Arras Christian, Krause Matthias, Frosch Karl-Heinz
Z Orthop Unfall. 2025 Apr;163(2):181-194. doi: 10.1055/a-2491-0972. Epub 2025 Mar 25.
The vascularity of the quadriceps tendon influences the risk of tendon rupture. Quadriceps and patellar tendon ruptures are rare but serious injuries, with an incidence of 1.37/100000 and 0.68/100000, respectively. Risk factors include age, degeneration, and systemic diseases such as kidney disease and rheumatoid arthritis. While quadriceps tendon ruptures predominantly affect people over 50, patellar tendon ruptures are more common in younger, physically active people, often with pre-existing tendon pathologies. The most common mechanism of rupture of the quadriceps tendon is indirect trauma, typically caused by sudden eccentric loading or reflexive contraction, with degeneration of the tendon tissue being a predisposing factor. Diagnosis is primarily clinical, supported by imaging modalities such as ultrasound and MRI. Treatment options depend on the severity of the tear. Partial ruptures can often be managed conservatively, whereas complete ruptures require surgical repair, typically by transosseous suture or fixation with bone anchors or transosseous sutures. Early functional rehabilitation is essential for optimal recovery. The prognosis is generally favorable with early treatment, although complications such as quadriceps atrophy and flexion deficits may occur. Proper documentation of the mechanism of injury and histopathological evaluation of the tendon tissue are important to determine the underlying cause and ensure appropriate insurance coverage.
股四头肌肌腱的血管分布会影响肌腱断裂的风险。股四头肌和髌腱断裂虽罕见但后果严重,发病率分别为1.37/100000和0.68/100000。风险因素包括年龄、退变以及肾病和类风湿关节炎等全身性疾病。股四头肌肌腱断裂主要影响50岁以上人群,而髌腱断裂在年轻、身体活跃的人群中更为常见,这些人往往已有肌腱病变。股四头肌肌腱断裂最常见的机制是间接创伤,通常由突然的离心负荷或反射性收缩引起,肌腱组织退变是一个诱发因素。诊断主要依靠临床判断,并借助超声和MRI等影像学手段辅助。治疗方案取决于撕裂的严重程度。部分撕裂通常可采用保守治疗,而完全断裂则需要手术修复,一般通过经骨缝合或使用骨锚或经骨缝线固定。早期功能康复对于实现最佳恢复至关重要。尽管可能会出现股四头肌萎缩和屈曲功能障碍等并发症,但早期治疗的预后通常良好。准确记录损伤机制以及对肌腱组织进行组织病理学评估,对于确定潜在病因和确保获得适当的保险赔付非常重要。