Suture Anchor Repair with V-Y Plasty and Achilles Allograft Augmentation for Chronic Quadriceps Tendon Injury

Abstract

Despite an overall incidence that remains low, quadriceps tendon injuries represent a common disorder of the knee extensor mechanism. Persistent pain, weakness, and loss of terminal extension can lead to poor clinical outcomes and significant functional impairment. In the acute setting, approach to management often includes primary repair of the injured tendon that can lead to excellent clinical outcomes. However, a delayed or missed diagnosis can bring forth a clinical scenario that can be difficult to manage thereafter. In the chronically injured tendon, challenges can be linked to limited tendon excursion, poor tissue quality, and increased risk of reinjury.

Left Knee Open Rectus Femoris Repair With Achilles Allograft Augmentation

“…A utograft or allograft reconstruction of QT ruptures should be considered when native tissue quality is poor or in the setting of larger defects not amenable to primary repair or repair with lengthening techniques 8 . Owing to the paucity of QT ruptures that cannot be repaired with primary reconstruction or V-Y lengthening, the literature on Achilles tendon allograft for the treatment of subacute and chronic QTruptures is limited to 5 prior reports 8,[15][16][17][18] .…”

“…Outcomes studying repair of subacute and chronic QT ruptures using autograft or allograft reconstruction have been rarely characterized because of a paucity of these injuries that cannot be treated with primary repair or tendon lengthening. Data on the use of Achilles tendon allograft reconstruction for the treatment of subacute and chronic QT ruptures is especially limited 8,[15][16][17][18] . We present an unusual presentation of a subacute tendon tear isolated to the rectus femoris tendon and a reconstruction technique using an Achilles tendon allograft.…”

Bilateral Chronic Quadriceps Tendon Ruptures Treated with Hamstring Autograft Reconstruction

“…Often, the allograft is placed over a V/Y repair and sutured into place around the periphery to augment the repair. The Achilles allograft augmentation may provide earlier range of motion and strength but may also predispose the patient to pain, infection, and graft rejection 10 . Although these approaches have demonstrated success, there are no established guidelines for chronic quadriceps tendon rupture treatment.…”

Quadriceps reconstruction with suture anchor and Achilles allograft combination in quadriceps tendon re-rupture after primary surgical repair: A novel technique

“…Despite these drawbacks, quadriceps reconstruction using the Achilles allograft and suture anchor is a feasible technique in the setting of failed quadriceps ruptures, particularly in ruptures located most commonly in the musculotendinous junction. [ 5 , 14 ] Its benefits such as no need for harvesting the tendon and absence of donor site morbidity should be weighted against previously mentioned disadvantages. [ 15 ] The decision for allograft should be made intraoperatively, when traditional techniques have failed to re-approximate the rupture ends.…”