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Rüttershoff A, Geisel D, Lacheta L, Akgün D, Stöckle U, Miltner O, Marth AA, Kim S. Clinical and radiological outcome of acute quadriceps tendon repair at 2 - year follow-up. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05552-7. [PMID: 39325166 DOI: 10.1007/s00402-024-05552-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 08/31/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE Though previous studies on surgical quadriceps tendon repair reported good to satisfactory results its impact on knee extensor strength and patellofemoral joint is unknown. The purpose of the study was to assess the clinical and functional outcome by quantifying subjective knee related outcome, isokinetic extensor strength complemented by magnetic resonance imaging (MRI). METHODS For this retrospective clinical trial twenty-one patients with a mean age of 59.1 (±14.9) years were carried out for follow-up evaluation. For clinical outcome numeric rating scale for pain (NRS), Kujala anterior knee pain score, Knee osteoarthritis outcome score (KOOS) with its subscores, Tegener Activity Score (TAS), Isokinetic extensor strength testing (ISO) and the Limb symmetry index (LSI) were utilized. Muscle volume (Vmqf), atrophy and cartilage status were assessed on MRI. Tendon integrity and implant loosening were evaluated. Statistical analysis was carried out using Student´s t-test, Pearson and Spearman correlation coefficient. RESULTS Mean follow-up was 56.2 (± 17.5) months. Clinical outcomes in mean were as follows: NRS 1.7 (±2.0), Kujala score 75.8 (± 15.8) points; KOOS 62.9 (±30.6) % (Subscores: (KOOSPain 84 (± 18.3)%, KOOSSymptoms 63.4 (± 15.3) %, KOOSADL 79.8% (± 19.4)%, KOOSSports&Rec 61.5 (± 28.8))%, TAS 3.7 (± 1.2). Mean ISO difference was 3.7 (±32.3) %). 41.2% of patients had an LSI < 90% and showed non-significantly (p > 0.05) better outcomes in NRS, Kujala score and KOOS than patients with LSI < 90%. ISO correlated with better subjective outcome (r > 0.5) but not with MRI findings. Vmqf asymmetry > 10% was seen in 41,2% of patients. Degenerative muscle and cartilage changes were few and low grade. One tendon showed partial retear. Patients showed no signs of implant loosening. CONCLUSION Distal quadriceps tendon repair leads to satisfactory subjective outcome in patients with low to moderate activity levels. Tendon integrity was reliably restored. However, extensor strength deficits remain in more than 40% of patients. Atrophy signs of advanced fatty infiltration were recorded in 15% and patellofemoral cartilage defects in 20% of all patients, indicating that previous assessment tools do not display functional outcome adequately.
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Affiliation(s)
- Anke Rüttershoff
- Centrum für Muskuloskelettale Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Deutschland.
| | - Dominik Geisel
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Deutschland
| | - Lucca Lacheta
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Doruk Akgün
- Centrum für Muskuloskelettale Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Deutschland
| | - Ulrich Stöckle
- Centrum für Muskuloskelettale Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Deutschland
| | - Oliver Miltner
- DocOrtho MVZ GmbH, Friedrichstraße 94, 10117, Berlin, Germany
| | - Adrian Alexander Marth
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Deutschland
| | - Suchung Kim
- Centrum für Muskuloskelettale Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Deutschland
- DocOrtho MVZ GmbH, Friedrichstraße 94, 10117, Berlin, Germany
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Thorne TJ, Dong W, Higgins TF, Rothberg DL, Haller JM, Marchand LS. Primary Repair of Complete Quadriceps Tendon Rupture with Extensor Mechanism Deficit. JBJS Essent Surg Tech 2024; 14:e23.00045. [PMID: 39314211 PMCID: PMC11415094 DOI: 10.2106/jbjs.st.23.00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Background Whereas partial quadriceps tendon ruptures may be treated nonoperatively if the extensor mechanism remains functional, complete ruptures require primary operative repair to achieve optimal functional results1,2. The 2 most common techniques are the use of transosseous tunnels and the use of suture anchors. The goal of these procedures is to reconstruct and restore mobility of the extensor mechanism of the leg. Description The patient is positioned supine with the injured leg exposed. A midline incision to the knee is made over the quadriceps tendon defect, exposing the distal quadriceps and proximal patella. Irrigation is utilized to evacuate the residual hematoma, and the distal quadriceps and proximal patella are debrided of degenerative tissue. When utilizing transosseous tunnels, a nonabsorbable suture is passed full-thickness through the medial or lateral half of the quadriceps tendon in a locked, running pattern (i.e., Krackow). A second nonabsorbable suture is passed full-thickness through the other half of the tendon. There should then be 4 loose strands at the distal quadriceps. The anatomic insertion of the quadriceps tendon is roughened with a sharp curet to expose fresh cancellous bone. Three parallel bone tunnels are created along the longitudinal axis of the patella. The knee is placed in full extension, with a bump under the heel in order to provide slight recurvatum at the knee and to allow for a properly tensioned repair. In pairs, the free ends of the sutures are passed through the tunnels. The sutures are tensioned and tied together in pairs at the distal aspect of the patella. Alternatively, when utilizing suture anchors, Arthrex FiberTape is passed full-thickness through the medial or lateral half of the quadriceps tendon in a Krackow pattern. A second FiberTape is passed full-thickness through the other half of the tendon. There should then be 4 loose tails at the distal quadriceps. The 2 tails of the medial FiberTape are placed into a knotless Arthrex SwiveLock anchor; this step is repeated for the 2 lateral tails. The anatomic insertion of the quadriceps tendon is roughened to expose fresh cancellous bone. With use of a 3.5-mm drill, create 2 parallel drill holes along the longitudinal axis of the patella, with sufficient depth to bury the SwiveLock anchor. Unlike in the transosseous tunnel technique, these drill holes do not run the length of the patella. The holes are then tapped. Following irrigation, the anchors are tensioned into the bone tunnels, and extra tape is cut flush to the bone. For both techniques, additional tears in the medial and lateral retinacula are repaired if present. Alternatives Alternatives include nonoperative treatment with use of a hinged knee brace; operative treatment with use of simple sutures; and augmentation with use of wire reinforcement, cancellous screws, the Scuderi technique, the Codivilla technique, tensor fasciae latae reinforcement, and/or MERSILENE tape (Ethicon). Rationale Primary operative repair of quadriceps tendon ruptures is a well-documented, successful procedure with biomechanical, clinical, and patient-reported data to support its use3-7. However, literature comparing the 2 most common surgical techniques remains controversial. Transosseous tunnel repair is the most common technique utilized to repair quadriceps tendon ruptures, but suture anchors have become increasingly popular in the past several years1,4. Most studies have reported no significant difference in biomechanical, clinical, and patient-reported outcome measures between these 2 techniques3,4,8-10. Decreased operative time and a smaller incision have been suggested as advantages of suture anchors4,9. However, this method incurs a higher average cost of surgery and risks a more complex revision in the event of deep infection9,10. Simple suture repair is a less commonly utilized technique and is now reserved for midsubstance tendon repairs. Nonoperative treatment of complete quadriceps tendon rupture is exceedingly rare and not recommended because of the profound functional consequences. Relative indications for nonoperative treatment include a patient who is unfit for surgery, is not ambulatory at baseline, or retains full extensor mechanism function. Nonoperative treatment is typically reserved for partial quadriceps ruptures and typically involves early immobilization with a hinged knee brace. Expected Outcomes Primary repair of quadriceps tendon ruptures, utilizing either the transosseous tunnel or suture anchor technique, yields excellent outcomes. Following surgical treatment, patients have near-full recovery in range of motion, with studies reporting a <5° deficit compared with the contralateral, uninjured limb3,4,10,11. The vast majority of patients (>90%) return to pre-injury levels of function and work3,4,7,11. The majority of patients also report satisfactory results, as assessed with use of patient-reported outcome measures3,4,10. The most commonly reported complications are knee stiffness and quadriceps muscle atrophy, which can both be treated with proper rehabilitation. Even in the event of these complications, however, patients can maintain adequate knee function2,3. More severe complications are rare (<3%) and include deep venous thrombosis and/or pulmonary embolism, superficial and/or deep infection, and tendon rerupture2-4,10-12. Delayed operative treatment is associated with worse outcomes and increased complication rates1,3,4,10,11. Important Tips When performing the Krackow stitch, be sure to tension and remove all slack before performing another tissue pass.Surgical repair should be performed as soon as possible from the time of injury in order to minimize risks and to achieve optimal surgical outcomes.If there is concern that the primary construct would be unstable, it can be augmented with wire reinforcement, cancellous screws, the Scuderi technique, the Codivilla technique, tensor fasciae latae reinforcement, and/or MERSILENE tape.Identify and repair patellar retinaculum tears, which are common concomitant injuries in the setting of complete quadriceps rupture. Acronyms and Abbreviations MRI = magnetic resonance imaging.
