Novel Treatment of a Failed Quadriceps Tendon Repair in a Diabetic Patient Using a Patella-Quadriceps Tendon Allograft

Traumatic rupture of the quadriceps tendon by itself is not an uncommon clinical condition. However, its association with concurrent ipsilateral closed distal tibia oblique fracture is exceedingly rare with only one previously reported case in English literature. The dual diagnosis of this atypical combination of injury may be masked by pain and immobilization of the more obvious fracture and may be missed, unless the treating physician maintains a high index of suspicion. Suprapatellar knee pain with or without a palpable gap in the quadriceps tendon and inability to straight leg raise in the setting of a distal tibia fracture should raise concern, but if initial treatment employs a long-leg splint the knee symptoms may be muted. In this report, we describe this unusual combination of injury in a 67-year-old male patient who sustained a trivial twisting injury to the leg. The aim of this report is to raise awareness and emphasize the importance of thorough and repeated clinical examinations in the presence of distracting injuries. Despite the complexity of the problem, standard techniques for quadriceps tendon repair using transpatellar bone tunnels following locked intramedullary rodding of the tibia fracture may lead to optimal outcomes.

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Gastrocnemius Myotendinous Flap for Patellar or Quadriceps Tendon Repair, or Both

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-200008000-00021 ◽

2000 ◽

Vol 377 ◽

pp. 152-160 ◽

Cited By ~ 30

Author(s):

Martin Rhomberg ◽

Anton H. Schwabegger ◽

Marina Ninkovic ◽

Thomas Bauer ◽

Milomir Ninkovic

Keyword(s):

Tendon Repair ◽

Quadriceps Tendon

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Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2015.11.038 ◽

2016 ◽

Vol 32 (6) ◽

pp. 1117-1124 ◽

Cited By ~ 15

Author(s):

Seth L. Sherman ◽

Marilyn E. Copeland ◽

Jeffrey L. Milles ◽

David A. Flood ◽

Ferris M. Pfeiffer

Keyword(s):

Suture Anchor ◽

Tendon Repair ◽

Quadriceps Tendon ◽

Biomechanical Evaluation ◽

Repair Techniques

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Arthroscopic Quadriceps Tendon Repair: Two Case Reports

Case Reports in Orthopedics ◽

10.1155/2015/937581 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Hidetomo Saito ◽

Yoichi Shimada ◽

Toshiaki Yamamura ◽

Shin Yamada ◽

Takahiro Sato ◽

...

Keyword(s):

Suture Anchor ◽

Case Reports ◽

Tendon Repair ◽

Quadriceps Tendon ◽

Tendon Injury ◽

Arthroscopic Repair ◽

Pull Out ◽

One Year ◽

Bone Tunnels ◽

Pull Out Suture

Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.

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A Canine Arthroscopic Anterior Cruciate Ligament Reconstruction Model for Study of Synthetic Augmentation of Tendon Allografts

The Journal of Knee Surgery ◽

10.1055/s-0036-1597618 ◽

2016 ◽

Vol 30 (07) ◽

pp. 704-711 ◽

Cited By ~ 12

Author(s):

Pat Smith ◽

James Stannard ◽

Ferris Pfeiffer ◽

Keiichi Kuroki ◽

Chantelle Bozynski ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Quadriceps Tendon ◽

Preclinical Model ◽

The Novel ◽

Tendon Allograft ◽

Study Results ◽

Internal Brace ◽

Anterior Cruciate

AbstractNovel graft types, fixation methods, and means for augmenting anterior cruciate ligament (ACL) reconstructions require preclinical validation prior to safe and effective clinical application. The objective of this study was to describe and validate a translational canine model for all-inside arthroscopic complete ACL reconstruction using a quadriceps tendon allograft with internal brace (QTIB). With institutional approval, adult research hounds underwent complete transection of the native ACL followed by all-inside ACL reconstruction using the novel QTIB construct with suspensory fixation (n = 10). Contralateral knees were used as nonoperated controls (n = 10). Dogs were assessed over a 6-month period using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for preclinical animal models. Study results suggest that the novel QTIB construct used for complete ACL reconstruction can provide sustained knee stability and function without the development of premature osteoarthritis in a rigorous and valid preclinical model. The unique configuration of the QTIB construct—the combination of a tendon allograft with a synthetic suture tape internal brace—allowed for an effective biologic–synthetic load-sharing ACL construct. It prevented early failure, allowed for direct, four-zone graft-to-bone healing, and functional graft remodeling while avoiding problems noted with use of all-synthetic grafts.

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