Acute and old ruptures of the extensor apparatus of the knee in adults (excluding knee replacement)

Abstract

Rupture of the extensor apparatus of the knee in adults is infrequent and dominated by patellar fracture, which in our experience is six times as frequent as quadriceps or patellar tendon tear. Patellar fracture poses few diagnostic problems and treatment is now well codified. Tension-band osteosynthesis is generally used, involving two longitudinal K-wires and wire in a figure-of-eight pattern looped over the anterior patella; sometimes, for more complex fractures, cerclage wiring is added to the tension band. Non-union is rare and generally well tolerated. Quadriceps tendon tear mainly affects patients over 40 years of age, in a context of systemic disease. Diagnosis is easily suggested by inability to actively extend the knee, but is unfortunately still often overlooked in emergency. In most cases, early surgical management is needed to reinsert the tendon at the proximal pole of the patella by bone suture. For chronic lesions, it is often necessary to lengthen the quadriceps tendon by V-Y plasty or the Codivilla technique. Patellar tendon tear, on the other hand, typically occurs in patients under 40 years of age, often involved in sports. Diagnosis is again clinically straightforward, but again may be missed in emergency, especially in case of incomplete tear. Surgery is mandatory in all cases. The procedure depends on the type of lesion: either end-to-end suture or transosseous reinsertion. In most cases repair is protected by tendon augmentation. Old lesions often require tendon graft or a tendon-bone-tendon-bone graft taken from the opposite side.

Erythropoietin stimulates patellar tendon healing in rats

“…It is generally agreed that a healthy patellar tendon will not tear, and that tearing usually involves a tendon weakened by iterative micro trauma [2] or local corticoid injections. Surgery is mandatory, regardless of age and physical activity, and should be undertaken as early as possible after injury [3]. Erythropoietin (EPO) is a glycoprotein hormone produced primarily by the kidneys that regulates the production of red blood cells.…”

Sonography of Traumatic Quadriceps Tendon Tears With Surgical Correlation

“…Although many high‐grade partial and complete quadriceps tendon tears are diagnosed on the basis of clinical examination, diagnosis can be missed in up to 50% of cases in the acute setting 17 . Radiographic findings of joint effusion, suprapatellar masses, osseous avulsion, and patella baja are helpful when present but are not always present or diagnostic 18 .…”

“…5,16 Although many high-grade partial and complete quadriceps tendon tears are diagnosed on the basis of clinical examination, diagnosis can be missed in up to 50% of cases in the acute setting. 17 Radiographic findings of joint effusion, suprapatellar masses, osseous avulsion, and patella baja are helpful when present but are not always present or diagnostic. 18 Because quadriceps tendon tears have the best outcomes with timely diagnosis and repair, imaging can have a direct effect on patient treatment when there is clinical ambiguity.…”

Les plaies du tendon patellaire

“…Presque toutes les séries de la littérature englobe rupture sous cutanée et plaie du tendon patellaire avec un faible pourcentage de ces derniers [7, 8]. Le caractère ouvert de la lésion pousse effectivement les patients a consulté par contre lorsque la rupture est sous cutanée la lésion peut passer inaperçu et peut rentrer dans la chronicité.…”