What did the study look at?
The quadriceps tendon is part of the system that straightens the knee (extension) and attaches at its lower end to the kneecap (patella). The authors note that ruptures of this tendon are rare (around 1 per 100,000 people per year), are markedly more common in men, and are seen particularly as a complication after total knee replacement.
When the tendon tears again, muscle wasting, loss of bone stock and complex retracted tendon defects can develop, which make revision repair difficult. The article aims to show how a re-revision repair with vastus muscle advancement is carried out in such a difficult situation.
How was it done?
The patient was a 71-year-old man who had undergone a quadriceps tendon repair 5 months earlier and a revision using an Achilles tendon allograft (donor tissue) 3 months earlier. He presented with marked loss of movement, difficulty walking and weakness of the right knee, and was walking with a walker and a hinged knee brace. X-rays showed a preserved joint space and no fracture, but a reduced patellar height. MRI showed a retracted quadriceps tendon and an avulsed Achilles allograft.
The main surgical steps were:
- Releasing adhesions and fibrotic tissue around the vastus muscles and tendon, and removing sutures and anchors from the previous operation.
- Measuring the gap and performing a V-Y quadricepsplasty at twice the gap length (or the available tendon length if shorter), so that the tendon could be advanced downwards.
- Placing two 5.5-mm bio-composite anchors at the upper pole of the kneecap, one medial and one lateral, and passing the anchor sutures through the tendon in a Krackow configuration.
- Covering the repair again with the Achilles allograft left from the previous operation.
What did it find?
The patient's postoperative outcome is not reported in figures in this publication. The postoperative plan included ice straight away, weight-bearing as tolerated and a brace locked in full extension until the first visit. Physiotherapy exercises were to start after one day, with the aim of reaching full extension and 90° of flexion within 6 to 8 weeks.
The authors cite the literature: early case reports of revision quadriceps repair have described good to excellent functional results and a painless return to sport, and a recent systematic review showed a low revision rate and successful return to daily activities.
The authors' conclusion
The authors state that although early studies report favourable outcomes with current repair techniques, there is a lack of good-quality literature on outcomes after primary or revision quadriceps repair. They stress that further studies are needed to establish the reliability, efficacy and clinical outcomes of this procedure.
Limitations
The overall quality of the studies in the systematic review the authors cite is low, and data on chronic cases in particular are limited. This publication is itself a technique description based on a single patient and does not report long-term results.
Reference
Vadhera AS, Gürsoy S, Sivasundaram L, Lee JS, Singh H, Bunachita S, Chahla J. (2023). Case Presentation: Re-revision Quad Tendon Repair and Vastus Advancement. Video Journal of Sports Medicine, 3(4), 26350254231177390. Licence: CC BY-NC-ND 4.0.
DOI: 10.1177/26350254231177390
Free full text: PMC11962180
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