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Affiliation(s)
- Tyler J. Thorne
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Willie Dong
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Thomas F. Higgins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - David L. Rothberg
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Justin M. Haller
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Lucas S. Marchand
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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Coladonato C, Hanna AJ, Patel NK, Sonnier JH, Connors G, Sabitsky M, Johnson E, Mazur DW, Brahmabhatt S, Freedman KB. Risk Factors Associated With Poor Outcomes After Quadriceps Tendon Repair. Orthop J Sports Med 2024; 12:23259671241229105. [PMID: 38379579 PMCID: PMC10878232 DOI: 10.1177/23259671241229105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 02/22/2024] Open
Abstract
Background Ruptures of the quadriceps tendon present most frequently in older adults and individuals with underlying medical conditions. Purpose To examine the relationship between patient-specific factors and tear characteristics with outcomes after quadriceps tendon repair. Study Design Case-control study; Level of evidence, 3. Methods A retrospective review was conducted on all patients who underwent quadriceps tendon repair between January 1, 2016, and January 1, 2021, at a single institution. Patients <18 years and those with chronic quadriceps tendon tears (>6 weeks to surgery) were excluded. Information was collected regarding patient characteristics, presenting symptoms, tear characteristics, physical examination findings, and postoperative outcomes. Poor outcome was defined as a need for revision surgery, complications, postoperative range of motion of (ROM) <110° of knee flexion, and extensor lag of >5°. Results A total of 191 patients met the inclusion criteria. Patients were aged 58.5 ± 13.2 years at the time of surgery, were predominantly men (90.6%), and had a mean body mass index (BMI) of 32.2 ± 6.3 kg/m2. Patients underwent repair with either suture anchors (15.2%) or transosseous tunnels (84.8%). Postoperatively, 18.5% of patients experienced knee flexion ROM of <110°, 11.3% experienced extensor lag of >5°, 8.5% had complications, and 3.2% underwent revision. Increasing age (odds ratio [OR], 1.03 [95% CI, 1.004-1.07]) and female sex (OR, 3.82 [95% CI, 1.25-11.28]) were significantly associated with postoperative knee flexion of <110°, and increasing age (OR, 1.08 [95% CI, 1.04-1.14]) and greater BMI (OR, 1.14 [95% CI, 1.05-1.23]) were significantly associated with postoperative extensor lag of >5°. Current smoking status (OR, 15.44 [95% CI, 3.97-65.90]) and concomitant retinacular tears (OR, 9.62 (95% CI, 1.67-184.14]) were associated with postoperative complications, and increasing age (OR, 1.05 [95% CI, 1.02-1.08]) and greater BMI (OR, 1.08 [95% CI, 1.02-1.14]) were associated with risk of acquiring any poor outcome criteria. Conclusion Patient-specific characteristics-such as increasing age, greater BMI, female sex, retinacular involvement, and current smoking status-were found to be risk factors for poor outcomes after quadriceps tendon repair. Further studies are needed to identify potentially modifiable risk factors that can be used to set patient expectations and improve outcomes.
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Affiliation(s)
- Carlo Coladonato
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adeeb Jacob Hanna
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neel K. Patel
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John Hayden Sonnier
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory Connors
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew Sabitsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emma Johnson
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Donald W. Mazur
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shyam Brahmabhatt
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B. Freedman
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Coladonato C, Perez AR, Sonnier JH, Looney AM, Delvadia BP, Okhuereigbe DO, Walia P, Tjoumakaris FP, Freedman KB. Similar Outcomes Are Found Between Quadriceps Tendon Repair With Transosseous Tunnels and Suture Anchors: A Systematic Review and Meta-Analysis. Arthrosc Sports Med Rehabil 2023; 5:100807. [PMID: 37868659 PMCID: PMC10585628 DOI: 10.1016/j.asmr.2023.100807] [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: 12/21/2022] [Accepted: 08/31/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To evaluate the clinical outcomes and biomechanical performance of transosseous tunnels compared with suture anchors for quadriceps tendon repair. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was performed in April 2021 in the following databases: Cochrane Database of Systematic Reviews, PubMed (1980-2021), MEDLINE (1980-2021), Embase (1980-2021), and CINAHL (1980-2021). Level I-IV studies were included if they provided outcome data for surgical repair of the quadriceps tendon using transosseous tunnels or suture anchors with minimum 1-year follow-up. Biomechanical studies comparing transosseous tunnels and suture anchors were separately analyzed. Results The systematic search yielded 1,837 citations, 23 of which met inclusion criteria (18 clinical, 5 biomechanical). In total, 13 studies reported results for transosseous repair and 7 studies reported results for repair with suture anchors. There were results for 508 patients from clinical studies. The average postoperative Lysholm score ranged from 88 to 92 for suture anchor repairs and 72.8 to 94 for transosseous repairs with range of motion ranging from 117° to 138° and 116° to 135°, respectively. Synthesis of the biomechanical data revealed the mean difference in load to failure was not significant between constructs (137.21; 95% confidence interval -10.14 to 284.57 N; P = .068). Conclusions Transosseous and suture anchor techniques for quadriceps tendon repair result in similar biomechanical and postoperative outcomes. No difference between techniques in regard to ultimate load to failure among comparative biomechanical studies were observed. Level of Evidence Level IV, systematic review level III-IV studies.
