Patellar tendon rupture

Classification according to ICD-10
S76.1	Injury to the muscle and tendon of the quadriceps femoris / patellar ligament
ICD-10 online (WHO version 2019)

The patellar tendon rupture is a tear in the tendon between the lower pole of the kneecap ( patella ) and the tibia ( tibial tuberosity ).

causes

Like the tear of the quadriceps tendon , the tear usually comes about as a result of over-tension trauma against resistance or a strong tension in the flexion of the knee joint . The patellar tendon ( ligamentum patellae ) is one of the tendons with the greatest cross-sectional load in the human body due to the relatively small lever between the pivot point of the knee joint and the kneecap . This can reach 1000 kp / cm² and more in heavy people. Patellar tendon ruptures occur more frequently in advanced age when there are degenerative changes, metabolic diseases such as diabetes mellitus or arterial occlusive disease . Bilateral ruptures are also not uncommon due to the previous damage. Antibiotics from the group of fluoroquinolones are a possible cause of drug-related patellar tendon ruptures.

Diagnosis

Lateral x-ray: Left torn patellar tendon: the kneecap is pulled up. On the right as a contrast: tear of the quadriceps tendon: depression of the kneecap and noticeable dent in the soft tissue above the kneecap.

The diagnosis can usually already be established on the basis of the clinical findings: There is an inability to actively stretch the knee joint against resistance, the typical "patellar high position", the easily palpable "hiking" of the kneecap when the knee is flexed or the thigh extensor muscles are tensed as well as the easily palpable "absence" of the patellar tendon. In cases of doubt, for example if the examinability of the knee joint is limited by severe swelling and pain, sonography or magnetic resonance imaging ( MRI or magnetic resonance imaging ) can provide clarity. In individual cases, the tendon does not tear itself, but there is a so-called " avulsion fracture " from the tibia or the lower kneecap pole, which is clearly visible on a conventional X-ray .

Differential diagnosis

The acute complete loss of extensibility of the knee joint can be caused not only by the rare patellar tendon rupture but also by a much more frequent patellar fracture . Here, too, a higher position of the kneecap or part of it can be felt. A lateral x-ray of the knee joint provides a reliable demarcation in the form of confirmation or exclusion of bony involvement. This x-ray can also provide reliable indications of a quadriceps tendon rupture , a possible differential diagnosis : the low position of the kneecap in the case of an acute extension deficit. (see illustration)

therapy

The treatment is usually performed surgically . Depending on the location of the rupture (central in the tendon area, proximal at the tip of the patella or distal at the attachment to the tibia), a tendon suture is performed, which is fixed in the bone with a suture anchor when the bone is close . In addition to the direct suture of the tendon stumps, a wire cerclage is placed between the patella and the tibia ( McLaughlin cerclage ), which allows early functional therapy as it completely relieves the suture of the patellar tendon. In the follow-up treatment, intensive physiotherapy is mainly used , which prevents atrophy of the thigh extensor muscles and maintains the mobility of the knee joint. The surgical removal of the cerclage takes place after three to six months. Very often the cerclage ruptures spontaneously as part of further functional treatment. In this case, the material should be removed early.

forecast

With consistent primary and follow-up treatment, the prognosis is favorable; in most cases, full restoration of the function of the extensor apparatus can be achieved. If the full load is too early, which can lead to breakage of the cerclage wire, but also post-operative wound infections can endanger the result. Depending on the initial situation, however, renewed ruptures of the tendon may occur, particularly in patients with previous degenerative damage.

swell

A. Rüter, O. Trentz, M. Wagner (Ed.): Trauma surgery. Study ed. the 2nd, revised. u. exp. Edition. Urban & Fischer, Munich 2008, ISBN 978-3-437-21851-4 , p. 1103.

Individual evidence

↑ F. Saint, G. Gueguen, J. Biserte, C. Fontaine, E. Mazeman: [Rupture of the patellar ligament one month after treatment with fluoroquinolone] . In: Revue De Chirurgie Orthopedique Et Reparatrice De L'appareil Moteur . tape 86 , no. 5 , September 2000, ISSN 0035-1040 , p. 495-497 , PMID 10970974 .
^ Daniel J. Stinner, Justin D. Orr, Joseph R. Hsu: Fluoroquinolone-associated bilateral patellar tendon rupture: a case report and review of the literature . In: Military Medicine . tape 175 , no. 6 , June 2010, ISSN 0026-4075 , p. 457-459 , PMID 20572481 .
↑ Bárbara Rosa, Pedro Campos, André Barros, Samir Karmali, Ricardo Gonçalves: Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone-induced tendinopathy . In: Clinical Case Reports . tape 4 , no. 7 , July 1, 2016, ISSN 2050-0904 , p. 678-681 , doi : 10.1002 / ccr3.592 ( wiley.com [accessed March 10, 2018]).

[1] F. Saint, G. Gueguen, J. Biserte, C. Fontaine, E. Mazeman: [Rupture of the patellar ligament one month after treatment with fluoroquinolone] . In: Revue De Chirurgie Orthopedique Et Reparatrice De L'appareil Moteur . tape 86 , no. 5 , September 2000, ISSN 0035-1040 , p. 495-497 , PMID 10970974 .

[2] Daniel J. Stinner, Justin D. Orr, Joseph R. Hsu: Fluoroquinolone-associated bilateral patellar tendon rupture: a case report and review of the literature . In: Military Medicine . tape 175 , no. 6 , June 2010, ISSN 0026-4075 , p. 457-459 , PMID 20572481 .

[3] Bárbara Rosa, Pedro Campos, André Barros, Samir Karmali, Ricardo Gonçalves: Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone-induced tendinopathy . In: Clinical Case Reports . tape 4 , no. 7 , July 1, 2016, ISSN 2050-0904 , p. 678-681 , doi : 10.1002 / ccr3.592 ( wiley.com [accessed March 10, 2018]).