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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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Hishimura R, Kondo E, Matsuoka M, Iwasaki K, Kawaguchi Y, Suzuki Y, Onodera T, Momma D, Iwasaki N. Double-bundle anterior cruciate ligament reconstruction using autologous hamstring tendon hybrid grafts in a patient with hypermobile Ehlers-Danlos Syndrome: A case report. Knee 2022; 35:81-86. [PMID: 35220136 DOI: 10.1016/j.knee.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/29/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by skin hyperextensibility, joint hypermobility, and tissue friability. Hypermobile type Ehlers-Danlos syndrome (hEDS) is considered one of the EDS subtypes characterized by generalized joint hypermobility. Although there have been a few case reports which described surgical considerations for anterior cruciate ligament (ACL) reconstructions in patients with other types of EDS, no reports have described those in patients with hEDS. CASE PRESENTATION We report a case of ACL injury in an 18-year-old male patient with hEDS. The patient was successfully treated with an anatomic double-bundle ACL reconstruction using autologous hamstring tendon hybrid grafts which consist of hamstring tendons connected in a series with commercially available polyester tape. The autogenous tendon portion of the anteromedial and posterolateral bundles were composed of 4 and 2 strands of hamstring tendons, respectively. After 2 weeks of knee joint immobilization, continuous passive motion exercise of the knee joint and partial weight-bearing was allowed. A hinged knee brace was used for a period of 5 months postoperatively. Second-look arthroscopy at 30 months showed that the ACL graft had no laceration and an excellent coverage of the synovium. At 36 months after surgery, the side-to-side differences in the anterior laxity was remarkably improved. The operated knee showed negative Lachman test and had a full range of motion. CONCLUSIONS To the best of our knowledge, this represents the first report of anatomic double-bundle ACL reconstruction in patients with hEDS and demonstrates excellent clinical and functional outcomes.
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Affiliation(s)
- Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, North 14 West 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan.
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Yasuyuki Kawaguchi
- Sports and Arthroscopy Center, Hanna Central Hospital, Ikoma, Nara 630-0243, Japan
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Daisuke Momma
- Centre for Sports Medicine, Hokkaido University Hospital, North 14 West 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
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Homere A, Bolia IK, Juhan T, Weber AE, Hatch GF. Surgical Management of Shoulder and Knee Instability in Patients with Ehlers-Danlos Syndrome: Joint Hypermobility Syndrome. Clin Orthop Surg 2020; 12:279-285. [PMID: 32904109 PMCID: PMC7449847 DOI: 10.4055/cios20103] [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: 05/04/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022] Open
Abstract
Ehlers-Danlos Syndrome (EDS) is a hereditary disorder of the connective tissue, which has been classified into numerous subtypes over the years. EDS is generally characterized by hyperextensible skin, hypermobile joints, and tissue fragility. According to the 2017 International Classification of EDS, 13 subtypes of EDS have been recognized. The majority of genes involved in EDS are either collagen-encoding genes or genes encoding collagen-modifying enzymes. Orthopedic surgeons most commonly encounter patients with the hypermobile type EDS (hEDS), who present with signs and symptoms of hypermobility and/or instability in one or more joints. Patients with joint hypermobility syndrome (JHS) might also present with similar symptomatology. This article will focus on the surgical management of patients with knee or shoulder abnormalities related to hEDS/JHS.
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Affiliation(s)
- Andrew Homere
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Tristan Juhan
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - George F Hatch
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
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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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Rosa B, Campos P, Barros A, Karmali S, Gonçalves R. Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone-induced tendinopathy. Clin Case Rep 2016; 4:678-81. [PMID: 27386128 PMCID: PMC4929805 DOI: 10.1002/ccr3.592] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/09/2016] [Accepted: 05/09/2016] [Indexed: 11/26/2022] Open
Abstract
The present case emphasizes the importance of adhering to strict indications when prescribing fluoroquinolones. Although rare, drug‐induced tendinopathy is not confined to fluoroquinolones. The patient's and physician's awareness should be increased to reduce fluoroquinolones‐associated morbidity, particularly in patients with previously described risk factors.
