Danaher Michael, Faucett Scott C, Endres Nathan K, Geeslin Andrew G
Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont, U.S.A.
Centers for Advanced Orthopaedics, Washington, DC, U.S.A.
Arthroscopy. 2023 Feb;39(2):142-144. doi: 10.1016/j.arthro.2022.10.034. Epub 2022 Nov 2.
Tears of the quadriceps or patellar tendon usually occur after a sudden eabccentric contraction and are diagnosed by a palpable gap at the injury site combined with an 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 compared with 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 to drill 3 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 use 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 usually can 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.
股四头肌或髌腱撕裂通常发生在突然的离心收缩之后，通过损伤部位可触及的间隙以及无法进行直腿抬高来诊断。与未受伤的膝关节相比，双侧膝关节X线片可能显示髌腱撕裂时髌骨高位，股四头肌肌腱撕裂时髌骨低位。当诊断存在不确定性时，超声和磁共振成像可能会有帮助。对于完全撕裂和一些高级别、部分撕裂，需要进行手术治疗。不可吸收的高强度缝线或缝合带以连续锁定的方式沿着受伤的肌腱放置，并通过骨隧道（即经骨）或缝合锚固定在髌骨上。经骨技术需要暴露髌骨的长度以钻3个骨隧道来穿梭缝线并在髌骨的任一极打结。缝合锚技术允许较小的切口和较少的软组织分离，并且可以使用打结或无结技术。尽管已证明锚在修复部位形成的间隙较小，但经骨技术和锚技术在失效载荷的生物力学测试上没有统计学差异。在肌腱中部损伤、慢性撕裂以及组织质量受损的情况下，使用移植物进行修复增强可能有益。康复通常可以立即开始，采用矫形器保护下的负重、安全区膝关节被动活动范围以及避免主动伸展。6周后，康复可以进展到全范围活动和同心强化计划。
