Lutnick Ellen, Puertas Sophia, Anders Mark
Department of Orthopaedic Surgery and Sports Medicine, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203, United States of America.
Trauma Case Rep. 2025 Jan 4;55:101132. doi: 10.1016/j.tcr.2025.101132. eCollection 2025 Feb.
Revision quadriceps tendon repair is a challenging problem. In this four-case series, novel quadriceps tendon revision resulted in improved range of motion and durable repair for patients with recurrent rupture.
Our technique includes a combination of a running locked #5 FiberWire or 2 mm SutureTape suture placed through parallel medial, lateral, and central drill holes in the patella with running Krackow-type quadriceps tendon repair medially and laterally resulting in four strands, delivering the vastus medialis and medial quadriceps tendon to an anatomic repair at the superior pole of the patella, with 2 sutures passed centrally and 1 each passed medially and laterally and then tied. Reinforcement is performed using a tibialis anterior tendon allograft with placement at the inferior pole of the patella starting superolaterally coursing lateral to medial through infrapatellar tendon. It is then threaded medially into the centrally repaired portion of the quadriceps tendon, and then back down to the lateral suprapatellar and lateral patellar retinaculum, giving three crossing strands. This is repaired with multiple interrupted 0 Vicryl mattress sutures. Immobilization postoperatively was dictated by patient's body habitus.
Patient 1 was a 79-year-old obese man treated after two prior revision periprosthetic quadriceps repair procedures. He was immobilized in a knee immobilizer for 8 weeks postoperatively. He was revised for TKA instability at 6 months postoperatively, and one month later returned to the operating room for persistent hematoma; repair was noted to be intact. Patient 2 was a 39-year-old morbidly obese man who was revised after failure of one revision quadriceps repair. He was protected with an external fixator for 6 weeks. Patient 3 was a 49-year-old obese man who was treated with four revision quadriceps repair procedures over the course of 15 years. Postoperatively he was treated with a knee immobilizer. Patient 4 was a 71-year-old obese man who was treated after failure of one prior revision quadriceps repair procedure. He was casted postoperatively for one month. On final follow up, all patients were able to maintain straight leg raise, with functional range of motion and ambulation.
Revision quadriceps tendon repair using an anterior tibialis tendon allograft is a viable solution for obese patients with recurrent quadriceps tendon ruptures.
股四头肌肌腱翻修修复是一个具有挑战性的问题。在这个包含四个病例的系列研究中，新型股四头肌肌腱翻修术使复发性破裂患者的活动范围得到改善，修复效果持久。
我们的技术包括将一根连续锁定的#5 FiberWire缝线或2毫米的缝合带缝线通过髌骨上平行的内侧、外侧和中央钻孔置入，同时在内侧和外侧进行连续的Krackow式股四头肌肌腱修复，形成四股缝线，将股内侧肌和股四头肌肌腱送至髌骨上极进行解剖修复，中央穿过2根缝线，内侧和外侧各穿过1根缝线，然后打结。使用胫骨前肌腱同种异体移植物进行加强，移植物置于髌骨下极，从髌骨上外侧开始，向内侧穿过髌下肌腱。然后将其从内侧穿入股四头肌肌腱的中央修复部分，再回到髌骨上外侧和髌外侧支持带，形成三股交叉缝线。用多根间断的0号薇乔褥式缝线进行修复。术后固定根据患者的身体状况而定。
患者1是一名79岁的肥胖男性，此前接受过两次假体周围股四头肌修复翻修手术。术后他使用膝关节固定器固定了8周。术后6个月因全膝关节置换术不稳定进行了翻修，1个月后因持续血肿再次返回手术室；修复处完好无损。患者2是一名39岁的病态肥胖男性，在一次股四头肌修复翻修失败后接受了翻修。他使用外固定器保护了6周。患者3是一名49岁的肥胖男性，在15年的时间里接受了四次股四头肌修复翻修手术。术后他使用膝关节固定器进行治疗。患者4是一名71岁的肥胖男性，在一次股四头肌修复翻修手术失败后接受了治疗。术后他用石膏固定了1个月。在最后随访时，所有患者都能够保持直腿抬高，具有功能性活动范围和行走能力。
对于复发性股四头肌肌腱断裂的肥胖患者，使用胫骨前肌腱同种异体移植物进行股四头肌肌腱翻修修复是一种可行的解决方案。
