Extensor Mechanism Injury in the Pediatric Population—A Clinical Review

2018 ◽  
Vol 31 (06) ◽  
pp. 490-497 ◽  
Author(s):  
William Sessions ◽  
Matthew Herring ◽  
Walter Truong
Keyword(s):  
Pediatric Population ◽  
Tensile Force ◽  
Quadriceps Tendon ◽  
Operative Management ◽  
Extensor Mechanism ◽  
Patellar Ligament ◽  
Tibial Tubercle ◽  
Mechanism Of Injury ◽  
Lower Extremity Function ◽  
Pediatric Knee

AbstractThe extensor mechanism of the knee—consisting of the four muscles of the quadriceps, the quadriceps tendon, the patella, and the patellar ligament—is essential for lower extremity function during both standing and ambulation. The presence of articular cartilage and growing physes in the pediatric knee, coupled with the generation of significant tensile force, creates an opportunity for pathology unique to the pediatric population.Tibial tubercle fractures and patella injuries are quite rare, and even pediatric-trained orthopaedic surgeons may not be exposed to these injuries on a regular basis. It is the intent of this article to discuss the current literature regarding the mechanism of injury, diagnostic workup, classification, indications for surgical versus non-surgical management, and techniques for operative management for both tibial tubercle and patella (transverse and sleeve) fractures.

scholarly journals Revision Quadriceps Tendon Repair With Bone-Achilles Allograft Augmentation

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110326
Author(s):  
Navya Dandu ◽  
Nicholas A. Trasolini ◽  
Steven F. DeFroda ◽  
Tai Holland ◽  
Adam B. Yanke
Keyword(s):  
Weight Bearing ◽  
Tendon Repair ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Bone Block ◽  
Tissue Quality ◽  
Recipient Site ◽  
Patient Reported ◽  
Bone Plug

Background: Surgical repair of chronic quadriceps tendon ruptures can be daunting, especially after failure of a prior repair. In this setting, tissue quality is usually poor, necessitating graft augmentation. In this video, we describe our technique for Achilles tendon allograft augmentation for revision quadriceps tendon repair. Indications: Failed quadriceps tendon repair defined as ongoing extensor mechanism deficit including patella baja, functional deficit, or palpable quadriceps defect with confirmed retear on advanced imaging. Technique Description: Patient is placed in the supine position, and a midline incision is extended to the tibial tubercle. Full thickness medial and lateral flaps are raised, nonviable scar tissue is excised, and suprapatellar adhesions are released to ensure full mobilization of the viable remnant quadriceps. A plane is then developed deep to the patellar tendon paratenon from proximal to distal. A reamer is used to prepare a socket just medial to the tibial tubercle. The calcaneal bone block of the Achilles allograft is fashioned to match the recipient site on the tibia with a sagittal saw. The graft is shuttled deep to the paratenon, and the bone plug is fixed to the tibia with an interference screw. Suture from the patellar anchors is then used to place 2 running Krackow stitches spanning the remnant quadriceps tendon proximally. The remnant tissue is subsequently reduced and tied with an anchor pull-through technique. The soft tissue component of the Achilles graft is laid over the repair and oversewn with free nonabsorbable suture. Patient is placed in a brace locked in extension for 6 weeks and allowed to be weight bearing as tolerated. Results: Long-term patient-reported outcomes of Achilles allograft reconstruction for revision extensor mechanism repairs are limited. Two studies of 17 reconstructions each reported this to be a reliable and durable option at a mean follow-up of 65 and 52 months, respectively. Discussion/Conclusion: Revision surgery for extensor mechanism deficits can be a challenging procedure. Our preference is to perform augmentation with Achilles allograft with bone plug fixation on the tibial side. This allows for augmentation of the entire extensor mechanism, as well as bone-to-bone healing on the tibial side.

New variant of bipartite patella with traumatic separation and complete disruption of the extensor mechanism of the knee

2021 ◽  
Vol 14 (1) ◽  
pp. e236773
Author(s):  
Kiran Kumar Naikoti ◽  
Raghuram Thonse
Keyword(s):  
Functional Recovery ◽  
Tendon Rupture ◽  
Case Reports ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Quadriceps Tendon Rupture ◽  
Bipartite Patella ◽  
New Variant ◽  
Complete Disruption ◽  
Type 3

Very few case reports have been reported on traumatic separation of the bipartite patella along with quadriceps tendon rupture. These reports relate to separation of superolateral bipartite patella (Saupe type 3). We describe a new variant which to our knowledge has not been described or classified so far, which is purely a superior bipartite patella with traumatic separation and complete functional disruption of the extensor mechanism of the knee in a young patient working in the army which was managed with open reduction and internal fixation along with repair of the extensor mechanism of the knee achieving complete functional recovery.

