure, the first stage consisted of transpatellar traction and the second stage was tendon-tendon suturing with fascia lata reinforcement. We describe a surgical technique performed in 2 stages; in the first stage, trans-skeletal traction is performed, and in the second stage, the technique of Kelikian et al. with our modification is performed. This technique is used in patients with chronic rupture of the patellar tendon associated with a high patella with nonreducible quadriceps shortening.
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Takeda S, Iwatsuki K, Takeichi Y, Kano T, Tabuchi A, Hirata H. A Man with Severe Right Knee Pain. Clin Pract Cases Emerg Med 2019; 3:168-169. [PMID: 31061981 PMCID: PMC6497207 DOI: 10.5811/cpcem.2019.1.41417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/19/2018] [Accepted: 01/22/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Shinsuke Takeda
- Anjo Kosei Hospital, Emergency and Critical Care Center, Anjo, Japan.,Anjo Kosei Hospital, Department of Orthopaedic Surgery, Anjo, Japan.,Nagoya University Graduate School of Medicine, Department of Hand Surgery, Nagoya, Japan
| | - Katsuyuki Iwatsuki
- Nagoya University Graduate School of Medicine, Department of Hand Surgery, Nagoya, Japan
| | - Yosuke Takeichi
- Anjo Kosei Hospital, Department of Orthopaedic Surgery, Anjo, Japan
| | - Tomohiro Kano
- Anjo Kosei Hospital, Department of Orthopaedic Surgery, Anjo, Japan
| | - Akihiko Tabuchi
- Anjo Kosei Hospital, Emergency and Critical Care Center, Anjo, Japan
| | - Hitoshi Hirata
- Nagoya University Graduate School of Medicine, Department of Hand Surgery, Nagoya, Japan
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Moura DL, Marques JP, Pinheiro JP, Fonseca F. Total bilateral ruptures of the knee extensor apparatus. Rev Bras Ortop 2017; 52:663-669. [PMID: 29234649 PMCID: PMC5720844 DOI: 10.1016/j.rboe.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/03/2016] [Indexed: 11/22/2022] Open
Abstract
Objective Bilateral extensor tendon ruptures of the knee are rare and have only been published in the form of case reports or small series. Methods Seven patients corresponding to 14 extensor tendon ruptures of the knee were evaluated by the same examiner after a minimum one year post-surgery. Clinical and radiographic evaluations were performed; for statistical analysis, the level of significance was set at 0.05. Results The most common injury was patellar tendon rupture (n = 9; 64.29%) followed by quadriceps tendon rupture (n = 5, 35.71%). The intrasubstance was the most affected location (57.15%), followed by the myotendinous junction (21.43%) and the patellar bone insertions (21.43%). Quadriceps tendon ruptures were more prevalent in patients older than 50 years, while patellar tendon ruptures tended to occur in younger individuals. All but one patient had recognized risk factors for tendinous degeneration and rupture: 75% of the cases suffered from diseases, 50% had history of drug use and/or abuse, and 37.5% had both disease and drug use history. Mean attained values for flexion ROM were 124.64° ± 9.43 (110–140°) and 89.57 ± 6.02 (78–94) for Kujala score. More than half of the patients complained of residual pain and quadriceps muscular weakness. Mean age was younger in the individuals who complained of residual pain. Conclusion Bilateral tendon ruptures of the knee extensor apparatus ruptures are rare and serious injuries, mostly associated with risk factors. Early surgical repair and intensive rehabilitation program for bilateral extensor tendon ruptures of the knee may warrant satisfactory functional outcomes in the medium to long term, despite non-negligible levels of residual pain, quadriceps muscle weakness, and atrophy.
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Affiliation(s)
- Diogo Lino Moura
- Coimbra University Hospital, Orthopedics Department, Coimbra, Portugal
| | - José Pedro Marques
- Coimbra University Hospital, Sports Medicine Department, Coimbra, Portugal
| | - João Páscoa Pinheiro
- Coimbra University Hospital, Physical Rehabilitation Medicine Department, Coimbra, Portugal
| | - Fernando Fonseca
- Coimbra University Hospital, Orthopedics Department, Coimbra, Portugal
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Abstract
The knee is the most complex and largest joint in the body. Injuries to any part of this joint affect the entire body. There are multiple injuries that can occur to the knee, with the most common being ligament and meniscus tears. A not-so-common injury to the knee is a patellar tendon rupture. A bilateral patellar tendon rupture is extremely rare. A case study of a 43-year-old man who sustained a bilateral patellar tendon rupture while playing softball is used to present this devastating injury. This discussion includes the incidence and diagnosis of the tear, surgical repair, as well as a description of the comprehensive rehabilitation process necessary to allow the patient to return to normal physical activity. Risks and complications of this surgery and the expected outcomes are also presented.
