EFFECTIVENESS OF A SUTURE BRIDGE TECHNIQUE FOR REPAIR OF QUADRICEPS TENDON RUPTURE IN UEAEMIC PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUOZhen ¹ , ZHAODewei ² ,  LIUYupeng ² , WANGWeiming ² , YUXiaobing ² , YUXiaoyong ¹

1. Department of Surgery, Graduate School, Dalian University, Dalian Liaoning, 116622, P. R. China;
2. Department of Orthopedics, Affiliated Zhongshan Hospital, Dalian University;

Corresponding author：

LIUYupeng, Email: lyp9748@163.com

Keywords：

Suture bridge technique; Quadriceps tendon rupture; Uraemia

DOI：

10.7507/1002-1892.20140134

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Objective To investigate the effectiveness of a suture bridge technique for quadriceps tendon rupture repair in uraemic patients. Methods Between March 2010 and September 2012, 10 uraemic patients (14 sides) with quadriceps tendon rupture were treated with the suture bridge technique. Of them, 8 were male and 2 were female, aged from 30 to 62 years (mean, 54.2 years). The duration of uremia was 3-11 years (mean, 5.5 years);the duration of quadriceps tendon rupture was 5 days to 2 months (median, 12 days). Six cases had a trauma history, and one case had diabetes. The left side was involved in 2 cases, the right side in 4 cases, and both sides in 4 cases. The active range of motion (ROM) of the knees was (115.0±8.3)°in flexion, and (72.5±21.2)°in extension. Lysholm score was 19.5±16.3. X-ray films showed downward shifting of patella. MRI revealed discontinuity between distal quadriceps tendon and upper pole of patella. Results The operation time was 30-50 minutes (mean, 40.3 minutes). Primary healing of incision was obtained in all patients without complications. All patients were followed up 12-25 months (mean, 16.3 months). There was no re-rupture of quadriceps tendon or loosening of internal fixation during follow-up. At last follow-up, the active ROM of the knees was (121.0±7.9)°in flexion, showing no significant difference when compared with preoperative one (t=-2.075, P=0.058); the active ROM was (8.2±6.1)°in extension, showing significant difference when compared with preoperative one (t=11.702, P=0.000). Lysholm score was 84.6±12.4, showing significant difference when compared with preoperative score (t=-16.226, P=0.000). According to the American Knee Society score (KSS), the results were excellent in 4 sides, good in 9 sides, and fair in 1 side, and the total excellent and good rate was 92.9%. At last follow-up, the active ROM of the knee, Lysholm score, and KSS score were significantly better in young patients (<45 years) than in elder patients (≥45 years), and in patients receiving early operation (<2 weeks) than in patients receiving late operation (≥2 weeks) (P<0.05). Conclusion For fewer traumas and early functional exercise after operation, the suture bridge technique benefits functional restoration of knee joint in uraemic patients. Operation chance and age seem to be important factors to the results. Early operation should be considered when quadriceps tendon ruptured.

Citation： LUOZhen, ZHAODewei, LIUYupeng, WANGWeiming, YUXiaobing, YUXiaoyong. EFFECTIVENESS OF A SUTURE BRIDGE TECHNIQUE FOR REPAIR OF QUADRICEPS TENDON RUPTURE IN UEAEMIC PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 601-605. doi: 10.7507/1002-1892.20140134 Copy

1.	Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury, 2008, 39(12):1338-1344.
2.	Bushnell BD, Whitener GB, Rubright JH, et al. The use of suture anchors to repair the ruptured quadriceps tendon. J Orthop Trauma, 2007, 21(6):407-413.
3.	Richards DP, Barber FA. Repair of quadriceps tendon ruptures using suture anchors. Arthroscopy, 2002, 18(5):556-559.
4.	Kim TW, Kamath AF, Israelite CL. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty. J Arthroplasty, 2011, 26(5):817-820.
5.	Hart ND, Wallace MK, Scovell JF, et al. Quadriceps tendon rupture:a biomechanical comparison of transosseous equivalent double-row suture anchor versus transosseous tunnel repair. J Knee Surg, 2012, 25(4):335-339.
6.	Neubauer T, Wagner M, Potschka T, et al. Bilateral, simultaneous rupture of the quadriceps tendon:a diagnostic pitfall? Report of three cases and meta-analysis of the literature. Knee Surg Sports Traumatol Arthrosc, 2007, 15(1):43-53.
7.	Masonis JL, Frick SL. Bilateral quadriceps tendon rupture as the initial presentation of amyloidosis. Orthopedics, 2001, 24(10):995-996.
8.	Shiota E, Tsuchiya K, Yamaoka K, et al. Spontaneous major tendon ruptures in patients receiving long-term hemodialysis. Clin Orthop Relat Res, 2002, (394):236-242.
9.	施卫东, 高懋峰, 刘凌, 等. 尿毒症并发双侧股四头肌肌腱断裂一例报告. 中华骨科杂志, 2012, 32(6):604-605.
10.	Seth AK, De la Garza M, Fang RC, et al. Excisional wound healing is delayed in a murine model of chronic kidney disease. PLoS One, 2013, 8(3):e59979.
11.	Jourde-Chiche N, Dou L, Cerini C, et al. Vascular incompetence in dialysis patients-protein-bound uremic toxins and endothelial dysfunction. Semin Dial, 2011, 24(3):327-337.
12.	O'Shea K, Kenny P, Donovan J, et al. Outcomes following quadriceps tendon ruptures. Injury, 2002, 33(3):257-260.
13.	Muratli HH, Celebi L, Hapa O, et al. Simultaneous rupture of the quadriceps tendon and contralateral patellar tendon in a patient with chronic renal failure. J Orthop Sci, 2005, 10(2):227-232.
14.	Memisuglu K, Atmaca H, Sarman H, et al. Delayed reconstruction of quadriceps tendon rupture with Endobutton^®:a new technique. Eur J Orthop Surg Traumatol, 2011, 21(5):371-374.
15.	Taylor CJ, Bansal R, Pimpalnerkar A. Acute distal biceps tendon rupture-a new surgical technique using a de-tensioning suture to brachialis. Injury, 2006, 37(9):838-842.
16.	Langenhan R, Baumann M, Ricart P, et al. Postoperative functional rehabilitation after repair of quadriceps tendon ruptures:a comparison of two different protocols. Knee Surg Sports Traumatol Arthrosc, 2012, 20(11):2275-2278.
17.	Peltz CD, Dourte LM, Kuntz AF, et al. The effect of postoperative passive motion on rotator cuff healing in a rat model. J Bone Joint Surg (Am), 2009, 91(10):2421-2429.
18.	Heller A, Westphal SE, Bartsch P, et al. Chronic kidney disease is associated with high abdominal incisional hernia rates and wound healing disturbances. Int Urol Nephrol, 2013.[Epub ahead of print].

1. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury, 2008, 39(12):1338-1344.
2. Bushnell BD, Whitener GB, Rubright JH, et al. The use of suture anchors to repair the ruptured quadriceps tendon. J Orthop Trauma, 2007, 21(6):407-413.
3. Richards DP, Barber FA. Repair of quadriceps tendon ruptures using suture anchors. Arthroscopy, 2002, 18(5):556-559.
4. Kim TW, Kamath AF, Israelite CL. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty. J Arthroplasty, 2011, 26(5):817-820.
5. Hart ND, Wallace MK, Scovell JF, et al. Quadriceps tendon rupture:a biomechanical comparison of transosseous equivalent double-row suture anchor versus transosseous tunnel repair. J Knee Surg, 2012, 25(4):335-339.
6. Neubauer T, Wagner M, Potschka T, et al. Bilateral, simultaneous rupture of the quadriceps tendon:a diagnostic pitfall? Report of three cases and meta-analysis of the literature. Knee Surg Sports Traumatol Arthrosc, 2007, 15(1):43-53.
7. Masonis JL, Frick SL. Bilateral quadriceps tendon rupture as the initial presentation of amyloidosis. Orthopedics, 2001, 24(10):995-996.
8. Shiota E, Tsuchiya K, Yamaoka K, et al. Spontaneous major tendon ruptures in patients receiving long-term hemodialysis. Clin Orthop Relat Res, 2002, (394):236-242.
9. 施卫东, 高懋峰, 刘凌, 等. 尿毒症并发双侧股四头肌肌腱断裂一例报告. 中华骨科杂志, 2012, 32(6):604-605.
10. Seth AK, De la Garza M, Fang RC, et al. Excisional wound healing is delayed in a murine model of chronic kidney disease. PLoS One, 2013, 8(3):e59979.
11. Jourde-Chiche N, Dou L, Cerini C, et al. Vascular incompetence in dialysis patients-protein-bound uremic toxins and endothelial dysfunction. Semin Dial, 2011, 24(3):327-337.
12. O'Shea K, Kenny P, Donovan J, et al. Outcomes following quadriceps tendon ruptures. Injury, 2002, 33(3):257-260.
13. Muratli HH, Celebi L, Hapa O, et al. Simultaneous rupture of the quadriceps tendon and contralateral patellar tendon in a patient with chronic renal failure. J Orthop Sci, 2005, 10(2):227-232.
14. Memisuglu K, Atmaca H, Sarman H, et al. Delayed reconstruction of quadriceps tendon rupture with Endobutton^®:a new technique. Eur J Orthop Surg Traumatol, 2011, 21(5):371-374.
15. Taylor CJ, Bansal R, Pimpalnerkar A. Acute distal biceps tendon rupture-a new surgical technique using a de-tensioning suture to brachialis. Injury, 2006, 37(9):838-842.
16. Langenhan R, Baumann M, Ricart P, et al. Postoperative functional rehabilitation after repair of quadriceps tendon ruptures:a comparison of two different protocols. Knee Surg Sports Traumatol Arthrosc, 2012, 20(11):2275-2278.
17. Peltz CD, Dourte LM, Kuntz AF, et al. The effect of postoperative passive motion on rotator cuff healing in a rat model. J Bone Joint Surg (Am), 2009, 91(10):2421-2429.
18. Heller A, Westphal SE, Bartsch P, et al. Chronic kidney disease is associated with high abdominal incisional hernia rates and wound healing disturbances. Int Urol Nephrol, 2013.[Epub ahead of print].

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF A SUTURE BRIDGE TECHNIQUE FOR REPAIR OF QUADRICEPS TENDON RUPTURE IN UEAEMIC PATIENTS

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