Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

Abstract

Background Chronic ruptures, ruptures following total knee arthroplasty (TKA), and re-ruptures of the quadriceps tendon (QT) are rare. A systematic review of the current literature was conducted on their treatment and outcome to provide evidence-based indications for their management. Methods We searched published articles in English on chronic ruptures of QT, QT ruptures that occurred after TKA, and re-ruptures in PubMed, Scopus, and Google Scholar up to January 2021. Twenty-five articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Data from 25 articles (97 patients) with a mean age of 57 were retrieved. Patients were classified into three groups depending on the type of rupture: 16 patients suffered chronic QTR, 78 a QTR after a TKA, and 9 patients reported a re-rupture. The most frequent surgical approaches were different for each group: Codivilla’s Y-V technique and end-to-end sutures were the most commonly used in the chronic tears group (62.5%), synthetic MESH was the most frequent choice in QTR after a TKA group (38 patients, 53%), while end-to-end sutures were the first choice in the re-rupture group (4 patients, 44%). Conclusions Complex ruptures of the QT can be chronic ruptures, re-ruptures, or ruptures occurring after TKA. The choice of the best surgical technique depends on the macroscopic quality of the tendon stumps rather than the timing of intervention. Evidence-based preventive and therapeutic strategies should be developed.

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

“…Interestingly, the re-rupture rate was found to be 11% in the study population compared to studies including younger patients with reported re-rupture rates of 2% [ 2 ]. Oliva et al also described 9% re-ruptures in a systematic review on complex QTR [ 14 ]. This finding may emphasize the need to identify previously described risk factors which can be addressed during surgery such as osteophytes near the patella pole or pre-existing tendinosis.…”

“…Advanced age and obesity have already been associated in the literature with an increased risk of rupture due to fatty degenerative changes, loss of collagen and tendon calcification [ 8 ]. In these conditions, MRI can provide additional information about tendon quality and muscular atrophy [ 14 ]. This detailed information can be helpful for surgeons to choose the best possible strategies for tendon debridement and refixation in an older and overweight population.…”

“…They defined complex ruptures as re-ruptures (9%), chronic (16.5%) or linked to total knee arthroplasty (74.5%). They concluded that macroscopic tendon quality, rather than time since trauma, was critical in the choice of the surgical technique [ 14 ]. As MRI sequences have the capability to demonstrate individual tendon quality at the rupture site in each individual patient, it can be assumed that surgical therapy might benefit from this additional information.…”

KNEE extension lag

“…While goniometers were utilized to establish the study's baseline of 5" EL, the examiner relied solely on visual inspection to establish the participant's actual range of motion during trial assessments. It is important for the examiner to be at the same eye level as the patient's lower extremity in order to properly evaluate any movements in the sagittal plane (Oliva F, 2021). A total of 194 measurements of tibiofemoral, patellofemoral, and superior tibiofibular articular pain, stiffness, and crepitus were taken.…”

“…The inability to achieve full range of motion in a joint is a hallmark symptom of muscle laziness. Strive for passive limits that require minimal effort and can be achieved despite the resistance of joint stiffness or other soft tissue tightness (Oliva F, 2021).…”