Quadriceps tendon tear rupture in healthy patients treated with patellar drilling holes: clinical and ultrasonographic analysis after 36 months of follow-up

Abstract

SummaryBackground: quadriceps tendon subcutaneous rupture is an uncommon injury affecting predominantly middle-aged men as a result of direct or indirect trauma; aim of this work is to evaluate clinical outcome and tendon morphology in patients treated surgically with transpatellar drilling suture. Methods: 20 patients (20 male) with an average age of 54 (42-59) were evaluated with a mean follow-up of 36 months. Measurements of range of motion (ROM) and of tight circumference were collected. Lysholm and Rougraff Score were also performed. All the patients underwent a US evaluation the morphologic changes of the repaired tendon. Results: mean active ROM was 1°-117°; average difference in the circumference of the quadriceps was 2.6% 10 C and 3.3% 15 C. The mean Lysholm Score calculated was 88/100; the mean Rougraff Score 17/25. At ultrasonographic evaluation all tendons were continuous; heterotopic ossification was present in 18 quadriceps tendons. Thickness was augmented in 18 quadriceps tendons and in 5 patellar tendons. Vascularization was always conserved. Lateral subluxation of patella was reported in 1 case. Conclusions: patellar drilling holes repair is a nondemanding procedure, inexpensive and technically uncomplicated. US evaluation confirms tendon healing; tendon remodeling does not affect patient's clinical outcome and quality of life. Level of incidence: IV

Outcomes after quadriceps tendon repair in patients over 80 years of age

“…The mean Lysholm score is 84.8, which is within the range of a good outcome and the mean Rougraff score is 21.3, which is an excellent outcome. While the older patient might be considered to be lower demand, these scores are similar to a recent study by Verdano et al focusing on those under the age of 60 with presumable higher demand and activity levels 14 . A 3-month follow up study by Puranik et al 15 on 21 QT ruptures with a mean age of 66.2 years demonstrates good outcomes, as does a recent longer term 6 year follow up study by Boudissa et al 16 of 50 QT ruptures with a mean age of 55.2 years.…”

Association between patella spurs and quadriceps tendon ruptures

“…Unilateral ruptures are more common than bilateral. Early diagnosis and prompt surgical repair have been shown to have good outcomes in QT ruptures, aided in part by the technical simplicity of the operation 11,12 . Patellar tendinopathy and ruptures have been studied in more detail and it is believed that eccentric exercises and even surgical interventions may be beneficial in tendinopathies which may avoid their progression and subsequent tendon ruptures [13][14][15] .…”

Etiology, Diagnosis and Treatment of Tendinous Knee Extensor Mechanism Injuries

“…In missed injuries with chronic ruptures or re-ruptures of the quadriceps tendon, the Scuderi (27) technique has been advocated to reinforce and the Codivilla technique to lengthen the tendon (18). In both techniques, a wide-based inverted V tendon flap is placed 1.5-2 cm proximal to the rupture and folded down and sutured over an end-to-end repair of the rupture site (see Fig.…”

“…According to literature, the most common surgical procedures, when treating tendinous knee extensor mechanism injuries, are fixation through patellar drill holes and simple end-to-end sutures (1, 5, 17–19). Fixation through patellar drill holes can be considered the gold standard in ruptures near the poles of the patella (see Fig.…”

“…According to Hart et al (21), both fixations are sufficiently strong, but trans-osseous fixation is stronger with higher ultimate tensile load. Fixation through patellar drill holes has a longer track record and has been shown to be a reliable, inexpensive, and straightforward procedure (18). The possible advantages of anchor fixation, however, are smaller skin incisions (22) and reduced operative time (20).…”