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Affiliation(s)
- Carlo Coladonato
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Andres R. Perez
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - John Hayden Sonnier
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Austin M. Looney
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Bela P. Delvadia
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | | | - Pankhuri Walia
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Fotios P. Tjoumakaris
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kevin B. Freedman
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
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5
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Sasaki R, Nagashima M, Aibara N, Aomatsu S, Aida S, Takeshima K, Ishii K. Simultaneous bilateral quadriceps tendon rupture in a healthy young male: a case report. J Med Case Rep 2023; 17:85. [PMID: 36879269 PMCID: PMC9990254 DOI: 10.1186/s13256-023-03802-7] [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: 03/03/2022] [Accepted: 02/01/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Simultaneous bilateral quadriceps tendon rupture is rare, particularly in young individuals with no prior medical history. We present the case of a young man who presented with bilateral quadriceps tendon rupture. CASE PRESENTATION A 27-year-old Japanese man missed a step while descending a flight of stairs, stumbled, and became aware of severe pain in both knees. He had no past medical history, but was severely obese, with a body mass index of 43.7 kg/m2 (height 177 cm, weight 137 kg). Five days after injury, he was referred to our hospital for examination and treatment. Bilateral quadriceps tendon rupture was diagnosed based on magnetic resonance imaging, and quadriceps tendon repair with suture anchor was performed on both knees 14 days after injury. The postoperative rehabilitation protocol was to immobilize both knees in extension for 2 weeks, then to gradually proceed with weight-bearing and gait training using hinged knee braces. Both knees obtained a range of motion from 0° to 130° without any extension lag by 3 months postoperatively. One year postoperatively, tenderness was evident at the suture anchor in the right knee. That suture anchor was therefore removed in a second operation, and histological evaluation of the tendon of the right knee revealed no pathological changes. As of 19 months after the primary surgery, the patient showed a range of motion from 0° to 140° in both knees, did not complain of any disability, and had fully returned to normal daily activities. CONCLUSIONS We experienced simultaneous bilateral quadriceps tendon rupture in a 27-year-old man with no past medical history other than obesity. Suture anchor repair was performed for both quadriceps tendon ruptures and achieved a favorable postoperative outcome.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan. .,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan. .,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan.
| | - Noriyuki Aibara
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Shuji Aomatsu
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Shinsuke Aida
- Department of Pathology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
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Quadriceps Tendon Ruptures in Middle-Aged to Older Patients: A Retrospective Study on the Preoperative MRI Injury Patterns and Mid-Term Patient-Reported Outcome Measures. J Pers Med 2023; 13:jpm13020364. [PMID: 36836598 PMCID: PMC9959605 DOI: 10.3390/jpm13020364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Quadriceps tendon rupture (QTR) is a rare pathology, usually occurring in elderly patients with comorbidities, requiring surgical therapy. The aim of this study was to analyze rupture patterns and concomitant injuries using preoperative magnetic resonance imaging (MRI) and to evaluate patient-reported outcome measures. (2) In this retrospective cross-sectional study, 113 patients with QTR were screened and rupture patterns/concomitant injuries (n = 33) were analyzed via MRI. Clinical outcome was assessed in 45 patients using the International Knee Documentation (IKDC) and Lysholm score with a mean follow-up of 7.2 (±5.0) years. (3) The evaluation of preoperative MRIs showed multiple ruptures of subtendons in 67% with concomitant knee injuries in 45%. The most common associated pathology detected using MRI was pre-existing tendinosis (31.2%). Surgical refixation demonstrated good results with a mean post-operative IKDC score of 73.1 (±14.1) and mean Lysholm score of 84.2 (±16.1). Patient characteristics and individual radiologic rupture patterns did not significantly affect the clinical outcome of patients. (4) Acute QTRs are complex injuries with common involvement of multiple subtendons. MRI imaging can be useful for achieving an accurate diagnosis as pre-existing tendinosis as well as concomitant injuries are common, and might be useful for providing an individual surgical strategy and improving outcomes.
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Duell B, Long MK, Divella M, Fogel J, Ruotolo C. Transosseous Repair With Nice Knot Augmentation Versus Knotless Suture Anchor Repair With Suture Tape for Quadriceps Tendon Rupture: A Cadaveric Study. Orthopedics 2022; 46:135-140. [PMID: 36508490 DOI: 10.3928/01477447-20221207-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Quadriceps tendon rupture is typically repaired using either transosseous tunnels or suture anchors. Recent literature has suggested that suture anchor repair is biomechanically superior to the use of transosseous tunnels. Augmentation of the transosseous technique with Nice knots may result in improved biomechanical properties as compared with a suture anchor construct. To compare biomechanical properties of a novel transosseous quadriceps tendon repair technique with Nice knot augmentation to those of knotless suture anchor repair, an artificial quadriceps tendon rupture was created in 10 matched pairs of cadaveric knees (n=20). Each cadaver was subjected to biomechanical testing to calculate the average ultimate load to failure, repair site gapping after early and late cyclic loading, and stiffness. Transosseous repair augmented with Nice knots as compared with knotless suture anchor repair had greater load to failure (mean±SD, 1489.5±297.6 N vs 717.7±191.4 N, P<.001), decreased gapping after early and late cyclic loading (cycles 1-20: mean±SD, 0.59±0.4 mm vs 2.1±1.2 mm, P=.008; cycles 21-250: mean±SD, 1.2±0.7 mm vs 3.9±1.7 mm, P=.002), and greater construct stiffness (mean±SD, 80.7±15.7 N/mm vs 44.4±13.4 N/mm, P=.001). The transosseous quadriceps tendon repair technique with Nice knot augmentation is biomechanically better than knotless suture anchor repair with regard to ultimate load to failure, gap formation after cyclic loading, and construct stiffness in cadaveric specimens. [Orthopedics. 202x;4x(x):xx-xx.].
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Lewis DC, Athoff AD, Kamalapathy P, Yarboro SR, Miller MD, Werner BC. Risk Factors for Infection and Revision Surgery following Patellar Tendon and Quadriceps Tendon Repairs: An Analysis of 3,442 Patients. J Knee Surg 2022; 35:1495-1502. [PMID: 33853152 DOI: 10.1055/s-0041-1727113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Disruption of the extensor mechanism is debilitating with surgical repair being the accepted treatment. The incidence of infection and reoperation after extensor mechanism repair are not well reported in the literature. Thus, the objective of the current study was to (1) determine the incidence of surgical site infection and reoperation within 1 year of primary extensor mechanism repair and (2) identify independent risk factors for infection and reoperation following patellar and quadriceps tendon repair. A retrospective review of the 100% Medicare Standard Analytic files from 2005 to 2014 was performed to identify patients undergoing isolated patellar tendon repair and quadriceps tendon repair. Diagnosis of infection within 1 year of operative intervention and revision repair were assessed. Extensor mechanism injuries in the setting of total knee arthroplasty and polytrauma were excluded. Multivariate logistic regression analysis was performed to evaluate risk factors for postoperative infection and reoperation within 1 year. Infection occurred in 6.3% of patients undergoing patellar tendon repair and 2.6% of patients undergoing quadriceps tendon repair. Diabetes mellitus (odds ratio [OR] = 1.89, p = 0.005) was found to be an independent risk factor for infection following patellar tendon repair. Reoperation within 1 year occurred in 1.3 and 3.9% following patellar tendon and quadriceps tendon repair, respectively. Age less than 65 years (OR = 2.77, p = 0.024) and obesity (OR = 3.66, p = 0.046) were significant risk factors for reoperation after patellar tendon repair. Hypertension (OR = 2.13, p = 0.034), hypothyroidism (OR = 2.01, p = 0.010), and depression (OR = 2.41, p = 0.005) were significant risk factors for reoperation after quadriceps tendon repair. Diabetes mellitus was identified as a risk factor for infection after patellar tendon repair. Age less than 65 years, peripheral vascular disease, and congestive heart failure were risk factors for infection after quadriceps tendon repair. The current findings can be utilized to counsel patients regarding preoperative risk factors for postoperative complications prior to surgical intervention for extensor mechanism injuries.