scholarly journals SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0013
Author(s):  
Alexandra H. Aitchison ◽  
Kenneth M. Lin ◽  
Daniel W. Green
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Force Vector ◽  
Tibiofemoral Rotation ◽  
The Mean

Background: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. Hypothesis/Purpose: The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI. Conclusion: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism. Tables/ Figures [Table: see text][Table: see text]

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

2021 ◽  
Author(s):  
Erhan Okay ◽  
Mehmet Cenk Turgut ◽  
Abbas Tokyay
Keyword(s):  
Suture Anchor ◽  
Surgical Repair ◽  
Primary Repair ◽  
Full Range ◽  
Knee Extensor ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Surgical Options ◽  
Knee Extensor Mechanism

Quadriceps ruptures are one of the pathological conditions of the knee extensor mechanism, accounting for 3% of all tendon injuries. These injuries cause substantial disability of the extensor mechanism. Primary repair is the treatment of choice in acute presentation. In the setting of chronic conditions, the treatment becomes more challenging. Available surgical options include lengthening procedures, and reconstruction with auto graft or allografts. The traditional Scuderi and Codivilla techniques are challenging to perform in degenerative or traumatic retracted ruptures. There is no standard effective treatment in these patients, which yields the best clinical and biomechanical outcomes. An 18 - year-old male patient with quadriceps re-rupture after a primary repair was managed with allograft reconstruction using suture anchors. At six years of follow-up, the patient gained a full range of motion with excellent clinical outcomes. He returned to his previous work. In conclusion, quadriceps reconstruction using suture anchor and Achilles allograft combination is a feasible technique in neglected cases who present with quadriceps tendon re-rupture after primary surgical repair.

scholarly journals A rare case of patellar fracture with quadriceps tendon rupture

2021 ◽  
Vol 7 (2) ◽  
pp. 406
Author(s):  
K. N. Subramanian ◽  
Ganesan G. Ram ◽  
Muthukumar S. ◽  
Mathiyazhagan Babu
Keyword(s):  
Patellar Tendon ◽  
Rare Case ◽  
Tendon Rupture ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Patella Fracture ◽  
Patellar Fracture ◽  
Quadriceps Tendon Rupture ◽  
Patellar Tendon Rupture ◽  
Bone Level

<p>Quadriceps tendon rupture is the rarest injury with an incidence of 1.37/1,00,000/year. A patellar fracture is the most common injury associated with extensor mechanism lag, but it is rarely found to have quadriceps rupture rather than patellar tendon rupture. Normally when patella fracture occurs the force is disseminated at the bone level rather than at the muscular level. In this case, the force has disseminated at both muscle and bone leading to fracture of patella and quadriceps tendon rupture. Here we report a case of patellar fracture along with quadriceps tendon rupture.<strong></strong></p>

Soft tissue extensor mechanism tendon ruptures of the knee

2021 ◽  
pp. 1-9
Author(s):  
John-Henry Rhind ◽  
Patrick Lancaster ◽  
Usman Ahmed ◽  
Michael Carmont
Keyword(s):  
Emergency Medicine ◽  
Soft Tissue ◽  
Acute Care ◽  
Quadriceps Tendon ◽  
Tendon Injuries ◽  
Extensor Mechanism ◽  
Patella Tendon ◽  
Tendon Ruptures ◽  
Serious Injuries ◽  
Prompt Diagnosis

Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps tendon is an uncommon injury and is more frequent in patients over the age of 40 years. Patella tendon ruptures are even rarer and are more frequent in patients under the age of 40 years. Causes can be direct or indirect. Complete ruptures of the quadriceps tendon or patella tendon benefit from early surgical management, while partial ruptures may be managed non-operatively. This article gives an overview of the presentation, assessment and management of soft tissue extensor mechanism tendon ruptures for core surgical, acute care common stem and emergency medicine trainees.

Tibial Tubercle Fragmentation: A Clue to Simultaneous Patellar Ligament Avulsion in Pediatric Tibial Tubercle Fractures

Orthopedics ◽  
2008 ◽  
Vol 31 (5) ◽  
pp. 1-4 ◽  
Author(s):  
Dennis E. Kramer ◽  
Tai-Li Chang ◽  
Nancy H. Miller ◽  
Paul D. Sponseller
Keyword(s):  
Patellar Ligament ◽  
Tibial Tubercle

Effect of Patella Alta on the Native Anatomometricity of the Medial Patellofemoral Complex: A Cadaveric Study

2020 ◽  
Vol 48 (6) ◽  
pp. 1398-1405
Author(s):  
Adam B. Yanke ◽  
Hailey P. Huddleston ◽  
Kevin Campbell ◽  
Michael L. Redondo ◽  
Alejandro Espinoza ◽  
...  
Keyword(s):  
Attachment Site ◽  
Quadriceps Tendon ◽  
Length Change ◽  
Patellar Height ◽  
Extensor Mechanism ◽  
Patella Alta ◽  
Similar Length ◽  
Custom Made ◽  
Length Changes ◽  
Medial Patellofemoral Complex

