Total bilateral ruptures of the knee extensor apparatus☆

Seven patients corresponding to 14 extensor tendon ruptures of the knee were evaluated by the same examiner after a minimum one year post-surgery. Clinical and radiographic evaluations were performed; for statistical analysis, the level of significance was set at 0.05.

RESULTS:

The most common injury was patellar tendon rupture (n = 9; 64.29%) followed by quadriceps tendon rupture (n = 5, 35.71%). The intrasubstance was the most affected location (57.15%), followed by the myotendinous junction (21.43%) and the patellar bone insertions (21.43%). Quadriceps tendon ruptures were more prevalent in patients older than 50 years, while patellar tendon ruptures tended to occur in younger individuals. All but one patient had recognized risk factors for tendinous degeneration and rupture: 75% of the cases suffered from diseases, 50% had history of drug use and/or abuse, and 37.5% had both disease and drug use history. Mean attained values for flexion ROM were 124.64° ± 9.43 (110-140°) and 89.57 ± 6.02 (78-94) for Kujala score. More than half of the patients complained of residual pain and quadriceps muscular weakness. Mean age was younger in the individuals who complained of residual pain.

CONCLUSION:

Bilateral tendon ruptures of the knee extensor apparatus ruptures are rare and serious injuries, mostly associated with risk factors. Early surgical repair and intensive rehabilitation program for bilateral extensor tendon ruptures of the knee may warrant satisfactory functional outcomes in the medium to long term, despite non-negligible levels of residual pain, quadriceps muscle weakness, and atrophy.

Keywords:
Knee joint; Tendon injuries; Patellar ligament/injuries; Rupture

Patient	Age at the time of injury	Diagnosis	Rupture location	Rupture timing	Mechanism	Presence of risk factors for rupture of knee tendon extensor apparatus
1 M	35	Right patellar tendon rupture	Intrasubstance	Simultaneous	Knee flexion and sudden contraction of the quadriceps	Yes
		Left patellar tendon rupture	Intrasubstance	Simultaneous	Knee flexion and sudden contraction of the quadriceps	Yes
2 M	40	Right patellar tendon rupture	Intrasubstance	Simultaneous	Knee flexion and sudden contraction of the quadriceps	Yes
		Left patellar tendon rupture	Intrasubstance	Simultaneous	Knee flexion and sudden contraction of the quadriceps	Yes
3 M	45	Right patellar tendon rupture	Intrasubstance	Simultaneous	knee hyperflexion	No
		Left patellar tendon rupture	Intrasubstance	Simultaneous	knee hyperflexion	No
4 M	41	Right quadriceps tendon rupture	Myotendinous junction	Simultaneous	knee hyperflexion	Yes
		Left patellar tendon rupture	Patellar bone insertion	Simultaneous	knee hyperflexion	Yes
5 M	78	Right quadriceps tendon rupture	Patellar bone insertion	Isolated	Excessive rotational movement of the knee	Yes
		Left quadriceps tendon rupture	Patellar bone insertion	Isolated	Excessive rotational movement of the knee	Yes
6 F	36	Right patellar tendon rupture	Intrasubstance	Isolated	Excessive rotational movement of the knee	Yes
		Left patellar tendon rupture	Intrasubstance	Isolated	Excessive rotational movement of the knee	Yes
7 M	50	Right quadriceps tendon rupture	Myotendinous junction	Simultaneous	Knee flexion and sudden contraction of the quadriceps	Yes
		Left quadriceps tendon rupture	Myotendinous junction	Simultaneous	Knee flexion and sudden contraction of the quadriceps	Yes

Patient	Surgical repair	Cerclage protection wire	Immobilization time (days)	Time between injury and surgery (hours)
1 M	End-to-end suture	Yes	45	5
	End-to-end suture	Yes	45	5
2 M	End-to-end suture	No	42	72
	End-to-end suture	No	42	72
3 M	End-to-end suture	Yes	56	96
	End-to-end suture	Yes	56	96
4 M	End-to-end suture	No	42	120
	Tenodesis with suture anchors	Yes	42	120
5 M	Tenodesis with suture anchors	No	70	120
	Tenodesis with suture anchors	No	70	120
6 F	End-to-end suture	No	42	96
	End-to-end suture	No	42	96
7 M	End-to-end suture	No	42	6
	End-to-end suture	No	42	6

Patient	Time between injury and evaluation (years)	Flexion ROM (degrees)	Extension lag (degrees)	Kujala Score	Insall–Salvati ratio	Residual pain	Quadriceps weakness feeling	Quadriceps atrophy	Satisfaction index (0–5)
1 M	1	135	No	94	1.1	Yes	Yes	Yes	4
	1	135	No	94	0.8	Yes	Yes	Yes	4
2 M	8	126	No	88	1.05	Yes	Yes	Yes	4
	8	134	No	88	1.08	Yes	Yes	Yes	4
3 M	7	140	No	78	0.88	No	No	No	5
	7	130	No	78	0.95	No	No	No	5
4 M	4	116	No	94	1	No	No	Yes	5
	4	124	No	94	1	No	No	Yes	5
5 M	8	110	Yes–3	94	0.8	Yes	Yes	No	5
	8	110	No	94	1.1	Yes	Yes	No	5
6 F	4	125	No	85	1.25	Yes	Yes	Yes	5
	4	120	No	85	1.3	Yes	Yes	Yes	5
7 M	5	117	No	94	0.9	No	No	No	5
	5	123	No	94	0.9	No	No	No	5

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: dflmoura@gmail.com (D.L. Moura).

Brasil

Brasil

Total bilateral ruptures of the knee extensor apparatus☆ ☆ Study conducted at the Coimbra University Hospital, Coimbra, Portugal.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Total bilateral ruptures of the knee extensor apparatus^☆ ☆ Study conducted at the Coimbra University Hospital, Coimbra, Portugal.