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Affiliation(s)
- Daniel C Lewis
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Alyssa D Athoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Seth R Yarboro
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Onggo JR, Babazadeh S, Pai V. Smaller Gap Formation With Suture Anchor Fixation Than Traditional Transpatellar Sutures in Patella and Quadriceps Tendon Rupture: A Systematic Review. Arthroscopy 2022; 38:2321-2330. [PMID: 35066110 DOI: 10.1016/j.arthro.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to compare the biomechanical properties between traditional transosseous tunnel and suture anchor technique repair for extensor mechanism ruptures and assess for differences in the mechanism of failure of both techniques. METHODS A multi-database search (PubMed, EMBASE, and Medline) was performed according to PRISMA guidelines on November 14, 2021. All articles comparing biomechanical properties of transpatellar and suture anchor technique for extensor mechanism ruptures were included. Abstracts, reviews, case reports, studies without biomechanical analysis, conference proceedings, and non-English language studies were excluded. Outcomes pursued included gap formation, load to failure, and mechanism of failure. Relevant data from studies meeting inclusion criteria were extracted and analyzed. Study methodology was assessed using the Methodological Index for Non-Randomized Studies score. RESULTS A total of 212 knees were biomechanically assessed, including 98 patella and 114 quadricep tendon ruptures. Five patellar tendon studies were included, and all of them reported significantly smaller gap formation in suture anchor group. Gap formation for suture anchors ranged from .9 mm to 4.1 mm, while that of transpatellar group ranged from 2.9 mm to 10.3 mm. One study reported a significantly higher load to failure in the suture anchor group, while the remaining four studies reported no significant difference. Load to failure for suture anchor ranged from 259 N to 779 N, while that of the transpatellar group ranged from 287 N to 763 N. The most common mechanism of failure was anchor pullout in suture anchor and knot failure in the transpatellar group. Five quadriceps tendon studies were included, and three studies reported statistically significant smaller gap formation in the suture anchor group. Gap formation for suture anchor ranged from 1.5 mm to 5.0 mm, while that of transpatellar group ranged from 3.1 mm to 33.3 mm. Two studies reported a significantly higher load to failure in the suture anchor group, while one study reported a higher load to failure in the transpatellar repair group. Load to failure for suture anchor ranged from 286 N to 740 N, while that of transpatellar group ranged from 251 N to 691 N. The most common mechanism of failure was suture failure in the suture anchor and knot failure in the transpatellar group. CONCLUSION Suture anchor fixation displays a better biomechanical profile than traditional transpatellar techniques in terms of smaller gap formations in the repair of both patella and quadriceps tendon injuries. Anchor pullout in suture anchor fixation was present mainly with the use of titanium anchors. CLINICAL RELEVANCE These findings above may result in better retention of tendon approximation in patella and quadriceps tendon fixation postoperatively, which may result in earlier recovery. Further randomized controlled clinical trials to compare these techniques are required.
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Affiliation(s)
| | | | - Vishal Pai
- Box Hill Hospital, Melbourne, Victoria, Australia
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10
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Rao S, Johnson EE, D’Amore T, Szeto S, Otlans P, Cohen SB. Outcomes After Repair of Quadriceps Tendon Rupture in Patients Aged 40 Years and Younger. Orthop J Sports Med 2022; 10:23259671221097107. [PMID: 35615753 PMCID: PMC9125636 DOI: 10.1177/23259671221097107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Injury to the quadriceps tendon is rare and most commonly occurs in
middle-aged men. Few reports are available regarding outcomes after
quadriceps tendon rupture in younger patients. Purpose/Hypothesis: To review the clinical outcomes of patients who underwent quadriceps tendon
repair at age ≤40 years. We hypothesized that this cohort would experience
better clinical outcomes in comparison to historical older controls. Study Design: Case series; Level of evidence, 4. Methods: Using an institutional database, we retrospectively identified patients who
underwent quadriceps tendon repair between January 2009 and December 2017.
Patients were included in the study if they were aged ≤40 years at the time
of surgery and had sustained an isolated, complete tendon rupture. Patient
and injury characteristics were recorded. Patients were contacted to
complete a custom survey, the 2000 International Knee Documentation
Committee (IKDC) form, the Lysholm scale, and the Tegner scale. Results: Included were 38 patients (86.8% male; mean age, 32.0 ± 6.9 years; age range,
15-40 years), with a mean follow-up of 5.9 ± 2.3 years (range, 2.4-11.3
years). At final follow-up, the mean IKDC score was 74.1 ± 22.6 (range,
26.4-100.0), and the mean Lysholm score was 85.4 ± 20.0 (range, 30-100),
which were similar if not inferior to historical controls of patients >40
years. Only 16 patients (42.1%) had unchanged or higher Tegner scores after
surgery, whereas 22 patients (57.9%) reported lower postoperative activity
level. Overall, 91.2% (31/34) of workers returned at a mean 3.9 months after
surgery, whereas 63% (12/19) of athletes were able to return to play at 8.8
months. At final follow-up, 12 patients (31.6%) reported persistent pain and
stiffness in their knees. Additionally, 3 patients (7.9%) reported pain
without stiffness, and 4 (10.5%) reported stiffness without pain. Patients
reporting pain or stiffness had significantly lower IKDC scores, Lysholm
scores, postoperative Tegner scores, and change in their Tegner score at
final follow-up in comparison to those who did not report pain or
stiffness. Conclusion: Although patients aged ≤40 years had satisfactory outcomes after quadriceps
tendon repair, this injury resulted in significant long-term sequelae in a
substantial percentage of patients, despite their youth. Further, this group
did not have better outcomes compared with historical controls aged > 40
years.
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Affiliation(s)
- Somnath Rao
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emma E. Johnson
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Taylor D’Amore
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stanley Szeto
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peters Otlans
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Steven B. Cohen
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Matthies NF, Paul RA, Dwyer T, Chahal J, Whelan D. A Survey of Treatment Trends for Acute Quadriceps Tendon Ruptures Among North American Surgeons. Orthop J Sports Med 2022; 10:23259671211045399. [PMID: 35368441 PMCID: PMC8972937 DOI: 10.1177/23259671211045399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background: To date, little clinical evidence exists to support a specific surgical technique or postoperative rehabilitation protocol for quadriceps tendon ruptures. With a lack of evidence-based superiority, assessment of clinical practices and surgeon preferences is pertinent. Purpose: To describe the current surgical technique and rehabilitation preferences among members of the Canadian Orthopaedic Association and American Orthopaedic Society for Sports Medicine pertaining to acute quadriceps tendon rupture. Study Design: Cross-sectional study. Methods: Orthopaedic staff members of the Canadian Orthopaedic Association and American Orthopaedic Society for Sports Medicine were invited to complete an internet-based survey composed of 26 questions assessing current trends in the management and rehabilitation of acute quadriceps tendon rupture. Survey questions were developed after a thorough review of current literature. Survey responses were analyzed and reported using descriptive statistics (absolute values, frequencies, and percentages) where appropriate. Statistical comparisons and contrasts between Canadian and American surgeons were made using chi-square analyses and Student t tests. Results: A total of 264 surgeons participated in the survey (136 Canadians; 128 Americans). Canadian surgeons were more likely to obtain a preoperative ultrasound as compared with Americans (43.0% vs 6.7%; P < .00001), while American respondents were more likely to obtain magnetic resonance imaging scans (65.8% vs 10.2%; P < .00001). The transosseous drill hole technique was the most commonly utilized (70.2%); the suture anchor technique was used 20.6% of the time. Canadian respondents trended toward a higher use of transosseous tunnels; however, this was not statistically significant (75.8% vs 64.2%; P = .068). American respondents were more likely to utilize suture anchors (27.5% vs 14.1%; P = .0096). Most respondents advanced range of motion goals stepwise in 2-week intervals of 30° (Canadians, 54.0% vs Americans, 58.5%; P = .3091); timing of range of motion initiation varied. Conclusion: Among North American surgeons who responded to this study, the transosseous technique was the most commonly used, and range of motion was generally advanced in a 2-week stepwise fashion. We found several differences in practice between Canadian and American respondents, including the type of preoperative imaging and the frequency of using the suture anchor technique.