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17
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Moura DL, Marques JP, Lucas FM, Fonseca FP. Simultaneous bilateral patellar tendon rupture. Rev Bras Ortop 2017; 52:111-114. [PMID: 28194391 PMCID: PMC5290082 DOI: 10.1016/j.rboe.2016.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 11/26/2022] Open
Abstract
Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.
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Affiliation(s)
- Diogo Lino Moura
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
| | - José Pedro Marques
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
| | - Francisco Manuel Lucas
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
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18
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Moura D, Fonseca F. Total ruptures of the extensor apparatus of the knee. Rev Bras Ortop 2017; 51:640-645. [PMID: 28050533 PMCID: PMC5198062 DOI: 10.1016/j.rboe.2016.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/18/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This was a retrospective case-control study on total ruptures of the extensor apparatus of the knee, aimed to compare patella fractures with tendinous ruptures. METHODS The sample included 190 patients and 198 total ruptures of the knee extensor apparatus. All patients were evaluated by the same examiner after a minimum one-year follow-up. RESULTS Tendinous ruptures occurred most frequently in men, in younger patients, and had better clinical and functional outcomes when compared with patella fractures; however, the former presented higher levels of thigh atrophy. Patella fractures occurred most frequently in women and in older patients and caused most frequently caused residual pain, muscle weakness, and limitations in daily activities. Comminuted fractures were related to high-energy trauma, lower clinical and functional outcomes, and higher levels of residual pain and osteosynthesis failure. Early removal of osteosynthesis material was related to better outcomes. Regarding the tendinous ruptures, over half of the patients presented risk conditions for tendinous degeneration; a longer delay until surgery was related to lower Kujala scores. CONCLUSION The surgical repair of bilateral ruptures of the knee extensor apparatus resulted in satisfactory clinical and functional outcomes, which were better for tendinous ruptures when compared with patella fractures. However, these lesions are associated with non-negligible levels of residual pain, muscle weakness, atrophy, and other complications.
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Affiliation(s)
- Diogo Moura
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
| | - Fernando Fonseca
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
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19
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Moura DL, Marques JP, Lucas FM, Fonseca FP. Rupturas bilaterais simultâneas dos tendões patelares. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Pengas IP, Assiotis A, Khan W, Spalding T. Adult native knee extensor mechanism ruptures. Injury 2016; 47:2065-2070. [PMID: 27423309 DOI: 10.1016/j.injury.2016.06.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 02/02/2023]
Abstract
Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery. Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.
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Affiliation(s)
- I P Pengas
- UHCW (University Hospitals of Coventry & Warwickshire NHS Trust), United Kingdom.
| | - A Assiotis
- ST5 NW London Rotation, St Marys Hospital, United Kingdom.
| | - W Khan
- Division of Trauma & Orthopaedics, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom.
| | - T Spalding
- UHCW (University Hospitals of Coventry & Warwickshire NHS Trust), United Kingdom.
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22
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Bethel J. An unusual cause of limp. Int Emerg Nurs 2016; 24:71-3. [DOI: 10.1016/j.ienj.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 03/10/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
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23
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Seng C, Lim YJ, Pang HN. Spontaneous disruption of the bilateral knee extensor mechanism: a report of two cases. J Orthop Surg (Hong Kong) 2015; 23:262-6. [PMID: 26321566 DOI: 10.1177/230949901502300233] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous disruption of the knee extensor mechanism is associated with systemic diseases, steroid usage, and repeated microtrauma. Early repair or reconstruction is imperative for optimal outcome. We report 2 cases of spontaneous disruption of the bilateral knee extensor mechanism. The first patient had connective tissue disease and long-term steroid use. She had acute-on-chronic spontaneous bilateral patellar tendon rupture. She underwent reconstruction with an allograft and defunctioning wire. The second patient had end-stage renal failure with tertiary hyperparathyroidism and was on haemodialysis. He had a right patellar tendon rupture and a left quadriceps tendon rupture. He underwent primary repair of both tendons. Postoperatively, both patients followed a strict physiotherapy regimen and achieved good functional outcome.