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Affiliation(s)
- Bárbara Rosa
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
| | - Pedro Campos
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
| | - André Barros
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
| | - Samir Karmali
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
| | - Ricardo Gonçalves
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
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Cherrad T, Louaste J, Kasmaoui EH, Bousbaä H, Rachid K. Neglected bilateral rupture of the patellar tendon: A case report. J Clin Orthop Trauma 2015; 6:296-9. [PMID: 26566349 PMCID: PMC4600838 DOI: 10.1016/j.jcot.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/14/2015] [Indexed: 11/15/2022] Open
Abstract
Simultaneous bilateral rupture of the patellar tendon (PT) is extremely rare and is generally associated to some chronic diseases. When the rupture becomes chronic, it is more difficult to repair that as it remained untreated. The diagnosis, which is clinical, is often delayed, guided by standard radiography and confirmed by ultrasound or MRI. The management of a bilateral neglected, chronic patellar tendon rupture must address some serious difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, the temporary protection of this repair. We report a case of neglected bilateral rupture of the patellar tendon in a chronic hemodialysis patient, treated with a plastic surgery of the ipsilateral quadriceps tendon.
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Affiliation(s)
- Taoufik Cherrad
- Resident in Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Moulay Ismail (HMMI), BP 50000, Meknes, Morocco
- Corresponding author. Tel.: +212 6 61 17 09 79.
| | - Jamal Louaste
- Assistant Professor in Orthopedic Surgery and Traumatology, HMMI, Meknes, Morocco
| | - El Houcine Kasmaoui
- Assistant Professor in Orthopedic Surgery and Traumatology, HMMI, Meknes, Morocco
| | - Hicham Bousbaä
- Resident in Orthopedic Surgery and Traumatology, HMMI, Meknes, Morocco
| | - Khaled Rachid
- Professor Head of the Department of Orthopedic Surgery and Traumatology, HMMI, Meknes, Morocco
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Williams D, Kahane S, Chou D, Vemulapalli K. Bilateral Proximal Tibial Sleeve Fractures in a Child: A Case Report. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e27898. [PMID: 26566509 PMCID: PMC4636667 DOI: 10.5812/atr.27898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 03/15/2015] [Indexed: 12/04/2022]
Abstract
Introduction: A sleeve fracture classically describes an avulsion of cartilage or periosteum with or without osseous fragments and usually occurs at the inferior margin of the patella. Tibial tubercle sleeve fractures in the skeletally immature are extremely rare. Case Presentation: In this report the authors describe a 12-year-old boy with no systemic disease and no steroid use who sustained bilateral proximal tibial sleeve fractures whilst playing football. Both ruptures were associated with rupture of the medial patellofemoral ligament and tear of the medial retinaculum. Treatment was performed with primary end-to-end repair, reinforcement with bone anchors and cerclage wires with an excellent outcome. Conclusions: We feel this rare, currently unclassified variant of a tibial tubercle avulsion fracture should be recognised and consideration taken to adding it to existing classification systems.
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Affiliation(s)
- Daniel Williams
- Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
- Corresponding author: Daniel Williams, Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK. Fax: +44-1689850915, E-mail:
| | - Steven Kahane
- Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
| | - Daud Chou
- Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
| | - Krishna Vemulapalli
- Department of Trauma and Orthopaedics, Queen’s Hospital Romford, Rom Valley Way, Romford, Essex RM7 0AG, UK
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Nielsen RH, Couppé C, Jensen JK, Olsen MR, Heinemeier KM, Malfait F, De Paepe SS, Schjerling P, Magnusson SP, Remvig L, Kjaer M. Low tendon stiffness and abnormal ultrastructure distinguish classic Ehlers‐Danlos syndrome from benign joint hypermobility syndrome in patients. FASEB J 2014; 28:4668-76. [DOI: 10.1096/fj.14-249656] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rie Harboe Nielsen
- Institute of Sports MedicineDepartment of Orthopaedic SurgeryBispebjerg HospitalCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Christian Couppé
- Musculoskeletal Rehabilitation Research UnitDepartment of Physical TherapyBispebjerg HospitalCopenhagenDenmark
| | - Jacob Kildevang Jensen
- Institute of Sports MedicineDepartment of Orthopaedic SurgeryBispebjerg HospitalCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Morten Raun Olsen
- Institute of Sports MedicineDepartment of Orthopaedic SurgeryBispebjerg HospitalCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Katja Maria Heinemeier
- Institute of Sports MedicineDepartment of Orthopaedic SurgeryBispebjerg HospitalCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | | | | | - Peter Schjerling
- Institute of Sports MedicineDepartment of Orthopaedic SurgeryBispebjerg HospitalCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Stig Peter Magnusson
- Musculoskeletal Rehabilitation Research UnitDepartment of Physical TherapyBispebjerg HospitalCopenhagenDenmark
| | - Lars Remvig
- Department of RheumatologyRigshospitaletCopenhagenDenmark
| | - Michael Kjaer
- Institute of Sports MedicineDepartment of Orthopaedic SurgeryBispebjerg HospitalCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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10
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Upper ankle ligament rupture and long term problems in a patient with Ehlers Danlos Syndrome — a case report. Open Med (Wars) 2013. [DOI: 10.2478/s11536-013-0232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractRupture of the upper ankle joint ligaments is a common injury. Therapy in patients with Ehlers Danlos Syndrome (EDS) is a challenge due to the autosomal-dominant collagenopathy. Therapeutic recommendations and long term results in treatment of patients with EDS are rare. Therefore uncertainty exists. We present a case of clinical and radiologic long term results after ligament rupture of the upper ankle joint in a patient with EDS. A literature review tries to reveal current therapeutic strategies in patients with EDS.