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Affiliation(s)
| | - Ryan A. Paul
- University of Toronto Orthopaedic Sports Medicine, Women’s College Hospital, University of Toronto, and University Health Network, Toronto, Ontario, Canada
| | - Tim Dwyer
- University of Toronto Orthopaedic Sports Medicine, Women’s College Hospital, University of Toronto, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Whelan
- University of Toronto Orthopaedic Sports Medicine, Women’s College Hospital, University of Toronto, and St Michael’s Hospital, Toronto, Ontario, Canada
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12
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Geyer S, Winden F, Braunsperger A, Kreuzpointner F, Kleim BD, Lappen S, Imhoff AB, Mehl J, Hinz M. Midterm outcome and strength assessment after quadriceps tendon refixation with suture anchors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:869-875. [PMID: 35137251 PMCID: PMC10125935 DOI: 10.1007/s00590-022-03218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Quadriceps tendon ruptures (QTR) occur predominantly in middle-aged patients through violent eccentric contraction that occurs either when trying to regain balance or during a fall on the hyperflexed knee. The aim of this study was to quantify midterm postoperative results, including strength potential measured via standardized strength tests following acute (< six weeks) quadriceps tendon refixation using suture anchors. METHODS All consecutive patients with QTR who underwent surgical suture anchor refixation between 2012 and 2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Tegner Activity Scale (TAS), Lysholm score, International Knee Documentation Committee subjective knee form (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, return to work rates, and Visual Analog Scale (VAS) for pain. Additionally, a standardized clinical examination and an isometric strength assessment of knee extension and flexion were performed. RESULTS A total of 17 patients (median age 61.0 [25-75% IQR 50.5-72.5]) were available for final assessment at a mean follow-up of 47.1 ± SD 25.4 months. The majority of patients were male (82.4%) and most injuries occurred due to a fall on the hyperflexed knee (76.5%). The average time interval between trauma and surgery was 12.7 ± 7.5 days. Patients achieved a moderate level of activity postoperatively with a median TAS of 4 (3-5.5) and reported good to excellent outcome scores (Lysholm score: 97 (86.5-100); IKDC: 80.7 ± 13.5; KOOS subscales: pain 97.2 (93.1-100), symptoms 92.9 (82.5-100), activities of daily living 97.1 (93.4-100), sport and recreation function 80 (40-97.5) and knee-related quality of life 87.5 (62.5-100). All patients were able to fully return to work and reported little pain [VAS: 0 (0-0)]. No postoperative complications were reported. Strength measurements revealed a significant deficit of knee extension strength in comparison to the contralateral side (p = 0.011). CONCLUSION Suture anchor refixation of acute QTR leads to good functional results and high patient satisfaction without major complications. Isometric knee extension strength, however, may not be fully restored compared to the unaffected side.
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Affiliation(s)
- Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Felix Winden
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Braunsperger
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian Kreuzpointner
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Benjamin D Kleim
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Lappen
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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13
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Belk JW, Lindsay A, Houck DA, Dragoo JL, Genuario JW, Mayer SW, Frank RM, McCarty EC. Biomechanical Testing of Suture Anchor Versus Transosseous Tunnel Technique for Quadriceps Tendon Repair Yields Similar Outcomes: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e2059-e2066. [PMID: 34977665 PMCID: PMC8689238 DOI: 10.1016/j.asmr.2021.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/25/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To systematically review the literature to evaluate the biomechanical properties of the suture anchor (SA) versus transosseous tunnel (TO) techniques for quadriceps tendon (QT) repair. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase using PRISMA guidelines to identify studies that evaluated the biomechanical properties of SA and TO techniques for repair of a ruptured QT. The search phrase used was "quadriceps tendon repair biomechanics". Evaluated properties included ultimate load to failure (N), displacement (mm), stiffness (N/mm), and mode of failure. RESULTS Five studies met inclusion criteria, including a total of 72 specimens undergoing QT repair via the SA technique and 42 via the TO technique. Three of 4 studies found QTs repaired with SA to have significantly less elongation upon initial cyclic loading when compared to QTs repaired with the TO technique (P < .05). Three of 5 studies found QTs repaired with SA to have significantly less elongation upon final cyclic loading when compared to QTs repaired with the TO technique (P < .05). The pooled analysis from 4 studies reporting on initial displacement showed a statistically significant difference in favor of the SA group compared to the TO group (P = .03). The pooled analysis from studies reporting on secondary displacement and ultimate load to failure showed no significant difference between the SA and TO groups (P > .05). The most common mode of failure in both groups was suture slippage. CONCLUSION On the basis of the included cadaveric studies, QTs repaired via the SA technique have less initial displacement upon cyclic testing when compared to QTs repaired via the TO technique. However, final displacement and ultimate load to failure outcomes did not reveal differences between the two fixation strategies. Knot slippage remains a common failure method for both strategies.
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Affiliation(s)
- John W. Belk
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Adam Lindsay
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Darby A. Houck
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Jason L. Dragoo
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - James W. Genuario
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Stephanie W. Mayer
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Rachel M. Frank
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Eric C. McCarty
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
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14
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Sasaki R, Nagashima M, Otani T, Okada Y, Aida S, Takeshima K, Ishii K. Suture Anchor Repair With Fully Threaded Knotless Anchors for Quadriceps Tendon Rupture Resulted in Favorable Outcomes After 2 Years. Arthrosc Sports Med Rehabil 2021; 3:e1931-e1936. [PMID: 34977650 PMCID: PMC8689259 DOI: 10.1016/j.asmr.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate clinical outcomes over 2 years in cases of quadriceps tendon rupture (QTR) that were surgically treated using fully threaded knotless anchors. Methods A total of four knees in four male patients with QTR repaired with fully threaded knotless anchors at our hospital from November 2017 to January 2019 were enrolled. Mean patient age at surgery was 65.3 years (range: 61-70 years). Intraoperatively, stability of the sutured site was confirmed by knee flexion to 90°. Full weight walking with the orthosis in extension was commenced on the seventh postoperative day. Surgical findings, pathologies of the ruptured quadriceps tendons, and postoperative clinical outcomes were evaluated in all patients. Results The QTR was complete in three cases and partial in one. Average surgical duration was 58.5 (range: 49–74) minutes. Pathological evaluation revealed hyaline degeneration with granulation of the quadriceps tendon in two cases. No complications, such as infection and rerupture, occurred. Magnetic resonance imaging performed 1 year postoperatively confirmed complete healing of the repaired tendon. The mean follow-up period was 35.5 months (range: 24–46 months). None of the patients had extension lag of the knee, and mean Lysholm score and range of flexion were 95.3 (range: 85–100) and 141.3° (range: 140–145°), respectively, at the final follow-up. Conclusions Clinical outcomes were favorable in all cases, including two cases with pathological degenerative changes. Suture anchor repair with fully threaded knotless anchors can be considered a minimally invasive and effective method for QTR, with sufficient strength to allow early rehabilitation.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita Hospital, Narita City, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita Hospital, Narita City, Japan
- Address correspondence to Masaki Nagashima, M.D., Ph.D., Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan.
