Surgical Treatment of Neglected Traumatic Quadriceps Tendon Rupture with Knee Ankylosis

Abstract

Quadriceps tendon rupture is an uncommon injury. This disabling condition is the result of direct or indirect trauma. It requires surgical repair to avoid poor outcomes in cases of neglected or chronic rupture. In most acute cases, simple tendon suture or reinsertion is suitable for an extensor mechanism reconstruction of the knee joint. However, chronic lesions often require a tendon graft or flap reconstruction. We report a case of a 15-year-old male who was diagnosed with a chronic quadriceps rupture with a patellar superior pole fracture. We performed quadriceps reconstruction using tibialis anterior allograft tendon and additional screw fixation to reconstruct the extensor mechanism and recover knee joint range of motion to prevent a high-level functional restriction. The treatment was difficult and limited due to neglect for 9-months that led to ankylosis accompanied with nonunion of tibial fracture. Our surgical treatment using allograft tendon resulted in a very good outcome after 30 months of follow-up.

Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

“…(2014) Hassani et al 1 M 32 Common fall 60 days Full thickness of the QT at the osteo-tendinous junction with retraction of 3 cm + calcifications Chronic renal failure, with hemodialysis dependence for 5 years Codivilla’s Y/V technique None [ 22 ] Bilateral extensor mechanism allograft reconstruction for chronic spontaneous rupture: a case report and review of the literature. (2019) Lamberti et al 1 F 51 Acute failure of the left knee while getting up from a chair 480 days Full-thickness lesion on the left QT End-stage renal failure + full-thickness lesion on the right patellar tendon A full extensor mechanism allograft None [ 36 ] Surgical treatment of neglected traumatic quadriceps tendon rupture with knee ankylosis. (2016) Lee et al 1 M 15 Motorcycle accident 270 days Chronic QT rupture + a patellar superior pole avulsion fracture of the left knee + nonunion of the left proximal tibia fracture Open fracture of the left femur shaft + an intra-articular fracture of the proximal tibia QT reconstruction using tibialis anterior allograft and additional screw fixation None [ 17 ] Reconstruction of a chronic quadriceps tendon tear in a body builder.…”

“…(2014) Hassani et al 1 M 32 CKD with hemodialysis dependence for 5 years [ 22 ] Bilateral extensor mechanism allograft reconstruction for chronic spontaneous rupture: a case report and review of the literature. (2019) Lamberti et al 1 F 51 End-stage CKD [ 36 ] Surgical treatment of neglected traumatic quadriceps tendon rupture with knee ankylosis. (2016) Lee et al 1 M 15 Open fracture of the left femur shaft, intra-articular fracture of the proximal tibia [ 17 ] Reconstruction of a chronic quadriceps tendon tear in a body builder.…”

“…Complete extensor-mechanism allografting was performed in two patients (2%), with no extension lag, full active extension, and no further complications except for a skin ulcer in one case [ 22 , 35 ]. One patient (1%) was treated with a tibialis anterior allograft, showing good functional results at the latest follow-up [ 36 ]. Furthermore, 35 patients (36%) with a complete QTR after TKA underwent synthetic mesh tendon reconstruction, but reported nine re-ruptures, of which five required a MESH revision and 2 developed a deep infection [ 37 , 38 ].…”

“…(2018) Piatek et al 1 M 51 90 days Fig. 7 Tibialis anterior [ 36 ] Surgical treatment of neglected traumatic quadriceps tendon rupture with knee ankylosis. (2016) Lee et al 1 M 15 270 days Synthetic mesh [ 37 ] Extensor mechanism reconstruction with use of Marlex Mesh.…”

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

“…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][7][8][9][10][11][12][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 Similar to PRP, PLX-PAD cells have rich immunomodulatory and angiogenic capacities, which have previously been shown to increase muscle volume and strength after iatrogenic muscle injury 16 and to improve blood flow in critical limb ischemia and peripheral artery disease.…”