Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.
Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy.
J Orthop Surg Res. 2021 Sep 4;16(1):547. doi: 10.1186/s13018-021-02696-9.
Chronic ruptures, ruptures following total knee arthroplasty (TKA), and re-ruptures of the quadriceps tendon (QT) are rare. A systematic review of the current literature was conducted on their treatment and outcome to provide evidence-based indications for their management.
We searched published articles in English on chronic ruptures of QT, QT ruptures that occurred after TKA, and re-ruptures in PubMed, Scopus, and Google Scholar up to January 2021. Twenty-five articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Data from 25 articles (97 patients) with a mean age of 57 were retrieved. Patients were classified into three groups depending on the type of rupture: 16 patients suffered chronic QTR, 78 a QTR after a TKA, and 9 patients reported a re-rupture. The most frequent surgical approaches were different for each group: Codivilla's Y-V technique and end-to-end sutures were the most commonly used in the chronic tears group (62.5%), synthetic MESH was the most frequent choice in QTR after a TKA group (38 patients, 53%), while end-to-end sutures were the first choice in the re-rupture group (4 patients, 44%).
Complex ruptures of the QT can be chronic ruptures, re-ruptures, or ruptures occurring after TKA. The choice of the best surgical technique depends on the macroscopic quality of the tendon stumps rather than the timing of intervention. Evidence-based preventive and therapeutic strategies should be developed.
慢性撕裂、全膝关节置换术后（TKA）后的撕裂和股四头肌肌腱（QT）的再撕裂较为罕见。我们对其治疗和结果进行了系统的文献回顾，以提供其管理的循证指征。
我们在 PubMed、Scopus 和 Google Scholar 上搜索了截至 2021 年 1 月发表的关于 QT 慢性撕裂、TKA 后 QT 撕裂和再撕裂的英文文献，并按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了筛选。
从 25 篇文章中（97 例患者）提取了数据，平均年龄为 57 岁。根据撕裂类型，患者被分为三组：16 例慢性 QTR，78 例 TKA 后 QTR，9 例报告再撕裂。每种类型的撕裂最常采用的手术方法也不同：Codivilla 的 Y-V 技术和端对端缝合是慢性撕裂组最常用的方法（62.5%），TKA 后 QTR 组最常使用合成 MESH（38 例，53%），而端对端缝合是再撕裂组的首选方法（4 例，44%）。
QT 的复杂撕裂可表现为慢性撕裂、再撕裂或 TKA 后撕裂。最佳手术技术的选择取决于肌腱残端的宏观质量，而不是干预时间。应制定基于证据的预防和治疗策略。
