Vadhera Amar S, Gursoy Safa, Sivasundaram Lakshman, Lee Jonathan S, Singh Harsh, Bunachita Sean, Chahla Jorge
Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.
Midwest Orthopaedics at Rush, LLC, Chicago, Illinois, USA.
Video J Sports Med. 2023 Jul 21;3(4):26350254231177390. doi: 10.1177/26350254231177390. eCollection 2023 Jul-Aug.
The quadriceps tendon is crucial in allowing knee extension, attaching distally to the patella. While ruptures of the tendon are rare, retear can lead to muscle atrophy and complex tendon deficits with retraction which may make revision repairs difficult to perform. To avoid re-rupture, the repair is commonly augmented with an allograft or autograft, theoretically strengthening the repair.
Patients are indicated for surgery when presenting with a chronic, symptomatic quadriceps rupture verified on provocative testing and advanced imaging.
Adhesions and fibrotic tissues around the vastus muscles and tendon are released. Sutures and anchor materials from the previous reconstruction are removed. Fibrotic tissues at the distal end of the retracted quad tendon are removed. The tendon is then loosened from the proximal aspect with the applied traction through the suspension suture placed distal to the tendon. The gap is measured and a V-Y quadricepsplasty was performed at twice the length of the measured gap. In the proximal aspect of the tendon, the limbs of the V-plasty are left incomplete. Next, traction is applied to allow for a tightening exertion to the patella. The proximal Y limb is sutured together in a side-to-side fashion to allow for tendon distalization while retaining the distal traction of the patellar tendon. The medial and lateral limbs were then closed with a suture, completing the tendon advancement. Fibrotic tissues around the superior pole of the patella are removed to prepare for tendon reattachment. Two anchors on the medial and lateral sides are placed, and the suture threads from both anchors are tied in a Krackow configuration. The medial and lateral-sided suture knots are then tied together over the tendon and covered again with the Achilles allograft, completing the repair.
Outcomes of revision quadriceps repair have been promising, with good to excellent functional outcomes, successful return to activities, and objective outcomes.
DISCUSSION/CONCLUSION: Although initial studies report favorable outcomes following current repair techniques, there is a lack of quality literature on outcomes following primary or revision quadriceps repair. Future studies are necessary to determine the reliability, efficacy, and clinical outcomes following this procedure.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
股四头肌肌腱对于实现膝关节伸展至关重要，其远端附着于髌骨。虽然该肌腱断裂较为罕见，但再次撕裂可导致肌肉萎缩和肌腱回缩引起的复杂肌腱缺损，这可能使翻修修复手术难以实施。为避免再次断裂，修复通常采用同种异体移植物或自体移植物增强，理论上可加强修复效果。
经激发试验和先进影像学检查证实为慢性、有症状的股四头肌断裂的患者适合手术。
松解股四头肌和肌腱周围的粘连及纤维化组织。移除先前重建时使用的缝线和锚定材料。切除回缩股四头肌远端的纤维化组织。然后通过置于肌腱远端的悬吊缝线施加牵引力，从近端松解肌腱。测量间隙，并进行长度为测量间隙两倍的V-Y股四头肌成形术。在肌腱近端，V形成形术的分支不完整。接下来，施加牵引力以使髌骨得到收紧。近端Y形分支以侧对侧方式缝合在一起，以使肌腱向远端移位，同时保持髌腱的远端牵引力。然后用缝线闭合内侧和外侧分支，完成肌腱推进。切除髌骨上极周围的纤维化组织，为肌腱重新附着做准备。在内侧和外侧放置两个锚定物，两个锚定物的缝线以Krackow方式打结。然后将内侧和外侧的缝线结在肌腱上方系在一起，并用跟腱同种异体移植物再次覆盖，完成修复。
股四头肌翻修修复的结果令人鼓舞，功能结果良好至优秀，成功恢复活动，且有客观结果。
讨论/结论：尽管初步研究报告了当前修复技术后的良好结果，但关于初次或翻修股四头肌修复后的结果，缺乏高质量文献。未来有必要进行研究以确定该手术的可靠性、疗效和临床结果。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本投稿发表包含患者发布声明或其他书面批准形式。
