DOI: 10.1097/BCO.0b013e3181c7ea2e

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Issn Print: 1940-7041

Publication Date: 2010/05/01


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Acellular dermal graft augmentation in quadriceps tendon rupture repair

Ross M. Wilkins

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Instability of the knee from failure of the extensor mechanism is a debilitating problem. Extensor mechanism failure frequently is the result of patellar tendon rupture, quadriceps tendon rupture, patellar fracture or avulsion of the patellar tendon.1,2 Such failures have been linked to underlying pathologies such as diabetes mellitus, gout, corticosteroid use, autoimmune inflammatory diseases, hyperthyroidism, obesity and end-stage renal disease.3–8 Often, the treatment of this problem is compounded by the presence of a total knee arthroplasty (TKA) or the need for a TKA.7 Depending on the root cause of the instability, there are a variety of ways to treat this soft-tissue insufficiency. Historically, problems of the extensor mechanism have been operatively treated using primary repair, tendon autografts, fascia, extensor mechanism allografts, Achilles tendon allografts, whole patellar allografts and synthetic reinforcing materials.9–14 In acute situations, extensor mechanism failure related to rupture of the patellar tendon or the quadriceps tendon treated operatively and early have yielded satisfactory results.15–19 Unfortunately, in chronic situations, including those involving a TKA, the results have been less satisfactory.1,4,9,14,20,21 Chronic or delayed repair of these tendons is complicated by musculature retraction, fatty infiltration of the tendon, scar tissue formation, muscle atrophy and poor tendon quality from previous surgeries.22–24
Although problems with the extensor mechanism of the knee are not uncommon, there are few reports detailing the effects of treatment with TKA. Furthermore, because of the proximity of tendons and their overall effects on the knee joint, quadriceps and patellar tendon ruptures often are lumped into one category along with other difficulties leading to patellofemoral instability. This generalization of results makes it difficult to isolate the individual effects of treatment on specific tendon tears. The limited data on quadriceps tendon tears is further confounded by misdiagnosis rates reported as high as 38%.6,17 Misdiagnosis of quadriceps tendon rupture has been attributed to palpable tendon gaps eclipsed by swelling and hematoma, nonspecific pain and swelling of the knee indicative of other more frequent soft-tissue maladies such as ligament rupture, partial tears, and the presence of intact medial and lateral patellar retinacula and iliotibial band.19 The purpose of this retrospective review was to describe a “stent” augmentation method for rupture of the quadriceps tendon and evaluate the effects of quadriceps tendon augmentation in both the presence and absence of a TKA.
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