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Affiliation(s)
- Chusheng Seng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yi-Jia Lim
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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24
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Pires e Albuquerque RS, de Araújo GCS, Labronici PJ, Gameiro VS. Patellar ligament rupture in an adolescent. BMJ Case Rep 2015; 2015:bcr-2014-208070. [PMID: 25743861 DOI: 10.1136/bcr-2014-208070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rupture of the patellar tendon is a well-known injury in the orthopaedic literature. However, it is unusual and rarely reported in adolescent children. On the one hand, in the immature skeleton, the most frequent lesion above the kneecap is the sleeve fracture. On the other hand, in the distal region, avulsion of the tibial tuberosity is more common. Patellar tendon rupture in an adolescent is a rare lesion. We report a case in which an adolescent sustained a fall when jumping. No predisposing factors have been found. The injury was treated with surgical repair with transosseous suturing and reinforcement with semitendinosus tendon. The aim of this study is to present a case of traumatic rupture of the extensor mechanism of the knee in an adolescent and the therapy used.
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25
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Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use. Case Rep Orthop 2015; 2015:215796. [PMID: 25960904 PMCID: PMC4413034 DOI: 10.1155/2015/215796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/25/2015] [Indexed: 11/18/2022] Open
Abstract
Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency) that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release.
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26
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Albuquerque RP, Giordano V, Albuquerque MIP, Carvalho ACP, do Amaral NP, Barretto JM. SIMULTANEOUS BILATERAL TEAR OF THE KNEE EXTENSOR MECHANISM IN A PRE-ADOLESCENT: CASE REPORT. Rev Bras Ortop 2012; 47:659-61. [PMID: 27047882 PMCID: PMC4799452 DOI: 10.1016/s2255-4971(15)30020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/04/2011] [Indexed: 11/05/2022] Open
Abstract
Unilateral tearing of a patellar tendon and a contralateral sleeve fracture in a pre-adolescent are rare lesions. We report a case in which a pre-adolescent sustained a fall while jumping during a soccer match. No predisposing risk factors were identified. The injuries were treated with surgical repairs and transosseous suturing. The aim of this study was to present a case of spontaneous concurrent tearing of the extensor mechanism of the knee in a pre-adolescent.
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Affiliation(s)
- Rodrigo Pires Albuquerque
- MSc and PhD in Medicine; Orthopedist and Coordinator of the Knee Surgery Sector, SOT-HMMC, Rio de Janeiro, RJ, Brazil
| | - Vincenzo Giordano
- MSc in Medicine; Orthopedist and Coordinator of the Medical Residence Program, SOT-HMMC, Rio de Janeiro, RJ, Brazil
| | | | - Antonio Carlos Pires Carvalho
- Associate Professor in the Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - João Maurício Barretto
- MSc and PhD in Medicine; Head of the Orthopedics Service, Santa Casa do RJ, Rio de Janeiro, RJ, Brazil
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27
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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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28
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Nguene-Nyemb AG, Huten D, Ropars M. Chronic patellar tendon rupture reconstruction with a semitendinosus autograft. Orthop Traumatol Surg Res 2011; 97:447-50. [PMID: 21596640 DOI: 10.1016/j.otsr.2011.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/21/2010] [Accepted: 01/11/2011] [Indexed: 02/02/2023]
Abstract
Chronic patellar tendon ruptures are somewhat rare, thus little work has been done in this area and their true incidence is not known. The management of a neglected, chronic patellar tendon rupture must address three difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, the temporary protection of this repair. By presenting a case of a chronic patellar tendon rupture, the advantages of reconstruction with an isolated semitendinosus tendon autograft, especially from an early rehabilitation perspective, are described.