| | - Toshiro Otani
- Department of Orthopaedic Surgery, International University of Health and Welfare, Ichikawa Hospital, Ichikawa City, Chiba, Japan
| | - Yoshifumi Okada
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Shinsuke Aida
- Department of Pathological Diagnosis, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita Hospital, Narita City, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita Hospital, Narita City, Japan
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Rhind JH, Lancaster P, Ahmed U, Carmont M. Soft tissue extensor mechanism tendon ruptures of the knee. Br J Hosp Med (Lond) 2021; 82:1-9. [PMID: 34601924 DOI: 10.12968/hmed.2021.0139] [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: 11/11/2022]
Abstract
Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps tendon is an uncommon injury and is more frequent in patients over the age of 40 years. Patella tendon ruptures are even rarer and are more frequent in patients under the age of 40 years. Causes can be direct or indirect. Complete ruptures of the quadriceps tendon or patella tendon benefit from early surgical management, while partial ruptures may be managed non-operatively. This article gives an overview of the presentation, assessment and management of soft tissue extensor mechanism tendon ruptures for core surgical, acute care common stem and emergency medicine trainees.
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Affiliation(s)
- John-Henry Rhind
- Department of Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire, UK
| | - Patrick Lancaster
- Department of Orthopaedics, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Usman Ahmed
- Department of Orthopaedics, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Michael Carmont
- Department of Orthopaedics, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
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16
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Haskel JD, Fried JW, Hurley ET, Mojica ES, Alaia MJ, Strauss EJ, Campbell KA. High rates of return to play and work follow knee extensor tendon ruptures but low rate of return to pre-injury level of play. Knee Surg Sports Traumatol Arthrosc 2021; 29:2695-2700. [PMID: 33760963 DOI: 10.1007/s00167-021-06537-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Extensor mechanism ruptures (EMR) of the knee are rare but debilitating injuries that always require surgery to restore knee function. The purpose of this study was to systematically review the literature to ascertain the rate of return to play following patellar or quadriceps tendon ruptures. METHODS A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the EMBASE, MEDLINE, and Cochrane Library databases. Inclusion criteria consisted of clinical studies reporting on return to play after patellar or quadriceps tendon repair. Statistical analysis was performed with the use of SPSS. RESULTS Our review found 48 studies including 1135 cases meeting our inclusion criteria. There were 33 studies including 757 patellar tendon (PT) repairs, and 18 studies including 378 quadriceps tendon (QT) repairs. The overall rate of return to play for PT repairs was 88.9%, with 80.8% returning to the same level of play. The overall rate of return to play for QT repairs was 89.8%, with 70.0% returning to the same level of play. Among professional athletes, the overall rate of return to play after PT repair and QT repair was 76.9% and 70.9%, respectively. Following PT repair, 95.8% were able to return to work, and following QT repair, 95.9% were able to return to work. CONCLUSION The overall rate of return to play was high following both PT and QT repairs. Moreover, a high percentage of those patients were able to return to their pre-operative level of sport with a low risk for re-rupture. LEVEL OF EVIDENCE Level IV.
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Miralles-Muñoz FA, Rubio-Morales M, Ruiz-Lozano M, Martinez-Mendez D, Gonzalez-Parreño S, Lizaur-Utrilla A. V-Y turndown flap augmentation for acute quadriceps rupture after total knee arthroplasty: a prospective matched cohort study. INTERNATIONAL ORTHOPAEDICS 2021; 45:1501-1507. [PMID: 33442759 DOI: 10.1007/s00264-021-04939-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effectiveness of the quadriceps V-Y turndown augmentation for acute quadriceps tendon ruptures in the setting of TKA. METHODS Prospective cohort of 22 patients with quadriceps rupture after TKA were compared with 44 matched patients underwent TKA without quadriceps rupture. Quadriceps ruptures were treated within three weeks after injury by suture augmented with Scuderi quadriceps V-Y turndown flap. Clinical evaluation was performed by the Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion. Patellar height was assessed by the Blackburne-Peel ratio. RESULTS The mean follow-up was 3.3 (range, 3-4) years. At the final follow-up, there were significant improvements in mean KSS scores in both groups (p = 0.001). In the quadriceps group, the mean flexion for all patients, but one with arthrodesis for periprosthetic infection, was 100.1° (range, 90-110°) and mean extensor lag was 7.1° (range, 0-20°). There were significant differences between groups in KSS scores (p = 0.001). Active flexion (p = 0.020) and extension (p = 0.001) were significantly better in the control group. However, there was no significant difference in WOMAC scores (p = 0.252) or patient satisfaction (p = 0.352). There were no quadriceps reruptures. One patient with periprosthetic infection was treated with arthrodesis. CONCLUSION The quadriceps V-Y turndown is an effective and safe procedure for quadriceps ruptures in the setting of TKA. Although the functional outcomes were lower than in TKA patients with no quadriceps rupture, the quality of life and satisfaction were successful in the TKA patients with quadriceps rupture.
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Affiliation(s)
- Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Marta Rubio-Morales
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Matias Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Daniel Martinez-Mendez
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Santiago Gonzalez-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain. .,Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain.
