McCormick Frank, Nwachukwu Benedict U, Kim Jaehon, Martin Scott D
Rush Sports Medicine Fellowship Program, Midwest Orthopedics at Rush Sports Medicine, Chicago, Illinois, USA.
Orthopedics. 2013 Apr;36(4):e529-32. doi: 10.3928/01477447-20130327-36.
A paucity of literature exists on quadriceps tendon reruptures. Failed quadriceps tendon repair can cause significant morbidity and disability. Surgical management of quadriceps tendon rerupture can be challenging due to tissue degeneration, tendon retraction, muscle atrophy, and poor bone fixation. A lack of guidance in the literature exists on the appropriate surgical techniques for managing quadriceps tendon reruptures.This article describes the case of a male recreational athlete with a failed primary quadriceps tendon repair who presented 10 months after rerupture. Examination was significant for morbid obesity, assisted ambulation, and a significant defect at the superior pole of the patella on the affected side. Intraoperative findings were consistent with a 2.0- to 4.5-cm tendon defect across the extensor mechanism with complete retinaculi tears. The authors performed a novel surgical approach for revision of quadriceps tears using a bilateral hamstring autograft through a quadriceps tendon weave and a transosseous patellar repair. Tendon length was restored, and extensor mechanism tension was reapproximated. Postoperatively, the patient achieved a good outcome and had returned to full, painless, sport participation at 2-year follow-up.This surgical technique is suitable for revision quadriceps tendon repairs of large tendon gap defects, repairs desiring tendon-to-bone in-growth, and repairs requiring large-force transmission across the repair.
关于股四头肌肌腱再断裂的文献较少。股四头肌肌腱修复失败会导致严重的发病情况和残疾。由于组织退变、肌腱回缩、肌肉萎缩和骨固定不佳，股四头肌肌腱再断裂的手术治疗具有挑战性。文献中缺乏关于处理股四头肌肌腱再断裂的合适手术技术的指导。本文描述了一名男性休闲运动员的病例，其初次股四头肌肌腱修复失败，在再断裂10个月后就诊。检查发现患者存在病态肥胖、需辅助行走，且患侧髌骨上极有明显缺损。术中发现伸肌机制存在2.0至4.5厘米的肌腱缺损，支持带完全撕裂。作者采用了一种新颖的手术方法来修复股四头肌撕裂，即通过股四头肌肌腱编织和经骨髌骨修复使用双侧自体腘绳肌腱。恢复了肌腱长度，并重新调整了伸肌机制的张力。术后，患者取得了良好的效果，在2年随访时已恢复到能完全无痛地参与运动。这种手术技术适用于修复大肌腱间隙缺损的股四头肌肌腱、需要肌腱与骨长入的修复以及需要在修复部位传递大力的修复。
