CASE REPORTS   

Panminerva Medica 2000 September;42(3):223-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

A new method of repair for quadriceps tendon ruptures. A case report

Maniscalco P., Bertone C., Rivera F., Bocchi L.

From the Istituto di Scienze Ortopedico-Traumatologiche e Riabilitative Università degli Studi, Siena, Italy

Rupture of the quad­ri­ceps ten­don is an uncom­mon inju­ry ­observed pre­dom­i­nant­ly in sub­jects ­over 40 ­years old. Multiple sur­gi­cal tech­niques ­have ­been ­employed to ­repair ­fresh and neglect­ed rup­tures; meth­ods ­that ­make use of allo­graft and aug­men­ta­tion ­with tis­sues har­vest­ed ­from ­around the ­knee ­have ­been report­ed. We ­describe a ­case of sur­gi­cal ­repair of a ten­don-­bone junc­tion rup­ture in a 64-­year-old ­patient by use of ­suture ­anchors to ­attach the ten­don to ­bone and ­improve fix­a­tion of the ­soft tis­sue ele­ments. Clinical diag­no­sis of rup­ture was con­firmed radio­graph­i­cal­ly and ech­o­graph­i­cal­ly. Surgical ­repair was per­formed with­in 24 ­hours of inju­ry. Active move­ment of the ­knee start­ed ­after 3 ­weeks and the ­patient was per­mit­ted to ­walk with­out ­weight-bear­ing ­with a ­knee ­cage. Three ­weeks lat­er, he was per­mit­ted to ­walk ­with ­full ­weight-bear­ing unas­sist­ed by crutch­es; the ­knee ­cage was ­removed 6 ­weeks ­after sur­gery. At his ­most ­recent fol­low-up 24 ­months post­op­er­a­tive, quad­ri­ceps ­strength was ­equal to ­that of the con­tro­lat­er­al ­knee and the ­patient has ­returned to ­sports and dai­ly activ­ities. The sur­gi­cal meth­od pre­sent­ed ­here pro­vides a ­suture of the ten­don ­ends with­out put­ting ­excess ­stress on the ­suture ­line dur­ing the peri­od of ear­ly ­knee mobil­iza­tion. Advantages ­over oth­er tech­niques ­include ­reduced oper­a­tive ­time, ­easy ­access to the implan­ta­tion ­site, and bet­ter resis­tance of the ­suture mate­ri­al: the ­patient is ­thus ­able to ­initiate phys­i­cal ther­a­py ear­li­er and ­more aggres­sive­ly.