ReviewClinical outcomes after repair of quadriceps tendon rupture: A systematic review
Introduction
Quadriceps tendon rupture (QTR) is a relative uncommon injury with an incidence of 1.37/100,000 patients per year, affecting predominantly middle aged males (M:F = 4.2:1, mean age: 51.1 years).1 This disabling condition is the result of direct or indirect trauma.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 Spontaneous ruptures, even sometimes bilaterally, have been reported in people with predisposing conditions such as chronic renal failure, rheumatoid arthritis, diabetes, gout, steroids abuse and other conditions13 or in healthy subjects during sporting activity.14 In case of traumatic injury, indirect and violent eccentric contraction is the most frequent cause of QTR.15 Patients usually report the experience of an intense pain felt during attempts to regain balance while avoiding a fall.15 Clinical history and physical examination usually suffice for the diagnosis of QTR. The clinical diagnostic triad includes: acute pain, inability to active extend the knee and a palpable suprapatellar gap.16 In case of a suspected tendon rupture, radiological investigations, such as ultrasound scan or MRI are used to confirm the diagnosis.17
QTR requires a prompt surgical repair to avoid poor outcomes previously reported in neglected or chronic ruptures.15, 18 Many surgical techniques have been described in the literature15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 to repair QTR, but no studies have been published to the best of our knowledge to compare the outcome of the different techniques.
The aim of this review therefore is to analyze the available evidence regarding the effectiveness of different techniques for the surgical repair of complete traumatic QTR, and to evaluate the potential influence of the timing of surgery on the functional outcome.
Section snippets
Materials and methods
All the studies dealing with quadriceps tendon rupture management, performed on adult patients (more than 16 years old), with a minimum follow-up of 12 months, published in a peer-reviewed journal in English language, within the last 25 years were eligible for inclusion. Case reports, biomechanical, animal or cadaveric studies, literature reviews, technical notes, letters to editor, editorials and instructional course lectures were excluded. An Internet-based search of the MEDLINE, EMBASE and
Features of the included studies and Coleman Methodology Score
The literature search yielded 474 studies and out of potentially 34 articles that were relevant to the objectives of this study, 1216, 18, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 met the inclusion criteria. All the included studies were retrospective cohort studies published from 198116 to 2008.24 The mean CMS was 50.46 (range: 3328 to 7224). The lowest scores reported were relevant to the type of study (0 for every study) and the study size (mean: 3, ranging from 023, 28, 29 to 718) (Table 1,
Discussion
Quadriceps tendon is a very strong structure contributing to the extensor mechanism of the knee. The structural and biomechanical properties of the quadriceps tendon allow it to sustain very high loads without rupture.30 The tendon tissue response to loads consists of three phases33: the first phase or the “toe” phase, in which the initial deformation, till 2% of load, depends only on flattening of the crimp pattern of collagen fibres. Beyond this point and up to 4% of the strain, tendon
Conflict of interest
None to declare.
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