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Affiliation(s)
- A G Nguene-Nyemb
- Department of Orthopaedic Surgery, Pontchaillou Hospital, Rennes Teaching Hospital Center, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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29
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Sibley T, Algren DA, Ellison S. Bilateral patellar tendon ruptures without predisposing systemic disease or steroid use: a case report and review of the literature. Am J Emerg Med 2010; 30:261.e3-5. [PMID: 21185665 DOI: 10.1016/j.ajem.2010.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 11/04/2010] [Indexed: 11/18/2022] Open
Abstract
Simultaneous bilateral patellar tendon rupture occurs rarely and is even rarer in patients without systemic disease or predisposing conditions. We present a case of bilateral, midsubstance patellar tendon ruptures along with a partial anterior cruciate ligament tear from a fall from a standing height in an otherwise healthy adult without any predisposing conditions. Most patients that sustain a tendon rupture have risk factors for tendonopathy including chronic renal disease, systemic lupus erythematosus, rheumatoid arthritis, or exposure to medications (such as corticosteroids or fluoroquinolones). Currently, there are approximately 50 reported cases of bilateral patellar tendon rupture in the scientific literature; however, only a small minority occurred in patients without any predisposing factors. Most of the reports of a bilateral tendon rupture without systemic disease occurred in the inferior pole of the tendon, with only a few of these occurring in the midsubstance. Because of the rarity of this event in a patient without systemic disease, this condition is often misdiagnosed. Emergency physicians should maintain a high degree of suspicion in those patients with concerning clinical and/or radiographic findings.
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Affiliation(s)
- Ted Sibley
- Department of Emergency Medicine, University of Missouri–Kansas City/Truman Medical Center, Kansas City, MO 64018, USA.
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30
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Kumar S, Rachakatla N, Kerin C, Kumar R. Simultaneous traumatic rupture of the patellar tendon and the contralateral quadriceps tendon in a healthy individual. BMJ Case Rep 2010; 2010:2010/nov04_1/bcr0620103057. [PMID: 22791858 DOI: 10.1136/bcr.06.2010.3057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A simultaneous traumatic complete rupture of the patellar tendon and the contralateral quadriceps tendon is reported to occur in patients with renal failure and other inflammatory diseases, but is extremely rare in a healthy individual because of the different contributory factors and mechanisms of injury. We present a rare case report of such a combination of injuries in a 48-year-old healthy man. To our knowledge only three such cases have been reported in the English literature. This is an unusual combination and hence there is potential for missed diagnosis leading to suboptimal treatment.
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Affiliation(s)
- S Kumar
- Department of Trauma and Orthopaedics, Mid Staffordshire General Hospital, Stafford, UK.
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31
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Concurrent bilateral patellar tendon rupture in a preadolescent athlete: a case report and review of the literature. J Pediatr Orthop B 2010; 19:511-4. [PMID: 20595921 DOI: 10.1097/bpb.0b013e32833cb7a0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Concurrent bilateral patellar tendon rupture in preadolescence is a very rare condition. It is mostly associated with systemic disease or steroid use in adults. We report a case of 12-year-old boy, who had bilateral patellar tendon rupture, treated with nonabsorbable synthetic suturing with titanium osseous anchors. Moreover, we discuss the causes of patellar tendon rupture, diagnostic clues and surgical options.
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32
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Savarese E, Bisicchia S, Amendola A. Bilateral spontaneous concurrent rupture of the patellar tendon in a healthy man: case report and review of the literature. Musculoskelet Surg 2010; 94:81-8. [PMID: 20480273 DOI: 10.1007/s12306-010-0077-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 04/06/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Eugenio Savarese
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, 81 Oxford Street, Rome, Italy.