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18
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Hinckel BB, Baumann CA, Ejnisman L, Cavinatto LM, Martusiewicz A, Tanaka MJ, Tompkins M, Sherman SL, Chahla JA, Frank R, Yamamoto GL, Bicos J, Arendt L, Fithian D, Farr J. Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e20.00083. [PMID: 33986224 PMCID: PMC7537824 DOI: 10.5435/jaaosglobal-d-20-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
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Affiliation(s)
- Betina B Hinckel
- From the Oakland University, Rochester (Dr. Hinckel, and Dr. Cavinatto); Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak (Dr. Hinckel, Dr. Cavinatto), MI; the University of Missouri-School of Medicine, Columbia, MO (Mr. Baumann); the Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR (Dr. Ejnisman); the Shoulder and Elbow Surgery, Beaumont Orthopaedic Associates, Beaumont Health (Dr. Martusiewicz); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Tanaka); the Department of Orthopedic Surgery, TRIA Orthopedic Center, University of Minnesota, Gillette Children's Specialty Healthcare, MN (Dr. Tompkins); the Department of Orthopedic Surgery, Stanford University, CA (Dr. Sherman); the Rush University Medical Center, Chicago, IL (Dr. Chahla); the Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, Aurora, CO (Dr. Frank); the Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Yamamoto); CEGH-CEL, Instituto de Biociências, Universidade de São Paulo (Dr. Yamamoto); DASA Laboratories, Sao Paulo, Brazil (Dr. Yamamoto); the Michigan Orthopedic Surgeons, Fellowship Director William Beaumont Sports Medicine Fellowship, Assistant Professor Oakland University William Beaumont School of Medicine, MI (Dr. Bicos); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Arendt); the Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, CA (Dr. Fithian); and the Knee Preservation, Cartilage Regeneration and OrthoBiologics, Department of Orthopedic Surgery, Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, IN (Dr. Farr)
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Relationships between Quadriceps Tendon Elasticity and Knee Flexion Angle in Young Healthy Adults. ACTA ACUST UNITED AC 2019; 55:medicina55020053. [PMID: 30781444 PMCID: PMC6409608 DOI: 10.3390/medicina55020053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 01/14/2023]
Abstract
Background and objectives: Although tendon elasticity by elastography is useful for diagnosing tendon disorders and planning rehabilitation regimens of the tendon, there are few reports on the quadriceps tendon. Moreover, relationships between the quadriceps tendon elasticity and knee angle have not been investigated. The purpose of this study was to clarify the relationship between quadriceps tendon elasticity and knee flexion angle in young healthy adults using elastography, and to investigate the difference in elasticity by sex and leg dominance. Materials and Methods: A total of 40 knees in 20 young healthy adults were included in this study (age: 25.5 (23.3⁻27.5) years). At knee flexion of 30°, 60°, and 90°, quadriceps tendon elasticity was measured using ShearWave™ Elastography during the ultrasound examination. Results: There were significant differences in the elasticity between all angles (p < 0.001). Elasticity was increased more at 60° than at 30° and at 90° than at 60°. Elasticity in men was higher than that in women at 60° (p = 0.029). There were no differences (p = 0.798) in elasticity at each angle between the dominant and non-dominant legs. Conclusions: The quadriceps tendon elasticity increased according to the knee flexion angle in young healthy adults. Moreover, elasticity was affected by sex, but not by leg dominance. Clinically, in a rehabilitation regimen, attention should be paid to exercises that could increase stiffness accompanying flexion of the knee to avoid further tendon damage as risk management in the acute phase.
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Hantes ME, Mathews R, Raoulis V, Varitimidis S, Karachalios T, Malizos KN. Better knee function after surgical repair of acute quadriceps tendon rupture in comparison to acute patellar tendon rupture. Orthop Traumatol Surg Res 2019; 105:119-123. [PMID: 30455100 DOI: 10.1016/j.otsr.2018.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to determine if there is a difference in knee function between patients with quadriceps tendon rupture and patellar tendon rupture after acute surgical repair. Our hypothesis was that knee function would be similar between the two groups. METHODS The study population included 24 patients; 13 patients suffered from quadriceps tendon rupture and 11 patients from patellar tendon rupture. All patients underwent acute surgical repair using heavy non-absorbable trans-osseous sutures; another non-absorbable suture, passed through both retinaculum and around the repaired tendon to augment the repair. Clinical evaluation was performed using the Lysholm, Kujala, and VAS scoring systems. In addition, radiographic evaluation to evaluate patellar height and patello-femoral joint arthritis using Iwano's classification was performed. RESULTS The average follow-up time was 70.5 months. All patients in the quadriceps tendon group had full range of knee motion while 3 patients (27%) in the patellar tendon group had reduced knee flexion. Patients in the quadriceps tendon group had a significantly higher Kujala score in comparison to the patellar tendon group (88 vs. 73 p=0.033). No significant differences were identified between the two groups according to the Lysholm scoring system. Patients in the quadriceps tendon group had significantly less pain according to VAS scale (1.2 vs. 3.5 p=0.012). Radiographic evaluation revealed that two patients from each group showed signs of grade II patello-femoral joint arthritis according to Iwano's classification. CONCLUSION Acute surgical repair of quadriceps tendon ruptures provides better knee function, in comparison to the surgical restoration of patellar tendon rupture. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Michael E Hantes
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Mezourlo, 41110 Larissa, Greece.
| | - Rejith Mathews
- Department of Orthopedic Surgery, Sri Narayani hospital and research centre, Vellore, Tamil Nadu, India
| | - Vasilios Raoulis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Mezourlo, 41110 Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Mezourlo, 41110 Larissa, Greece
| | - Theophilos Karachalios
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Mezourlo, 41110 Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Mezourlo, 41110 Larissa, Greece
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Brossard P, Le Roux G, Vasse B. Acute quadriceps tendon rupture repaired by suture anchors: Outcomes at 7 years' follow-up in 25 cases. Orthop Traumatol Surg Res 2017; 103:597-601. [PMID: 28373140 DOI: 10.1016/j.otsr.2017.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/07/2017] [Accepted: 02/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute quadriceps tendon rupture is rare. The gold-standard repair technique is transosseous patellar suture. Biomechanical studies have validated the use of anchors as an alternative. The present study sought to report long-term clinical and radiological results in a series of acute quadriceps tendon rupture repaired with anchors. The study hypothesis was that results are comparable to those of the gold-standard technique. METHODS A retrospective continuous study included 25 knees with acute quadriceps tendon rupture, operated on by a single surgeon between 2007 and 2013: 22 patients; 17 males, 5 females; mean age, 64 years (range: 52-87 years). Modified Bunnell suture was performed, using either 2 anchors (19 knees) or 3 anchors (6 knees). Anchors were positioned under 20° flexion. The factors studied were: active range of motion, muscle strength, patient satisfaction, Lysholm score, return to work, and the radiological behavior of the anchors. RESULTS At a mean follow-up of 7 years (range: 3-9 years), all but 1 patient had 0° active extension. Mean active flexion was 128° (range: 110-150°), and mean muscle strength was 4.9/5. Mean Lysholm score was 92. Subjective results proved satisfactory or very satisfactory in 23 cases. Working patients returned to work at a mean 4.2 months. There were no cases of anchor migration or of re-rupture. One poorly tolerated anchor was ablated at 2 years, without functional impact. CONCLUSION Outcomes with anchors were comparable to those of the gold-standard technique. Anchors allow immediate rehabilitation, without risk of anchor migration. The technique provided satisfactory functional recovery. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- P Brossard
- Service d'orthopédie et de traumatologie, centre hospitalier de La Rochelle, 17019 La Rochelle, France
| | - G Le Roux
- Service d'orthopédie et de traumatologie, centre hospitalier de La Rochelle, 17019 La Rochelle, France
| | - B Vasse
- Service d'orthopédie et de traumatologie, centre hospitalier de La Rochelle, 17019 La Rochelle, France.
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- 18, rue de Bellinière, 49800 Trélazé, France
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22
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Severyns M, Renard G, Guillou R, Odri GA, Labrada-Blanco O, Rouvillain JL. Arthroscopic suture repair of acute quadriceps tendon ruptures. Orthop Traumatol Surg Res 2017; 103:377-380. [PMID: 28212989 DOI: 10.1016/j.otsr.2016.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 02/02/2023]
Abstract
Acute quadriceps tendon ruptures disrupt the continuity of the extensor mechanism and must be treated surgically. Tendon reattachment with suture anchors has recently been shown to be biomechanically superior to reattachment through transosseous tunnels. In this context, arthroscopy is an interesting alternative. It can limit postoperative wound healing and infectious complications, while ensuring functional outcomes that are equivalent to standard techniques. The goal of this technical note is to describe an original, reproducible method for arthroscopic reattachment of the quadriceps tendon with suture anchors. Four patients were operated using this technique in a pilot study. No wound healing, infectious complications or re-tears were observed. At 6 months' postoperative, the mean subjective IKDC score was 85.8/100.
