CONCLUSION AND RESULTS :
We performed quadriceps tendon reconstruction using ipsilateral
autologous semitendinosus graft. The proximal part of the graft was
fixed to the remnant of quadriceps tendon using the 5-0 Ethibond with
Krackow suture technique. The distal part of the graft was fixed to the
patella using double 5.5 mm metal suture anchors at the superior pole of
patella. The postoperative Xray is shown in Figure 4. Postoperatively,
the patient was immobilized in backslab with his left knee in fully
extended position. After 3 weeks the patient was sent for physiotherapy
to regain his left knee’s range of motion. At final follow up at six
months, patient was able to walk with bipedal unassisted normal gait.
Active knee extension and straight leg raising was possible. Final knee
range of motion was from 0° to 130°
DISCUSSION :
The injury known as ”chronic extensor mechanism quadriceps tendon
rupture” is a severe condition that typically occurs when the rupture is
not diagnosed in a timely manner, either owing to misdiagnosis or the
incomplete rupture progressing to a complete rupture and seeking medical
assistance at a later stage. Chronic rupture of a muscle will cause the
muscle to contract, resulting in an expansion gap. The muscle body in
this area becomes scarred, and the gap cannot be reduced. In addition,
the quadriceps muscle experiences atrophy, leading to weakened
quadriceps even after undergoing repair. This weakness, along with
arthrofibrosis and residual stiffness, hinders the ability to attain the
whole range of motion. In this patient, we used semitendinosus muscle in
the specific situation of Quadriceps Tendon Rupture (QTR). The patient
was reported to be free of any significant complaints. Various surgical
methods can be employed to treat acute quadriceps tendon ruptures,
including transosseous patellar tunnels, end-to-end sutures, anchor
fixation, and graft augmentation. For cases of chronic quadriceps tendon
rupture with tissue loss, it is advisable to utilise an autologous graft
for the purpose of repairing and restoring the structure and function of
the quadriceps tendon. McCormick and al [2] performed a surgical
intervention utilising autografts from the patient’s semitendinosus and
gracilis tendons to repair and substitute injured tendons in instances
of chronic quadriceps tendon rupture. The hamstring tendon transplant
was threaded through the quadriceps tendon (QT) and went through three
patellar tunnels, which were created by piercing the bone. Afterwards,
the graft was secured and attached to the distal end of the patella. The
semitendinosus graft is an autograft commonly employed in surgical
procedures for anterior cruciate ligament (ACL) replacement. The
semitendinosus tendon, in conjunction with the gracilis tendon, is
extracted from the patient’s own hamstring muscles and employed as a
transplant to substitute the damaged ACL [3]. The semitendinosus
tendon is folded to form a 4-stranded graft, resulting in a rigid
biomechanical structure that is stiffer than other grafts including the
patellar tendon, quadriceps tendon, and Achilles tendon grafts. A study
has shown the restoration of the mechanical characteristics of the
hamstring tendons following ACL surgery using a semitendinosus tendon
autograft. Quadriceps tendon rupture that is not treated promptly can
result in unfavourable outcomes, such as decreased functional outcomes,
worse satisfaction levels, and reduced isokinetic data in patients who
have delayed repair [4]. Postponing the surgical procedure can
result in tendon shortening, scar tissue formation, and reduced blood
circulation, ultimately leading to an unfavourable outcome.