Quadriceps tendon tear rupture in healthy patients treated with patellar drilling holes: clinical and ultrasonographic analysis after 36 months of follow-up

Abstract

Background: quadriceps tendon subcutaneous rupture is an uncommon injury affecting predominantly middle-aged men as a result of direct or indirect trauma; aim of this work is to evaluate clinical outcome and tendon morphology in patients treated surgically with transpatellar drilling suture. Methods: 20 patients (20 male) with an average age of 54 (42-59) were evaluated with a mean follow-up of 36 months. Measurements of range of motion (ROM) and of tight circumference were collected. Lysholm and Rougraff Score were also performed. All the patients underwent a US evaluation the morphologic changes of the repaired tendon. Results: mean active ROM was 1°-117°; average difference in the circumference of the quadriceps was 2.6% 10 C and 3.3% 15 C. The mean Lysholm Score calculated was 88/100; the mean Rougraff Score 17/25. At ultrasonographic evaluation all tendons were continuous; heterotopic ossification was present in 18 quadriceps tendons. Thickness was augmented in 18 quadriceps tendons and in 5 patellar tendons. Vascularization was always conserved. Lateral subluxation of patella was reported in 1 case. Conclusions: patellar drilling holes repair is a nondemanding procedure, inexpensive and technically uncomplicated. US evaluation confirms tendon healing; tendon remodeling does not affect patient's clinical outcome and quality of life.

Similar Outcomes Are Found Between Quadriceps Tendon Repair With Transosseous Tunnels and Suture Anchors: A Systematic Review and Meta-Analysis

“…Ultimately upon full-text review, there were 24 studies suitable for qualitative analysis (18 clinical, 6 biomechanical), with 4 biomechanical studies for quantitative analysis. 3 , 4 , 6 , 7 , 8 , 9 , 10 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 …”

“… 35 2012 J Orthop Trauma Retrospective case control 3 36 36 0 57.5 NA 34:2 NA NR (1-6.7) NA Verdano et al. 36 2014 Muscles Tendons Ligaments J Retrospective case series 4 20 20 0 54 (42-59) NA 20:0 NA 3 (2.1-4) NA Wenzl et al. 37 2003 Injury Retrospective case series 4 35 30 0 53.3 NA 33:2 NA 4.6 (0.6-14) NA LOE, level of Evidence; NA, not applicable; NR, not reported; SA, suture anchor; SD, standard deviation; TO, transosseous.…”

The effect of quadriceps anatomical factors on patellar stability: A systematic review

“…No studies evaluating the relationship between QT ruptures and patellar instability were found. Gathering data regarding the effect of QT tendon rupture on patellar stability could be hindered by their rarity [24]. Cadaveric studies could help determine the relationship between the degree of QT rupture and the severity of patellar dislocation/instability.…”

“…No studies evaluating the relationship between QT ruptures and patellar instability were found. This could be because quadriceps tendon (QT) rupture has an incidence of only 1.37/100,000 patients per year [24]. Therefore its effects on patellar stability are relatively unknown.…”

Safety and Efficacy of Postoperative Nonsteroidal Anti-inflammatory Drugs in Sports Medicine

“…Another area of interest to sports medicine knee surgeons is the safety and efficacy of NSAIDs around the time of open tendon repairs, such as with the quadriceps or patellar tendon. For quadriceps tendon repairs, heterotopic bone formation is common; this has been reported as high as 90% by Verdano et al 19 in a series of 20 patients. NSAIDs may have a role in postoperative pain control in these patients with the additional benefit of limiting heterotopic bone formation.…”