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Repair of Quadriceps and Patellar Tendon Tears

Published:November 01, 2022DOI:https://doi.org/10.1016/j.arthro.2022.10.034

      Abstract

      Tears of the quadriceps or patellar tendon usually occur after a sudden eccentric contraction and are diagnosed by a palpable gap at the injury site combined with inability to perform a straight leg raise. Bilateral knee radiographs may demonstrate patella alta with patellar tendon tears and patella baja with quadriceps tendon tears when compared to the uninjured knee. Ultrasound and magnetic resonance imaging can be helpful when there is uncertainty in the diagnosis. Surgical treatment is indicated for complete tears and some high-grade partial tears. Nonabsorbable high-strength sutures or suture tape are placed in running locking fashion along the injured tendon and secured to the patella with bone tunnels (i.e. transosseous) or suture anchors. The transosseous technique requires exposure of the length of the patella in order to drill three bone tunnels to shuttle the sutures and tie over either pole of the patella. The suture anchor technique allows for a smaller incision and less soft tissue dissection and may utilize a knotted or knotless technique. Biomechanical testing with load to failure is not statistically different between the transosseous and anchor techniques, although anchors have been shown to have less gap formation at the repair site. Repair augmentation with a graft may be beneficial in mid-substance injuries, chronic tears, and in cases of compromised tissue quality. Rehabilitation can usually be initiated immediately with protected weight bearing in an orthosis, safe-zone knee passive range of motion, and avoidance of active extension. After a period of 6 weeks, rehabilitation can progress with full range of motion and a concentric strengthening program.
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