A Modified Method for Reconstruction of Chronic Rupture of the Quadriceps Tendon after Total Knee Replacement

Singh, Sushil Kumar; Choon, SK; Tai, CC

doi:10.5704/moj.0811.008

Cited by 6 publications

(7 citation statements)

References 3 publications

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“…As there is currently no standardized strategy available for the treatment of chronic QTRs, surgical algorithms are merely based on personal experience and case reports 6–13 . In 2015, Rehman and Kovacs described a case in which a chronic QTR was treated successfully by a combined hamstring autograft and Prolene® mesh augmentation and an injection of autologous platelet‐rich plasma (PRP) to enhance graft incorporation 32 .…”

Section: Discussionmentioning

confidence: 99%

Intramuscular and intratendinous placenta‐derived mesenchymal stromal‐like cell treatment of a chronic quadriceps tendon rupture

Maleitzke

Reinke

Agres

et al. 2022

J cachexia sarcopenia muscle

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Background Quadriceps tendon ruptures (QTRs) are rare but debilitating injuries, often associated with chronic metabolic conditions or long‐term steroid treatment. While the surgical treatment for acute QTRs is described thoroughly, no common strategy exists for the often frustrating treatment of chronic, reoccurring QTRs. The pro‐angiogenic and immunomodulatory properties of placenta‐derived adherent mesenchymal stromal‐like (PLX‐PAD) cells have been described to protect musculoskeletal tissues from inflammation and catabolic cytokine migration, yet little is known about the regenerative potential of PLX‐PAD cells in repetitively damaged tendon tissue. Case We report the case of an 80‐year‐old male patient with a chronic three‐time QTR of his right knee. The quadriceps tendon was reconstructed applying a conventional suture anchor repair procedure combined with a synthetic mesh augmentation and additional intramuscular and intratendineous PLX‐PAD cell injections as an individualized treatment approach. No adverse events were reported, and excellent radiological and functional outcomes with a passive range of motion of 0/0/120° knee extension‐flexion were observed at the 12 month follow‐up. Gait analysis confirmed restoration of joint motion, including gait speed, deficit in step length, and knee extensor muscle strength (pre‐surgery: 0.98 m/s, 40 cm, 42.4 ± 12.4 N; 9 months post‐surgery: 1.07 m/s, 0 cm, 10.4 ± 18.9 N) as well as hyperextension throughout stance and late swing phases (pre‐surgery: −11.2 ± 0.9°; 9 months post‐surgery: −2.7 ± 1.6°). Postoperative lymphocyte and cytokine analyses from the patient's peripheral blood serum suggested a systemic short‐term immunoregulatory reaction with postoperatively increased interleukin (IL)‐6 (pre‐surgery: 0.79 pg/mL; day 1: 139.97 pg/mL; day 5: 5.58 pg/mL; 9 months: 1.76 pg/mL) and IL‐10 (pre‐surgery: 0.9 pg/mL; day 1: 1.21 pg/ mL; day 5: 0.3 pg/mL; 9 months: 0.34 pg/mL) levels that decreased again over time. Conclusions Herein, we demonstrate a successfully treated chronic QTR with a synergistic surgical and biological reconstructive treatment approach. This local add‐on treatment with PLX‐PAD cells may be considered in specific cases of chronic QTRs, not susceptible to traditional suture anchor procedures and which exhibit a high risk of treatment failure. Further scientific engagement is warranted to explore underlying immunomodulatory mechanisms of action behind PLX‐PAD cell treatment for tendon injuries.

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Section: Discussionmentioning

confidence: 99%

Intramuscular and intratendinous placenta‐derived mesenchymal stromal‐like cell treatment of a chronic quadriceps tendon rupture

Maleitzke

Reinke

Agres

et al. 2022

J cachexia sarcopenia muscle

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“…More recently, different types of Dacron grafts (i.e., Dacron tape) have been described in the literature. Singh et al report a variation with a double-eight fashion augmentation with a 6 mm Dacron graft in complex ruptures of the quadriceps, once again recognizing the earlier post-operative mobilization [ 13 ]. Fernandez-Baillo et al described a primary suture repair augmented with Dacron tape, with excellent results at 1-year follow-up [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

A novel technique with Dacron vascular graft augmentation for knee extensor mechanism repairs: Technical note

Silva

Pereira

Distefano

et al. 2022

SICOT-J

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Ruptures of the extensor apparatus can have different etiologies and be complicated by underlying situations. Direct repair is not always possible, and reconstruction procedures can be insufficient, which leads to the appearance of multiple augmentation techniques to improve the strength of these constructs. Despite the proven results of these techniques, numerous procedures are described without any gold standard. We present our augmentation method for repairing the knee extensor apparatus with a vascular prosthesis that facilitates healing, does not interfere with the primary procedure, has no donor morbidity or rejection risk, and allows earlier mobilization and rehabilitation. The technique was used in different cases with multiple etiologies that needed reinforcement, with promising results.

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“…Fernandez-Baillo et al 9 observed a good outcome with the use of Dacron (US Catheter and Instrument, Glen Falls, New York) to reinforce an end-toend suture in a patient with rupture of the quadriceps tendon. Singh et al 16 reported a patient who underwent TKA and a second surgical intervention for recurrent patellar dislocation and then had partial rupture of the quadriceps tendon. After failure of conservative management, the patient received a Dacron graft using a figure-of-8 technique with the knee in full extension.…”

Section: Discussionmentioning

confidence: 99%

Chronic Quadriceps Tendon Rupture After Total Knee Arthroplasty Augmented With Synthetic Mesh

Ormaza¹,

Moreta²,

Mosquera³

et al. 2017

Orthopedics

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Tear of the quadriceps tendon after revision or primary total knee arthroplasty is a rare complication, but when it occurs, this injury has serious functional consequences. In complete tears, the outcome of direct repair is unpredictable, and several authors recommend that the suture should be reinforced. Several techniques have been described, including the use of autografts, allografts, and synthetic mesh. The goal of this study was to assess the outcomes of a reconstruction technique augmented with synthetic mesh. A retrospective study was performed involving 3 patients who had chronic partial quadriceps tendon tear after total knee revision. In 2 cases, proximal quadriceps release was performed. When conservative management failed, surgical reconstruction with suture reinforced with synthetic mesh was attempted. The knee was immobilized in full extension for 6 weeks after the surgical procedure. A minimum follow-up of 12 months was required to assess results. All reconstructions showed clinical success at a mean follow-up of 19 months. Mean Knee Society Score improved from 55.7 to 87.3, with average postoperative extensor lag of 3.3° (range, 0°-10°). The mean visual analog scale pain score was 2.3 (range, 0-4). No complications were reported. Synthetic mesh has previously been shown to be an effective treatment for patellar tendon repairs after total knee replacement, but there have been few articles on quadriceps rupture. Surgical reconstruction with synthetic mesh is a viable option that provides good functional outcomes in chronic quadriceps tendon rupture after total knee arthroplasty. [Orthopedics. 2017; 40(1):38-42.].

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A Modified Method for Reconstruction of Chronic Rupture of the Quadriceps Tendon after Total Knee Replacement

Cited by 6 publications

References 3 publications

Intramuscular and intratendinous placenta‐derived mesenchymal stromal‐like cell treatment of a chronic quadriceps tendon rupture

Intramuscular and intratendinous placenta‐derived mesenchymal stromal‐like cell treatment of a chronic quadriceps tendon rupture

A novel technique with Dacron vascular graft augmentation for knee extensor mechanism repairs: Technical note

Chronic Quadriceps Tendon Rupture After Total Knee Arthroplasty Augmented With Synthetic Mesh

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