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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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Zengui ZF, El Adaoui O, Fargouch M, Okouango BJC, El Andaloussi Y, Fadili M. Quadriceps tendon repair using double row suture anchor fixation: Case reports and review of the literature. Int J Surg Case Rep 2022; 92:106838. [PMID: 35202938 PMCID: PMC8881491 DOI: 10.1016/j.ijscr.2022.106838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Traumatic rupture of the quadricipital tendon is rare and disabling. The traditional repair technique involving transpatellar tunnels is still relevant, but this technique seems to be superseded for the technique using anchors. This study aimed to present the place of the anchors in quadriceps tendon tears, and assess the functional results after a means follow-up of 18.66 months. Case reports We report 03 cases of acute rupture of the quadricipital tendon collected in the Trauma Surgery and Orthopaedics Department. The average age was 53.66 years, all patients were male, the rupture occurred after a sporting accident in one case, and in 2 cases concerning minimal trauma from a fall in 2 patients followed for renal failure. The average consultation time was 48 h. The right knee was affected in 2. The clinical presentation was identical in all patients with the deficit of active extension of the leg. All patients were treated surgically with the use of double row anchors. The technique used consisted of insertion of two 5.0 mm anchors at the base of the patella, and the proximal part of the quadricipital tendon was sutured with heavy absorbable sutures using Krakow suture. Results At a mean follow-up of 18.66 months, no infectious complications were noted, no active extension deficit and the active flexion average was 123.33°. Conclusion The rupture of the quadricipital tendon is a rare injury. Surgical treatment by double row anchors gives excellent results with a satisfactory medium-term functional recovery and allow early rehabilitation. Quadriceps tendon ruptures are rare and compromise the knee's extension mechanism. The surgical traditional technique consisted of reinsertion of the quadricipital tendon by transosseous stitches. Surgical repair with suture anchors has been shown to have decreased gap formation and increased ultimate loads to failure.
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Affiliation(s)
- Z F Zengui
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco.
| | - O El Adaoui
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - M Fargouch
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - B J C Okouango
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Y El Andaloussi
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - M Fadili
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
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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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Mehta AV, Wilson C, King TS, Gallo RA. Outcomes following quadriceps tendon repair using transosseous tunnels versus suture anchors: A systematic review. Injury 2021; 52:339-344. [PMID: 33041016 DOI: 10.1016/j.injury.2020.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/19/2020] [Accepted: 10/04/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Two major techniques are used to repair complete quadriceps tendon ruptures, transosseous tunnel (TT) and the suture anchor (SA). There are multiple studies comparing the biomechanical outcomes of repairs performed with TT or SA. Our purpose was to compare the clinical outcomes following quadriceps tendon repair using SA and TT fixation techniques. METHODS Three major search engines were used with predetermined keyword searches to perform a systematic review of literature. These studies were independently scanned by two reviewers using PRISMA criterion. All included studies had to include at least one of the following outcome measures: range of motion (ROM), Lysholm score, complications, and/or re-ruptures. RESULTS Using three major search engines, 1039 articles were identified. After removing duplicates and screening for inclusion, 49 articles were reviewed. Two independent reviewers searched the studies to meet the inclusion criteria, and eight studies were selected. These eight studies included 156 knees in the TT group and 54 knees in the SA group. The TT group had a significantly better ROM after QT repair (132.5° versus 127.0°, p = 0.02). There was no significant difference in Lysholm scores between the TT group (92.6) and SA group (91.0, p = 0.11). There were significantly more complications in SA groups (9.3% versus 1.3%, p = 0.013), but not a significant difference in re-rupture rate between those undergoing SA vs. TT repair (3.7% versus 0%, p = 0.065). The SA group had a significantly higher age at time of surgery (63.62 vs. 54.32) CONCLUSION: The current study suggests that, following quadriceps tendon rupture, there are no significant differences in functional outcome between TT and SA techniques. Those undergoing TT repair attained a statistically significantly greater final ROM but this difference may not be clinically relevant. There was a statistically significantly higher rate of post-operative complications using SA technique.