Background: Patella alta has been identified as an important risk factor for lateral patellar instability and medial patellofemoral complex (MPFC) reconstruction failure. Purpose: To evaluate the length changes of the MPFC at multiple possible reconstruction locations along the extensor mechanism in varying degrees of patella alta throughout knee motion. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knees were used in this study. The MPFC was identified and dissected with the patellar tendon and quadriceps tendon. A custom-made jig was utilized to evaluate lengths from 0° to 90° of flexion with physiological quadriceps loading. Length was measured with a 3-dimensional robotic arm at 4 possible reconstruction locations along the extensor mechanism: the midpoint patella (MP), the MPFC osseous center (FC), the superior medial pole of the patella (SM) at the level of the quadriceps insertion, and 1 cm proximal to the SM point along the quadriceps tendon (QT). These measurements were repeated at 0°, 20°, 40°, 60° and 90° of flexion. Degrees of increasing severity of patella alta at Caton-Deschamps index (CDI) ratios of 1.0, 1.2, 1.4, and 1.6 were then investigated. Results: Patella alta and MPFC attachment site location significantly affected changes in MPFC length from 0° to 90° of flexion ( P< .0005). Length changes at attachment MP showed no difference when CDI 1.0 was compared with all patella alta values (CDI 1.2, 1.4, 1.6; P > .05). Similarly, FC showed no difference in length change from 0° to 90° until CDI 1.6, in contrast to proximal attachments (SM, QT), which demonstrated significant changes at CDI 1.4 and 1.6. When length changes were analyzed at each degree of flexion (0°, 20°, 40°, 60°, 90°), Spearman correlation analysis showed a moderate negative linear correlation for QT at CDI 1.0 ( r= −0.484; P = .002) and 1.6 ( r = −0.692; P < .0005), demonstrating constant loosening at the QT point at normal and elevated patellar height. In contrast, no differences in length were observed for MP at CDI 1.0 throughout flexion, and at CDI 1.6, there was a difference only at 0° ( P < .05). Points FC and MP at CDI 1.6 had similar length change properties to points SM and QT at CDI 1.0 ( P > .05), suggesting that distal attachments in the setting of patella alta may provide similar length changes to proximal attachmentswith normal height. Conclusion: Anisometry of the MPFC varies not only with attachment location on the extensor mechanism but also with patellar height. Increased patellar height leads to more significant changes in anisometry in the proximal MPFC attachment point as compared with the distal component. In the setting of patella alta, including a CD ratio of 1.6, the osseous attachments of the MPFC remain nearly isometric wheras the proximal half length changes increase significantly. Clinical Significance: The results of this study support the idea that the MPFC should be considered as 2 separate entities (proximal medial quadriceps tendon femoral ligament and distal medial patellofemoral ligament) owing to their unique length change properties.

scholarly journals Tracheobronchial foreign body aspiration in children aged ≤ 2 years: the use of flexible bronchoscopy and urology stone retrieval basket in emergency setting

2021 ◽  
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Main Bronchus ◽  
Pediatric Population ◽  
Operation Time ◽  
Operative Management ◽  
Flexible Bronchoscopy ◽  
Emergency Setting ◽  
Flexible Bronchoscope ◽  
Pediatric Airway

Objective: Tracheobronchial aspiration of foreign body in children is an emergency that can lead to major complications. In the last years flexible bronchoscopy has gained popularity for foreign bodies retrieval in the pediatric population, yet the small size of the pediatric airway and of the flexible bronchoscope channel limit the availability of instruments during the procedure. Aim of this paper is to describe our experience in treating foreign bodies tracheobronchial aspiration in children aged 2 years or less by means of flexible bronchoscope and an urology stone retrieval basket. Methods: A review of endoscopic foreign bodies removal by means of flexible bronchoscopy and urology stone retrieval basket has been carried out in children ≤ 2 years that presented at the Emergency Room of our hospital from 2005 to 2019. In the paper, we analyze characteristics of patients, timing of bronchoscopy, instruments and operative management. Results: There were 25 patients with a mean age of 20 ± 3.8 months. Organic material was the most frequent observed foreign body. Association of main bronchus and distal bronchi was the preferred site of the foreign body in 19 patients and the right side of the bronchial tree was involved in 17 cases. Complications occurred in one case. Mean operation time was 37 ± 20 minutes. Conclusions: The use of flexible bronchoscope can be helpful in handling endoscopic removal of tracheobronchial foreign bodies in toddlers. The use of the urology stone retrieval basket resulted very effective in all shapes of foreign bodies and/or when the object was located in the distal bronchi.

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