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Dowlen H, Roberton BJ, Owers K. Bilateral sequential closed traumatic wrist flexor tendon ruptures. J Hand Surg Eur Vol 2012; 37:694-5. [PMID: 22457253 DOI: 10.1177/1753193412442432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- H. Dowlen
- Hand Surgery Unit of the Trauma and Orthopaedics Department, Chelsea and Westminster Hospital, London, UK
| | - B. J. Roberton
- Hand Surgery Unit of the Trauma and Orthopaedics Department, Chelsea and Westminster Hospital, London, UK
| | - K. Owers
- Hand Surgery Unit of the Trauma and Orthopaedics Department, Chelsea and Westminster Hospital, London, UK
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13
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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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14
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Multiple triggering in a girl with Ehlers-Danlos syndrome: case report. J Hand Surg Am 2010; 35:1675-7. [PMID: 20843613 DOI: 10.1016/j.jhsa.2010.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 06/16/2010] [Accepted: 06/21/2010] [Indexed: 02/02/2023]
Abstract
We report a case of multiple triggering associated with Ehlers-Danlos syndrome. We postulate that the propensity for tendon degeneration in Ehlers-Danlos syndrome coupled with repetitive microtrauma might lead to fraying of the tendon fibers and, consequently, triggering. Indeed, in our case, debridement of the tendons rather than resection of A1 pulley resulted in a good long-term functional outcome 2 years after surgery.
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15
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O'Brien TD, Reeves ND, Baltzopoulos V, Jones DA, Maganaris CN. Mechanical properties of the patellar tendon in adults and children. J Biomech 2009; 43:1190-5. [PMID: 20045111 DOI: 10.1016/j.jbiomech.2009.11.028] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 11/06/2009] [Accepted: 11/24/2009] [Indexed: 11/27/2022]
Abstract
It is not currently known how the mechanical properties of human tendons change with maturation in the two sexes. To address this, the stiffness and Young's modulus of the patellar tendon were measured in men, women, boys and girls (each group, n=10). Patellar tendon force (F(pt)) was calculated from the measured joint moment during a ramped voluntary isometric knee extension contraction, the antagonist knee extensor muscle co-activation quantified from its electromyographical activity, and the patellar tendon moment arm measured from magnetic resonance images. Tendon elongation was imaged using the sagittal-plane ultrasound scans throughout the contraction. Tendon cross-sectional area was measured at rest from ultrasound scans in the transverse plane. Maximal F(pt) and tendon elongation were (mean+/-SE) 5453+/-307 N and 5+/-0.5 mm for men, 3877+/-307 N and 4.9+/-0.6 mm for women, 2017+/-170 N and 6.2+/-0.5 mm for boys and 2169+/-182 N and 5.9+/-0.7 mm for girls. In all groups, tendon stiffness and Young's modulus were examined at the level that corresponded to the maximal 30% of the weakest participant's F(pt) and stress, respectively; these were 925-1321 N and 11.5-16.5 MPa, respectively. Stiffness was 94% greater in men than boys and 84% greater in women than girls (p<0.01), with no differences between men and women, or boys and girls (men 1076+/-87 N/mm; women 1030+/-139 N/mm; boys 555+/-71 N/mm and girls 561.5+/-57.4 N/mm). Young's modulus was 99% greater in men than boys (p<0.01), and 66% greater in women than girls (p<0.05). There were no differences in modulus between men and women, or boys and girls (men 597+/-49 MPa; women 549+/-70 MPa; boys 255+/-42 MPa and girls 302+/-33 MPa). These findings indicate that the mechanical stiffness of tendon increases with maturation due to an increased Young's modulus and, in females due to a greater increase in tendon cross-sectional area than tendon length.
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Affiliation(s)
- Thomas D O'Brien
- Institute for Biomedical Research into Human Movement and Health (IRM), Manchester Metropolitan University, John Dalton Tower, Chester Street, Manchester, M1 5GD, UK.
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