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Edge CC, Widmeyer J, Protzuk O, Johnson M, O’Connell R. Gouty destruction of a patellar tendon reconstruction and novel revision reconstruction technique: A case report. World J Orthop 2024; 15:675-682. [PMID: 39070936 PMCID: PMC11271696 DOI: 10.5312/wjo.v15.i7.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Gout is a disease characterized by hyperuricemia, and resultant deposition of uric acid crystals in tissues. While typically manifested as intraarticular crystals or tophi, gout can also cause pathology at entheses. Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture. Furthermore, allografts can also be at risk of rupture in the setting of severe gout. We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction. CASE SUMMARY A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs. She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years. This patient presented with pain and extensor lag. A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle. The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction. She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks. At twelve weeks, she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises. CONCLUSION Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.
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Affiliation(s)
- Carl C Edge
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Jonathan Widmeyer
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Omar Protzuk
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Maya Johnson
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Robert O’Connell
- Division of Sports Medicine, Orthowest, Carrolton, GA 30117, United States
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Ikumi A, Okuwaki S, Hara Y, Yoshii Y, Kawamura H. Spontaneous rupture of the extensor pollicis longus tendon in systemic lupus erythematosus: A case report and literature review. Mod Rheumatol Case Rep 2022; 6:29-32. [PMID: 34505159 DOI: 10.1093/mrcr/rxab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
Spontaneous tendon rupture is a rare entity. Herein, we report a case of spontaneous rupture of the extensor pollicis longus (EPL) tendon in a 61-year-old woman with systemic lupus erythematosus (SLE). The patient worked as an aesthetician and had a 42-year history of SLE that was well controlled using oral steroids. She presented with an inability to extend her left thumb, with no prior history of trauma or symptoms. On imaging, there was no evidence of degenerative changes or osteophyte formation in the gliding area of the EPL tendon. Intraoperatively, there was evidence of tendon rupture around Lister's tubercle. We performed a tendon transfer of the extensor indicis proprius for repair. The patient recovered active thumb extension and returned to work 4 months after surgery without any complications. We suspected that spontaneous EPL tendon rupture was caused by a combination of disease-related factors, including long-term steroid use, chronic inflammation, and continuous mechanical stress from her work and daily activity. This case report demonstrates the multifactorial aetiology of spontaneous tendon rupture in patients with SLE and the importance of monitoring for this complication during routine follow-up.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Haruo Kawamura
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
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Huang SW, Lin CL, Lin LF, Huang CC, Liou TH, Lin HW. Autoimmune Connective Tissue Diseases and the Risk of Rotator Cuff Repair Surgery: A Population-Based Retrospective Cohort Study. BMJ Open 2019; 9:e023848. [PMID: 30808669 PMCID: PMC6398915 DOI: 10.1136/bmjopen-2018-023848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Autoimmune connective tissue diseases (ACTDs) commonly involve the shoulder joint; however, clinical epidemiological studies investigating their association with tendons are scant. Rotator cuff (RC) tears can cause shoulder disability, and surgical intervention is usually required. The study investigated RC repair surgery risk in ACTD patients. The effect of anti-inflammatory medication on RC repair surgery risk was also investigated. METHODS We conducted a retrospective cohort study with a 7-year longitudinal follow-up period. Patients with systemic lupus erythematosus, systemic sclerosis, sicca syndrome, dermatomyositis and polymyositis diagnoses between 2004 and 2008 were enrolled. The control cohort comprised age- and sex-matched controls. The HR and adjusted HR (aHR) were estimated for the risk of RC surgery between ACTD and control cohorts after adjustment for confounders. Furthermore, the effects of steroid and non-steroidal anti-inflammatory drug (NSAID) use on the HR and aHR of RC surgery risk were analysed. RESULTS We enrolled 5019 ACTD patients and 25 095 controls in the ACTD and control cohorts, respectively. RC surgery incidence was 49 and 24 per 100 000 person-years in the ACTD and control cohorts, respectively. In the ACTD cohort, the crude HR for RC surgery was 2.08 (95% CI , 1.08 to 4.02, p<0.05), and the aHR was 1.97 (95% CI, 1.01 to 3.82, p<0.05). The ACTD patients who used NSAIDs had an aHR of 3.13 (95% CI, 1.21 to 8.07, p<0.05) compared with the controls, but the ACTD patients who used steroids did not have a significantly higher aHR than the controls. CONCLUSIONS ACTD patients had an increased risk of RC repair surgery. However, no difference was found in RC surgery risk when steroids were used compared with the control cohort. This could indicate that inflammation control may be a strategy for managing subsequent RC lesions.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Che-Li Lin