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33
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Alves EM, Macieira JC, Borba E, Chiuchetta FA, Santiago MB. Spontaneous tendon rupture in systemic lupus erythematosus: association with Jaccoud’s arthropathy. Lupus 2010; 19:247-254. [DOI: 10.1177/0961203309351729] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Tendon rupture has rarely been described in patients with systemic lupus erythematosus. From observation of three cases of Jaccoud’s arthropathy with tendon rupture, and considering that this arthropathy is more related to an inflammatory process of the tendon sheath than to synovitis per se, the intention of this study was to review the cases of tendon rupture in patients with systemic lupus erythematosus, in the hope of determining the frequency of Jaccoud’s arthropathy associated with this complication. Systematic review using MEDLINE, Scielo and LILACS databases (1966 to 2009) and the following keywords: systemic lupus erythematosus, tendon rupture, Jaccoud’s arthropathy. Secondary references were additionally obtained. Additionally, three Brazilian systemic lupus erythematosus patients who developed tendon rupture are described. Only 40 articles obtained fulfilled the previously established criteria. They were all case reports; the number of cases reported was 52 which, together with the three cases presented herein add up to 55 cases. Forty-six patients were women aged between 19 and 71 years, with a mean age of 40.1 ± 12.4 years, and the average duration of the disease was 10 years. The most frequently observed rupture sites were the patellar and Achilles’ tendons. While almost all patients described were on various doses of corticosteroids, 16 patients concomitantly had Jaccoud’s arthropathy (29%). In conclusion, the association between Jaccoud’s arthropathy and tendon rupture in systemic lupus erythematosus has been underestimated. As almost one-third of the systemic lupus erythematosus patients with tendon rupture also have Jaccoud’s arthropathy, this arthropathy may be recognized as risk marker for tendon rupture. Lupus (2010) 19, 247—254.
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Affiliation(s)
- EM Alves
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - JC Macieira
- Universidade Federal de Sergipe, Aracaju, Brazil
| | - E. Borba
- Disciplina de Reumatologia, Universidade de São Paulo, São Paulo, Brazil
| | - FA Chiuchetta
- Universidade Federal do Paraná and Hospital da XV, Curitiba, Brazil
| | - MB Santiago
- Serviço de Reumatologia do Hospital Santa Izabel and EBMSP, Salvador, Brazil,
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34
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Cree C, Pillai A, Jones B, Blyth M. Bilateral patellar tendon ruptures: a missed diagnosis : case report and literature review. Knee Surg Sports Traumatol Arthrosc 2007; 15:1350-4. [PMID: 17604980 DOI: 10.1007/s00167-007-0350-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 04/11/2007] [Indexed: 11/26/2022]
Abstract
Knee extensor mechanism disruption is an unusual but serious emergency presentation. Rarely disruption can occur within the patellar tendon which is often associated with systemic diseases such as rheumatoid arthritis and systemic lupus erythematosus. Surgical management is required to repair the patellar tendon after clinical assessment and diagnosis. We describe the case of a 75-year-old man without any known predisposing systemic disease presenting on several occasions before accurate diagnosis and treatment. We include a literature review of similar cases and discuss the importance of missed diagnosis and underlying causes. A treatment algorithm to avoid missing similar injuries is also proposed.
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Affiliation(s)
- Calum Cree
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow G40SF, UK
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35
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Recurrent bilateral rupture of the patellar tendons: Tendon replacement using polyester connective tissue prosthesis. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.injury.2006.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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36
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Affiliation(s)
- Stephen R Christian
- Department of Radiology, Medical University of South Carolina, PO Box 250322, 169 Ashley Avenue, Charleston, SC 29425, USA
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37
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Ozkan C, Kalaci A, Tan I, Sarpel Y. Bilateral dislocation of the knee with rupture of both patellar tendons. A case report. Knee 2006; 13:333-6. [PMID: 16806939 DOI: 10.1016/j.knee.2006.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 03/15/2006] [Accepted: 04/20/2006] [Indexed: 02/02/2023]
Abstract
Knee dislocations are rare injuries caused by violent trauma. Damage to soft tissues and ligament lesions almost always accompany the injury. Vascular compromise further complicates the situation. We report a case of bilateral posterior knee dislocation with traumatic rupture of both patellar tendons. Treatment consisted of external fixation of both knees. Vascular compromise resolved with reduction and traction pins were placed on both patellae which were connected to the external fixators on following days. Primary repair of patellar tendon was undertaken after gradual distal repositioning of patella. The result is successful with full range of motion. Rupture of patellar tendon should be considered with posterior dislocation of the knee. External fixators provide quick stabilization in case of vascular compromise and can be modified to provide a traction system for distal repositioning of patella which allows primary repair of the patellar tendon.
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Affiliation(s)
- Cenk Ozkan
- Cukurova University Faculty of Medicine, Department of Orthopaedics and Traumatology 01330/ BALCALI/ADANA/Turkey.
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