Functional Results Following Surgical Repair of Simultaneous Bilateral Quadriceps Tendon Ruptures

Surgical treatment of Achilles tendon ruptures provides excellent functional results in active individuals, although it carries an incidence of wound complications. After experiencing a 25% wound complication rate with the traditional techniques in Achilles tendon ruptures, we modified the Bosworth technique by passing the gastrocsoleus flap percutaneously through the distal stump. This modification eliminated one third of the distal incision, which appears to be the most vulnerable part. We performed the operation in three consecutive cases. At 2-year follow-up there were no wound complications and no reruptures.

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Return of an Intact Hook Test Result: Clinical Assessment of Biceps Tendon Integrity After Surgical Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119827311 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711982731 ◽

Cited By ~ 1

Author(s):

Graham D. Pallante ◽

Shawn W. O’Driscoll

Keyword(s):

Surgical Repair ◽

Biceps Tendon ◽

Distal Biceps Tendon ◽

Level Of Evidence ◽

Distal Biceps ◽

Effective Manner ◽

Distal Biceps Repair ◽

Tendon Ruptures ◽

Test Result

Background: The hook test is a sensitive and specific tool that has been previously described for diagnosing distal biceps tendon ruptures in an efficient, cost-effective manner. However, its application in postoperative evaluations after surgical repair of distal biceps tendon ruptures is not documented. Hypothesis/Purpose: We hypothesized that the hook test result returns to normal at some point postoperatively after distal biceps repair. This information could be used in decision making during follow-up examinations with both normal and abnormal findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively reviewed records of distal biceps repair. Between July 1, 2003, and July 1, 2016, a total of 56 patients underwent distal biceps repair and also had clear documentation of the results of the hook test during the postoperative period. Hook test results consisted of “intact,” “abnormal,” or “absent.” The timing of the return to a normal hook test result was recorded. Results: Overall, 51 of 57 (89%) repairs were documented to have the hook test result return to “intact.” The test result returned to intact by a mean of 10 weeks after surgery (range, 2 weeks to 15 months). The biceps tendon was intact according to the hook test at the 4-month follow-up in 45 of the 51 patients (88%) in whom it ultimately returned. The hook test result was abnormal in 5 repairs in 5 patients with only a short-term follow-up, ranging from 2 to 7 weeks postoperatively. One patient with an abnormal hook test result at 2 weeks postoperatively underwent revision and was confirmed to have a partial tear of the biceps insertion. His hook test result returned to intact 3 months after revision repair. Conclusion: The hook test result returns to normal in patients who undergo distal biceps repair in the primary and revision settings with adequate follow-up. The vast majority of patients have a normal hook test result by 4 months postoperatively. An abnormal hook test result at 4 months postoperatively may indicate a failed repair and should prompt further investigation.

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The Influence of Diabetes on Acute Achilles Tendon Rupture Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00282 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0028

Author(s):

Jonathan Kaplan ◽

Jeffery Hillam ◽

Amiethab Aiyer ◽

Niall Smyth

Keyword(s):

Diabetes Mellitus ◽

Postoperative Complications ◽

Achilles Tendon ◽

Power Analysis ◽

Tendon Rupture ◽

Surgical Repair ◽

Achilles Tendon Rupture ◽

The United States ◽

Foot And Ankle ◽

Tendon Ruptures

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.

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

Joint Diseases and Related Surgery ◽

10.52312/jdrs.2021.14 ◽

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.

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Soft tissue extensor mechanism tendon ruptures of the knee

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0139 ◽

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.

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Carpometacarpal Dislocation of the Third to Fifth Fingers and an Associated Fracture of the Hamate in a Military Paratrooper

Case Reports in Orthopedics ◽

10.1155/2020/2861604 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Georgios Kalinterakis ◽

Emmanouil Antonogiannakis ◽

Arezoo Abdi ◽

Georgios Demetriades ◽

Alexandros Koulouktsis ◽

...