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Institute of Gerontology and Health Management, Taipei Medical University, Taipei, Taiwan
| | - Chi-Chang Huang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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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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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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Takata Y, Nakase J, Numata H, Oshima T, Tsuchiya H. Repair and augmentation of a spontaneous patellar tendon rupture in a patient with Ehlers-Danlos syndrome: a case report. Arch Orthop Trauma Surg 2015; 135:639-44. [PMID: 25701458 DOI: 10.1007/s00402-015-2179-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Disruption of the knee extensor mechanism is a serious disorder that requires prompt treatment. It often occurs in the form of a patellar tendon rupture. It may occur in association with systemic disease or after administration of corticosteroids or fluoroquinolones. These conditions can cause tendon weakness, and consequent ruptures usually require both repair and augmentation. This paper reports on repair and augmentation for treating patellar tendon rupture in patients with Ehlers-Danlos syndrome (EDS). CASE REPORT We report a patellar tendon rupture in a 27-year-old man with EDS, which occurred in the midsubstance of the patella. As the patient has tendon weakness, extensive repair will increase the risk of patella baja, and the use of end-to-end suturing technique alone will not be enough to prevent a rupture recurring; however, augmentation could be used to address the tendon weakness. Repair of the rupture and augmentation with hamstring tendon was performed. One year after the surgery, the patient was able to move his knee joint without pain and had an active range of motion of 0° (passive 20°)-145°. He was able to perform a straight leg raise without an extension lag. CONCLUSIONS Repair and augmentation with hamstring tendon was an effective treatment option for patellar tendon rupture in a patient with EDS.
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Affiliation(s)
- Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan,
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Albayrak İ, Küçük A, Arslan Ş, Özbek O. Spontaneous patellar tendon rupture in a case followed up for diagnosis of systemic lupus erythematosus. Eur J Rheumatol 2014; 1:159-160. [PMID: 27708904 DOI: 10.5152/eurjrheumatol.2014.140044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/16/2014] [Indexed: 12/22/2022] Open
Abstract
Spontaneous patellar tendon rupture is a rare condition that usually occurs secondary to conditions, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), and use of steroids and fluoroquinolones. This paper presents a full-thickness patellar tendon rupture detected with magnetic resonance imaging, which was performed due to pain and swelling that started spontaneously on the front side of the left knee without a history of any trauma, of a 35-year-old male patient who had been followed up for a diagnosis of SLE for approximately 4 months and who had started taking methylprednisolone 4 mg/day 4 months prior, used it for 1 month, and then stopped using it. In patients who are followed up for a diagnosis of SLE, it should be kept in mind that there is a risk of developing a spontaneous tendon rupture secondary to chronic inflammation and use of corticosteroids.
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Affiliation(s)
- İlknur Albayrak
- Department of Physical Medicine and Rehabilitation, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Adem Küçük
- Department of Physical Medicine and Rehabilitation, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Şevket Arslan
- Department of Physical Medicine and Rehabilitation, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Orhan Özbek
- Department of Physical Medicine and Rehabilitation, Selçuk University Faculty of Medicine, Konya, Turkey
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Rupture of an Unscarred Uterus in a Woman With Long-Term Steroid Treatment for Systemic Lupus Erythematosus. Obstet Gynecol 2013; 122:472-475. [DOI: 10.1097/aog.0b013e3182998fb6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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