Tear of Quadriceps and Patellar Tendon with Superior Pole Avulsion of Patella

Abstract

Case: A 58-year-old man presented with right knee pain and inability to extend the knee after falling. magnetic resonance imaging (MRI) demonstrated complete rupture of the quadriceps tendon, avulsion of the superior pole patella, and a highgrade partial tear of the proximal patellar tendon. Surgical dissection revealed that both tendon tears were full-thickness disruptions. Repair was performed without complications. The patient achieved independent ambulation and passive range of motion from 0°to 118°at 3.8 years postoperatively.Conclusions: We present a case of a simultaneous ipsilateral tear of the quadriceps and patellar tendons with superior pole patella avulsion that resulted in a clinically successful repair. Extensor mechanism disruption of the knee due to complete tendon rupture of the quadriceps tendon occurs in 1.3% of the US population annually and rupture of the patellar tendon occurs in less than 0.5% 1,2 . Both injuries are more common in men; however, rupture of the patellar tendon is more common before 40 years while quadriceps tendon rupture is positively correlated with age 1,2 . Risk factors of tendon ruptures include chronic inflammation, chronic renal disease, hyperparathyroidism, diabetes mellitus, rheumatoid arthritis, and systemic lupus erythematosus 1,2 . Early diagnosis and surgical repair of these injuries is essential to optimize recovery and functionality. 1,2 Bifocal disruption of the knee extensor mechanism, or floating patella, is an uncommon injury and is more sparsely documented in the literature 3 . We present a case of simultaneous ipsilateral rupture of the quadriceps and patellar tendons with superior pole avulsion of the patella that resulted in a clinically successful repair.Written consent for publication was obtained from the patient. Case ReportA 58-year-old man presented to the emergency department with right knee pain and inability to straighten his right leg after a fall directly onto the anterior aspect of his knee.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C44).