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Affiliation(s)
- Anuj V Mehta
- Penn State University College of Medicine, United States of America.
| | | | - Tonya S King
- Penn State University College of Medicine, United States of America
| | - Robert A Gallo
- Penn State University College of Medicine, United States of America; Penn State Hershey Medical Center, Department of Orthopaedics, United States of America
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Wadhwani J, Vashishth S, Bansal H. Management of chronic quadriceps rupture with novel "chariot suture technique": A case report and review. J Clin Orthop Trauma 2020; 14:142-144. [PMID: 33680820 PMCID: PMC7919959 DOI: 10.1016/j.jcot.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022] Open
Abstract
Quadriceps tendon is one of the important segment of knee extensor mechanism. Acute ruptures are more common than chronic ruptures and have better outcomes. Chronic ruptures are rare with lot of surgical challenges including tendon retraction, fibrosis, degenerative calcification. We present a rare case of a 48 year old male diabetic patient with history of fall eight months ago and chief complaint of inability to actively extend his left knee. Diagnosis was made clinically and was confirmed radiologically with MRI. Surgical management was done with the use of novel "Chariot Suture Technique". It involves use of three Krakow whipstitches with Ethibond No. 5 suture across the distal ruptured end of quadriceps tendon and their intraosseous passage through patella in longitudinal fashion followed by tying knot at the distal pole of patella. The formation of Chariot makes the construct stable. At one year follow up patient was actively able to extend the knee with good range of motion. The technique is relatively cost effective, has no donor site morbidity, easy to learn and practice.
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Affiliation(s)
- Jitendra Wadhwani
- Department of Orthopaedics, Pt.B.D.S. PGIMS, Rohtak, Haryana, India,Corresponding author. Department of Orthopaedics, Pt. B.D.S. PGIMS, 6/CH, Medical Enclave, PGIMS Campus, Rohtak, Haryana, 124001, India.
| | | | - Himanshu Bansal
- Department of Orthopaedics, Pt.B.D.S. PGIMS, Rohtak, Haryana, India
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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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Pengas IP, Assiotis A, Khan W, Spalding T. Adult native knee extensor mechanism ruptures. Injury 2016; 47:2065-2070. [PMID: 27423309 DOI: 10.1016/j.injury.2016.06.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 02/02/2023]
Abstract
Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery. Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.
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Affiliation(s)
- I P Pengas
- UHCW (University Hospitals of Coventry & Warwickshire NHS Trust), United Kingdom.
| | - A Assiotis
- ST5 NW London Rotation, St Marys Hospital, United Kingdom.
| | - W Khan
- Division of Trauma & Orthopaedics, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom.
| | - T Spalding
- UHCW (University Hospitals of Coventry & Warwickshire NHS Trust), United Kingdom.
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Ennaciri B, Montbarbon E, Beaudouin E. Surgical management of acute quadriceps tendon rupture (a case report with literature review). Pan Afr Med J 2015; 22:243. [PMID: 26958106 PMCID: PMC4764314 DOI: 10.11604/pamj.2015.22.243.7533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/31/2015] [Indexed: 12/20/2022] Open
Abstract
Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long period of tendon weakening by statin therapy, hypertension and diabetes. The repair has consisted on end-to-end Krackow sutures associated with bone suture to the proximal pole of the patella. Surgeons and emergency physicians must think to this form of extensor apparatus rupture, because early diagnosis leads to early treatment and to best outcomes.
