Lee Dennis, Stinner Daniel, Mir Hassan
Division of Orthopedic Trauma, Department of Orthopedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.
J Knee Surg. 2013 Oct;26(5):301-8. doi: 10.1055/s-0033-1353989. Epub 2013 Aug 16.
The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasound and magnetic resonance imaging when the work-up is equivocal further aids diagnosis; however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears and disruptions following total knee arthroplasty are special cases requiring reconstructions with allograft, synthetic mesh, or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, knee stiffness, and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair.
股四头肌和髌腱断裂的诊断需要高度的怀疑指数和全面的病史采集，以评估可能使患者易患肌腱退变的内科合并症。当检查结果不明确时，通过X线平片进行影像学评估，并辅以超声和磁共振成像，有助于进一步诊断；然而，对于有功能性伸膝机制缺陷的患者，通常无需进行高级影像学检查。急性修复是首选方法，当肌腱在髌骨附着处断裂时，经髌骨骨隧道是主要的固定方式，是否进行增强固定取决于外科医生的偏好。全膝关节置换术后的慢性撕裂和断裂是特殊情况，需要使用同种异体移植物、合成网片或自体移植物进行重建。康复方案通常允许在膝关节伸直锁定并借助拐杖支撑的情况下立即负重。早期开始有限弧度的活动，进行主动屈曲和被动伸展，然后逐渐进展，随后进行全范围的主动活动和强化训练。并发症较少，但包括股四头肌萎缩、膝关节僵硬和再断裂。如果进行急性修复，效果极佳，而延迟修复则与较差的结果相关。