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Affiliation(s)
- M Severyns
- Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS90632, 97261 Fort-de-France, Martinique.
| | - G Renard
- Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS90632, 97261 Fort-de-France, Martinique
| | - R Guillou
- Clinique chirurgicale orthopédique et traumatologique, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes, France
| | - G A Odri
- Service de chirurgie orthopédique, CHU Lariboisière, rue Ambroise-Paré, 75010 Paris, France
| | - O Labrada-Blanco
- Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS90632, 97261 Fort-de-France, Martinique
| | - J L Rouvillain
- Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS90632, 97261 Fort-de-France, Martinique
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23
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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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24
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Kindya MC, Konicek J, Rizzi A, Komatsu DE, Paci JM. Knotless Suture Anchor With Suture Tape Quadriceps Tendon Repair Is Biomechanically Superior to Transosseous and Traditional Suture Anchor-Based Repairs in a Cadaveric Model. Arthroscopy 2017; 33:190-198. [PMID: 27514943 DOI: 10.1016/j.arthro.2016.06.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties of a knotless suture anchor with suture tape quadriceps tendon repair technique with transosseous and suture anchor repair techniques. METHODS Twenty matched pairs of cadaveric knees underwent a quadriceps tendon avulsion followed by repair via the use of transosseous tunnels with #2 high-strength sutures, 5.5-mm biocomposite fully threaded suture anchors with #2 high-strength sutures, or 4.75-mm biocomposite knotless suture anchors with suture tape. Ten knees were repaired via transosseous repair and 10 via fully threaded suture anchor repair, and their matched specimens were repaired with suture tape and knotless anchors. Biomechanical analysis included displacement during cyclic loading over 250 cycles, construct stiffness, ultimate load to failure, and failure mode analysis. RESULTS Compared with transosseous repairs, quadriceps tendons repaired with knotless suture tape demonstrated significantly less displacement during cyclic loading (cycles 1-20 3.6 ± 1.3 vs 6.3 ± 1.9 mm, P = .003; cycles 20-250 2.0 ± 0.4 vs 3.1 ± 0.9 mm, P = .011), improved construct stiffness (67 ± 25 vs 26 ± 12 N/mm, P = .001), and greater ultimate load to failure (616 ± 149 vs 413 ± 107 N, P = .004). Our repair technique also demonstrated improved biomechanical parameters compared with fully threaded suture anchor repair in initial displacement during cyclic loading (cycles 1-20 3.0 ± 0.8 vs 5.1 ± 0.9 mm, P < .001), construct stiffness (62 ± 20 vs 28 ± 10 N/mm, P = .001) and ultimate load to failure (579 ± 129 vs 399 ± 87 N, P = .006). CONCLUSIONS Repair of quadriceps tendon ruptures with this knotless suture anchor with suture tape repair technique is biomechanically superior in cyclic displacement, construct stiffness, and ultimate load to failure compared with transosseous and fully threaded suture anchor techniques in cadaveric specimens. CLINICAL RELEVANCE The demonstration that our repair technique is biomechanically superior to previously described techniques in a cadaveric setting suggests that consideration should be given to this technique.
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Affiliation(s)
- Michael C Kindya
- Department of Orthopaedic Surgery, SUNY Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | | | - Angelo Rizzi
- Department of Orthopaedic Surgery, SUNY Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - David E Komatsu
- Department of Orthopaedic Surgery, SUNY Stony Brook University Medical Center, Stony Brook, New York, U.S.A
| | - James M Paci
- Department of Orthopaedic Surgery, SUNY Stony Brook University Medical Center, Stony Brook, New York, U.S.A..
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Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques. Arthroscopy 2016; 32:1117-24. [PMID: 26895785 DOI: 10.1016/j.arthro.2015.11.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 09/24/2015] [Accepted: 11/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical fixation strength of suture anchor and transosseous tunnel repair of the quadriceps tendon in a standardized cadaveric repair model. METHODS Twelve "patella-only" specimens were used. Dual-energy X-ray absorptiometry measurement was performed to ensure equal bone quality amongst groups. Specimens were randomly assigned to either a suture anchor repair of quadriceps tendon group (n = 6) or a transosseous tunnel repair group (n = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 0.1 mm/s up to 100 N after which cyclic loading was applied at a rate of 1 Hz between magnitudes of 50 to 150 N, 50 to 200 N, 50 to 250 N, and tensile load at a rate of 0.1 mm/s until failure. Outcome measures included load to failure, displacement at 1st 100 N load, and displacement after each 10th cycle of loading. RESULTS The measured cyclic displacement to the first 100 N, 50 to 150 N, 50 to 200 N, and 50 to 250 N was significantly less for suture anchors than transosseous tunnels. There was no statistically significant difference in ultimate load to failure between the 2 groups (P = .40). Failure mode for all suture anchors except one was through the soft tissue. Failure mode for all transosseous specimens but one was pulling the repair through the transosseous tunnel. CONCLUSIONS Suture anchor quadriceps tendon repairs had significantly decreased gapping during cyclic loading, but no statistically significant difference in ultimate load to failure when compared with transosseous tunnel repairs. Although suture anchor quadriceps tendon repair appears to be a biomechanically superior construct, a clinical study is needed to confirm this technique as a viable alternative to gold standard transosseous techniques. CLINICAL RELEVANCE Although in vivo studies are needed, these results support the suture anchor technique as a viable alternative to transosseous repair of the quadriceps tendon.
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Roudet A, Boudissa M, Chaussard C, Rubens-Duval B, Saragaglia D. Acute traumatic patellar tendon rupture: Early and late results of surgical treatment of 38 cases. Orthop Traumatol Surg Res 2015; 101:307-11. [PMID: 25771528 DOI: 10.1016/j.otsr.2014.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/06/2014] [Accepted: 12/23/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute patellar tendon rupture is easy to diagnose but is still often overlooked. The aim of this study was to assess early and late results of surgical treatment of acute patellar tendon rupture. Our hypothesis was that functional outcome is satisfactory. METHODS A retrospective study included 38 knees in 37 patients (4 female, 33 male). Mean age was 42.6 ± 9.9 years (range, 23-81 years). Lesions comprised 15 tendon body ruptures, 20 avulsions from the tip of the patella and 3 avulsions from the anterior tibial tuberosity. Tendon repair was protected in more than 95% of cases by a reinforcement frame: hamstring (21 cases), synthetic ligament (12 cases) or metallic wire (3 cases). Results were evaluated in 2 steps: on patient files at a mean follow-up of 7.1 months (range, 3-24 months) to assess complications and early functional and radiological results; and by phone at a mean follow-up of 9.3 years (range, 19-229 months) in order to assess long-term functional outcome on Lysholm score and patient satisfaction. RESULTS Thirty-one knees were assessed at a mean 7.1 months. Mean knee flexion was 128.5° ± 7.5° (range, 85°-150°), extension -1° (range, -15° to 0°) and Caton-Deschamps index 0.96 (range, 0.57-1.29). Twenty-three knees were further assessed at a mean 9.3 years. Mean Lysholm score was 93.7 points (range, 61-100). Ninety-six percent of patients were satisfied or very satisfied with the result. All had returned to their previous job, and 20 had returned to sports activities, including 8 at pretrauma level. CONCLUSION Patellar tendon rupture has good prognosis if diagnosis and surgical treatment is early.
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Affiliation(s)
- A Roudet
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France
| | - M Boudissa
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France
| | - C Chaussard
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France
| | - B Rubens-Duval
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France
| | - D Saragaglia
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France.
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