- See:
Extensor Mechanism Injuries of the Knee:
- Discussion:
- rupture of
quadriceps tendons is most common in the 6th & 7th decades, and is probable
associated w/ decreased vasculature;
- Male:female
8:1
- more common w/ cortisone injections, diabetes, chronic renal failure; hyperthyroidism, and gout;
- tear may involve either portion of trilaminar tendon or its entirety;
- usually the tear is initiated centrally and progresses peripherally;
- tendon usually ruptures transversely at the osteotendinous junction;
- rupture often extends thru the
vastus intermedius tendon, proximal
to the rupture of the
rectus femoris tendon;
- its level usually corresponds to amount of flexion at time of injury;
- superficial and deep tears rarely involve the trilaminar structure at the same level;
- unlike the
achilles tendon rupture, the
quadriceps disruption is usually associated w/ intense pain,
although in cases of chronic tendon atrition (as from renal failure) pain may be minimal;
- Clinical Presentation:
- large hemarthrosis
- freely mobile patella and an impressive loss of extensor function with intact knee flexion;
- patient is unable to walk;
- look for palpable defect(suprapatellar gap) swelling 2nd to hemarthrosis, pt unable to extend the knee;
- hemarthrosis/swelling may mask defect; aspiration or knee flexion may widen the gap by shortening the rectus
- quad tendon usually ruptures transversely just proximal to patella;
-
partial tears
- an extensor lag usually is present;
- in these patients, MRI may delineate the extent of injury.
- partial tears of quadriceps tendon may be treated nonsurgically w/ immobilization and early range of motion.
- Radiographs:
- may show patella in a lower position than normal, use contralateral patella for comparison;
- Insall-Salvati method for determining patella alta/baja
Constant relationship
length of patella (P) and length of the patellar tendon (T)
Normal (T/P) = 0.80 - 1.2
Patella Infera/Baja < .80
possible Quad tendon rupture
Patella Alta
> 1.2
possible Patella tendon rupture
- Surgical Treatment:
- rupture is repaired within 48 hrs if possible;
- early intervention allows end-to-end repair of the tendon;
- make anterior longitudinal incision in midline of extremity;
- fibers of
rectus femoris tendon are sutured to superior pole of patella through drill holes,
as is done for patellar tendon ruptures;
- roughen the surface of the patella to promote healing;
- take care not to place the drill holes too close to the anterior patellar surface, (in order to avoid patellar tilt);
- No 5 Ethibond suture is then passed thru the quadriceps tendon (using the Krachow technique)
and then is passed thru the drill holes;
- because rupture nearly always takes place early thru an area of degeneration,
consider reinforcement of sutures w/ fascia strips;
- if the repair is strong, consider not repairing the lateral retinaculum (if it is torn) inorder to avoid patellar subluxation;
-
Scuderi technique:
- triangular tongue of tissue distally from the anterior surface of the proximal tendon;
- from anterior surface of proximal part of tendon fashion triangular flap 2-3 mm thick,
7.5 cm long on each side, and 5 cm wide;
- the base of the flap is left attached 5 cm above the rupture;
- the proximal tip of the flap is then turned over the rupture and is sutured in place;
- turn down triangular distally and suture it in place across rupture;
-
Codivilla technique:
- indicated for chronic ruptures where the tendon edges cannot be opposed;
- create a full thickness inverted V flap which ends 1.5 cm above the rupture;
- the tendon edges are repaired w/ heavy suture;
- the proximal portion of the inverted V is closed down (coverting it to a verticle line);
- Post Operative Care:
- immobilize for 4-6 weeks, and then begin ROM, followed by crutch walking for 6-8 weeks;
Primary repair of quadriceps tendon ruptures. Results of treatment.
A method of repair for quadriceps tendon or patellar ligament (tendon) ruptures without cast immobilization. Preliminary report.
Bilateral simultaneous rupture of the quadriceps tendons. A report of four cases and review of the literature.
Ruptures of the extensor mechanism of the knee joint.
Outcomes following repair of quadriceps tendon ruptures.
GA Konrath et al.
J. Orthop Trauma. Vol 12. No 4. p 273-279. 1998.