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Affiliation(s)
- Badr Ennaciri
- Department of Orthopedics, Avicenna University Hospital, Rabat, Morocco
| | - Eric Montbarbon
- Department of Orthopedics, Chambéry Hospital, Chambéry, France
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Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:85-92. [PMID: 26441330 DOI: 10.1007/s00590-015-1710-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Quadriceps tendon avulsions are typically treated by reattaching the tendon through bone tunnels, with or without tendon or hardware augmentation. The operated knee joint can be moved right away; however, tendon grafting or tension banding will be required to protect the repair, and the hardware must be removed later on. The goal of this study was to evaluate the clinical and functional outcomes when suture anchors are used to reattached torn quadriceps tendon, and also to assess tendon healing using MRI. MATERIALS AND METHODS Thirteen consecutive patients with avulsed quadriceps tendons were operated and then followed prospectively. The surgical technique consisted of tendon reattachment using at least three anchors, in addition to intratendinous weaving of the sutures. Weight bearing was allowed while using a splint. Rehabilitation was initiated immediately after surgery according to a set protocol. RESULTS Eleven patients were followed for a mean of 14.7 months. Two retears occurred in patients who did not wear the splint. Eighty-two per cent of patients were satisfied or very satisfied with the outcome. The mean knee flexion was 124.5°. All patients were able to return to their pre-injury activity levels. The mean time for clinical and functional recovery was 3 months. MRI performed 6 months after the surgical repair revealed good tendon healing. DISCUSSION This was the first prospective study performed on quadriceps avulsion patients undergoing suture anchor repair. Prior clinical case reports have shown that this method leads to predictable clinical and functional results. Our results were comparable to those in published cases. CONCLUSION The procedure is simpler when only suture anchors are used. Tendon healing was observed on MRI in all cases. This simple, reproducible technique is free of the drawbacks associated with the typical repair augmentation.
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Outcomes after knee joint extensor mechanism disruptions: is it better to fracture the patella or rupture the tendon? J Orthop Trauma 2012; 26:648-51. [PMID: 23100078 DOI: 10.1097/bot.0b013e31824a3bb5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the outcome after the operative treatment of patella fractures (PFs) as compared with those of quadriceps tendon and patella tendon (PT) ruptures. DESIGN This pertains to a retrospective case control. SETTING The setting was in academic teaching hospitals. PATIENTS Ninety-four patients with 99 extensor mechanism disruptions were treated operatively. Of these, 50 (50%) were PFs; 36 (37%) were quadriceps ruptures; and 13 (13%) were PT ruptures. MAIN OUTCOME MEASURES The patients were evaluated at 6 and 12 months and were tested for range of motion, quadriceps circumference and strength, SF36, Lysholm, and Tegner outcome scores by independent observers. Radiographs of the knee were obtained to assess bony healing, posttraumatic arthritis, and heterotopic ossification. RESULTS A minimum of 12-month follow-up (range 12-81 months) was available for 76 patients (77%). PFs were seen more commonly in women (P < 0.001) and PT ruptures tended to occur in younger males (P < 0.001), with no difference in the body mass index. Thigh circumference was significantly smaller than normal in PFs at 1 year as compared with tendon injuries. At latest follow-up, there were no significant differences noted with respect to knee range of motion, radiographic arthritis, Tegner, Lysholm, or SF36 scores. CONCLUSIONS There were no significant differences with regard to outcome in patients sustaining these injuries. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Hardy JRW, Chimutengwende-Gordon M, Bakar I. Rupture of the quadriceps tendon: an association with a patellar spur. ACTA ACUST UNITED AC 2005; 87:1361-3. [PMID: 16189308 DOI: 10.1302/0301-620x.87b10.16624] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We reviewed the records of 107 consecutive patients who had undergone surgery for disruption of the knee extensor mechanism to test whether an association existed between rupture of the quadriceps tendon and the presence of a patellar spur. The available standard pre-operative lateral radiographs were examined to see if a patellar spur was an indicator for rupture of the quadriceps tendon in this group of patients. Of the 107 patients, 12 underwent repair of a ruptured patellar tendon, 59 had an open reduction and internal fixation of a patellar fracture and 36 repair of a ruptured quadriceps tendon. In the 88 available lateral radiographs, patellar spurs were present significantly more commonly (p < 0.0005) in patients operated on for rupture of the quadriceps tendon (79%) than in patients with rupture of the patellar tendon (27%) or fracture of the patella (15%). In patients presenting with failure of the extensor mechanism of the knee in the presence of a patellar spur, rupture of the quadriceps tendon should be considered as a possible diagnosis.
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Affiliation(s)
- J R W Hardy
- BUPA Hospital Bristol, 3 Redland Hill, Bristol BS6 6UT, UK.
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