Hind limb ossification centre hypoplasia and deformities induced by quadriceps contracture: Radiographic and Computed Tomographic study in 13 Doberman Pinscher littermates

Quadriceps contracture (QC) is reported in dogs mainly as a complication of trauma or parasitic infection. QC causes progressive hind limb deviation, muscular hypotrophy and degenerative joint disease and, in puppies, bone hypoplasia. The aim of this clinical case series is to describe the radiographic and computed tomographic (CT) changes in hind limb ossification centres in thirteen 55 to 57-days-old Doberman Pinscher related littermates induced by QC after repeated intramuscular injections. The presence, size, and shape of ossification centres of affected and unaffected hind limbs were compared. Affected limbs were hyperextended and externally rotated, with genu recurvatum and proximo-medial patellar luxation. QC had no influence on the time of appearance of ossification centres however, it was associated with femoral head flattening, hip subluxation, flattening of the femoral distal epiphysis. The tibial plateau was tilted caudoproximally-craniodistally and wedged into the growth plate. Thirty-two out of fifty-five ossification centres (including diaphyseal and epiphyseal centres, such as femoral head and tibial plateau) were significantly smaller in affected limbs (p < 0.05). Lack of weight-bearing could account for the smaller size of ossification centres in affected tarsi and metatarsi. Progressive limb hyperextension and external rotation might have induced gradual loading withdrawal on the medial aspect of the foot justifying the reduced size observed only for the medial ossification centres of the digits of affected limbs. To the best of our knowledge, this is the first study describing CT findings of hind limb ossification centre changes in puppies with QC contracture.

Combined quadriceps lengthening (using an external ring fixator) and patellar tendon reconstruction (using a tendoachilles allograft) in a case of chronic patellar tendon rupture: A case report

BACKGROUND

Patellar tendon rupture is an infrequent and debilitating condition, which if left untreated, is complicated by quadriceps contracture and patella alta. This results in reduced function of the knee extensor mechanism including extension lag, reduced range of motion (ROM), chronic knee pain, and frequent falls. Early primary repair has good results in most cases and is performed by opposing and suturing the tendon ends. However, when there is a delay between rupture and repair or in case of a re-rupture, primary repair techniques may not work due to retraction of the extensor mechanism. Several treatment modalities have been proposed in such cases, but there is no clear consensus.

METHODOLOGY

We present the case of a 39-year-old male with chronic rupture of patellar tendon that was reconstructed with a two-stage technique. In the first stage, a ring-fixator was applied to stretch the quadriceps muscle and the second stage consisted of reconstruction of the patellar tendon with a tendoachilles allograft. This procedure was performed in two stages five weeks apart and almost four years after the initial injury.

RESULTS

Results were excellent at three years' follow-up with the patient achieving full extension, a ROM of 0-110° and 85% quadriceps strength. There was significant improvement in his pain, mobility and quadriceps bulk.

CONCLUSION

To our knowledge, this treatment has not previously been described in the literature. We present this case as a proven treatment option for treatment of chronic patellar tendon injuries with extensor mechanism shortening.

Distal quadricepsplasty in children: 88 cases of retractile fibrosis following intramuscular injections treated in Benin

INTRODUCTION

Retractile fibrosis of the quadriceps (RFQ) is a physical and social handicap in children, and often results from a past history of quadriceps intramuscular injection. The aim of this study was to evaluate the therapeutic results of RFQ treated by distal quadricepsplasty using a modified Thompson-Payr procedure (DQPMTP).

HYPOTHESIS

Functional recovery will be good with DQPMTP.

PATIENTS AND METHODS

This is a descriptive retrospective 10-year study from 2002 to 2011, including 74 children (88 knees) less than 15 years old, admitted for RFQ and treated in Benin. The types of RFQ were: knee flexion loss of motion 16 cases (18.2%), lag of extension 54 cases (61.4%) and associated genu recurvatum, 18 cases (20.5%). Wasting of the thigh was found in all cases. An associated distal femoral osteotomy was performed to correct a bone deformity in 18 cases (20.5%).

RESULTS

There were 16 cases (18.2%) of poorly looking postoperative scars and 2 cases (2.3%) of fracture during physical therapy. Mean flexion ROM after surgery was 77.7°. Mean flexion increased from 77.7° to 108.5° following postoperative rehabilitation or a mean gain of 30.7°. The quadriceps muscle testing scores were at least 3/5. Results of DQPMTP were good in 80.7% of cases, as shown by mean active knee flexion of 108.5° with normal active extension. The results were satisfactory in 17 cases (19.3%).

DISCUSSION

DQPMTP has the advantage of cutting a minimum of blood vessels, thus limiting the risk of hematoma. Laterally placed incisions create less tension reducing the risk of skin necrosis. The clinical and radiological results of this series confirm those in the literature. Treatment of RFQ by DQPMTP provides satisfactory functional rehabilitation in patients, which confirms our hypothesis.

LEVEL OF EVIDENCE

Level IV, retrospective study without comparison.