Midterm outcome and strength assessment after quadriceps tendon refixation with suture anchors

Abstract

Purpose Quadriceps tendon ruptures (QTR) occur predominantly in middle-aged patients through violent eccentric contraction that occurs either when trying to regain balance or during a fall on the hyperflexed knee. The aim of this study was to quantify midterm postoperative results, including strength potential measured via standardized strength tests following acute (< six weeks) quadriceps tendon refixation using suture anchors. Methods All consecutive patients with QTR who underwent surgical suture anchor refixation between 2012 and 2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Tegner Activity Scale (TAS), Lysholm score, International Knee Documentation Committee subjective knee form (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, return to work rates, and Visual Analog Scale (VAS) for pain. Additionally, a standardized clinical examination and an isometric strength assessment of knee extension and flexion were performed. Results A total of 17 patients (median age 61.0 [25–75% IQR 50.5–72.5]) were available for final assessment at a mean follow-up of 47.1 ± SD 25.4 months. The majority of patients were male (82.4%) and most injuries occurred due to a fall on the hyperflexed knee (76.5%). The average time interval between trauma and surgery was 12.7 ± 7.5 days. Patients achieved a moderate level of activity postoperatively with a median TAS of 4 (3–5.5) and reported good to excellent outcome scores (Lysholm score: 97 (86.5–100); IKDC: 80.7 ± 13.5; KOOS subscales: pain 97.2 (93.1–100), symptoms 92.9 (82.5–100), activities of daily living 97.1 (93.4–100), sport and recreation function 80 (40–97.5) and knee-related quality of life 87.5 (62.5–100). All patients were able to fully return to work and reported little pain [VAS: 0 (0–0)]. No postoperative complications were reported. Strength measurements revealed a significant deficit of knee extension strength in comparison to the contralateral side (p = 0.011). Conclusion Suture anchor refixation of acute QTR leads to good functional results and high patient satisfaction without major complications. Isometric knee extension strength, however, may not be fully restored compared to the unaffected side.

Concentric Isokinetic Strengthening Program’s Impact on Knee Biomechanical Parameters, Physical Performance and Quality of Life in Overweight/Obese Women with Chronic Meniscal Lesions

“…Knee flexion and extension (amplitude) joint ranges were measured using a goniom eter by centering it on the knee's lateral condyle and aligning one arm of the goniomete along the femur axis toward the greater trochanter and the other along the leg toward the lateral malleolus in the supine position [11,36] (Figure 3). Heel-to-buttock distance (HBD) was measured to detect potential loss of muscle size or reduced flexibility, primarily of the quadriceps [37]. The examiner passively bended their knee and used a meter tape, to measure the HBD increase in cm (Figure 4).…”

“…The patient then rotates his knee and body both internally and externally three times, keeping the knee in slight flexion at 5°. The same testing procedure is then repeated with the patient maintaining the knee in greater flexion Heel-to-buttock distance (HBD) was measured to detect potential loss of muscle size or reduced flexibility, primarily of the quadriceps [37]. The examiner passively bended their knee and used a meter tape, to measure the HBD increase in cm (Figure 4).…”