Keyword(s):

Surgical Repair ◽

Functional Results ◽

Concomitant Injuries ◽

Military Hospitals ◽

The Third ◽

Carpometacarpal Joints ◽

Orthopedic Surgeons ◽

Term Basis ◽

Great Force ◽

High Index Of Suspicion

Multiple carpometacarpal dislocations with a simultaneous fracture of the hamate represent less than 1% of all injuries to the hand and wrist regions, with a scarcity of published cases. These injuries usually require a great force, and diagnosis can be missed or delayed because of the high likelihood of other severe concomitant injuries. We report a case of acute closed dislocation of the third through fifth carpometacarpal joints and an associated fracture of the hamate in a military paratrooper. The injury was caused by a wrong landing technique during parachuting. The patient was managed with primary surgical repair, and after a six-month follow-up, he has excellent functional results. The fact that both this clinical entity and the mechanism of injury are very unusual a high index of suspicion is needed, especially for orthopedic surgeons working in military hospitals. Additionally, given that there is a paucity of published cases and optional treatment is controversial, this study corroborates the superiority of surgical repair in a long-term basis.

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Incidence of Major Tendon Ruptures and Anterior Cruciate Ligament Tears in US Army Soldiers

The American Journal of Sports Medicine ◽

10.1177/0363546507301256 ◽

2007 ◽

Vol 35 (8) ◽

pp. 1308-1314 ◽

Cited By ~ 49

Author(s):

Daniel W. White ◽

Joseph C. Wenke ◽

Dan S. Mosely ◽

Sally B. Mountcastle ◽

Carl J. Basamania

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Tendon Rupture ◽

Medical Center ◽

Cruciate Ligament ◽

Rare Event ◽

Quadriceps Tendon ◽

Level Of Evidence ◽

Black Soldiers ◽

Tendon Ruptures

Background Although a rare event, the prevalence of major tendon rupture has increased in recent decades. Identification of risk factors is important for prevention purposes. Hypothesis Race is a risk factor for major tendon ruptures. Study Design Cohort study (prevalence); Level of evidence, 2. Methods All patients admitted for surgical management of a rupture of a major tendon at Womack Army Medical Center, Fort Bragg, North Carolina, in 1995 and 1996 were identified and evaluated for risk factors. Results The authors identified 52 major tendon ruptures 29 Achilles, 12 patellar, 7 pectoralis major, and 4 quadriceps tendon ruptures. All patients were active-duty soldiers, and 1 was a female soldier. Forty-one tendon ruptures occurred among black soldiers, 8 occurred among white soldiers, and 3 occurred among Latino soldiers. The population at risk included 93 224 exposures during the 2-year period, of which 67.1% were white, 24.5% were black, and 8.4% were self-classified as other race. The rate ratio for tendon rupture, adjusted for gender and age, was 13.3 (95% confidence interval, 6.2-28.5) between blacks and whites and 2.9 (95% confidence interval, 0.8-10.9) between Latinos and whites. Conclusion The rate of major tendon rupture was 13 times greater for black men in this study population when compared with whites. Interventions among those at a higher risk for injury should be considered.

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Fixation of Acute Distal Biceps Tendon Ruptures Using Mitek Anchors: A Retrospective Study

The Open Orthopaedics Journal ◽

10.2174/1874325001408010052 ◽

2014 ◽

Vol 8 (1) ◽

pp. 52-55 ◽

Cited By ~ 5

Author(s):

M. Al-Taher ◽

Diederick B. Wouters

Keyword(s):

Biceps Brachii ◽

Biceps Tendon ◽

Tendon Repair ◽

Functional Results ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Tendon Ruptures ◽

Biceps Tendon Repair ◽

Dash Questionnaire

Purpose of this Study: The aim of this study was to evaluate the outcomes of surgical intra-osseous fixation of the distal tendon of the ruptured biceps brachii muscle using Mitek anchors. Materials and Methods: Between 2005 and 2011, seven patients underwent unilateral distal biceps tendon repair using Mitek anchors. All patients were men aged between 36 and 47 years. Six patients were assessed by physical examination and use of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: Surgery was performed within 3 to 17 days of rupture with a mean follow-up of 35 months. Of the six fully completed DASH questionnaires, three patients had a score of 0, and three patients had scores of 5.8, 10 and 10.8, respectively (10.1 is the mean score for the general population). Transient paraesthesias in the lateral antebrachial cutaneous nerve region occurred in two patients and one patient experienced a transient stiffness of the elbow due to scarring of the wound. No major complicatons have occurred. Conclusion: The use of Mitek anchors for the re-insertion of the ruptured distal biceps tendon proved to be a safe and effective technique with excellent functional results in our series.

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