Quadricep tendon rupture in native knees: techniques and outcomes

Background & Methods

Quadriceps tendon (QT) rupture is an uncommon condition requiring early intervention and repair to maintain stability and function of the knee. Surgical Management and success can be variable, and the aim of this study was to assess patient outcomes and factors associated with failure. A retrospective review of a prospective database was conducted between 2010 and 2018. Data collected included patient demographics, comorbidities and known risk factors for rupture.

Results

There were 72 QT ruptures in 68 patients. 60 men and 8 women with a mean age of 60 years. Risk factors identified included renal failure (13), steroid misuse (6) and use of fluoroquinolone antibiotics (2). Surgical techniques included transosseous (TO) repair (28), TO + artificial ligament augmentation (AL) (27), suture anchors (SA) (7), SA + AL augmentation (6), others (4). All but four patients were started on a standardised rehabilitation protocol. There were five failures (1 TO+AL, 2 TO and 2 SA) and 10 wound complications. One-way ANOVA showed no statistical difference in failures between groups. Unpaired t-test showed increased failure and wound complications in patients with at least one risk factor (renal failure, steroid use etc.) p< 0.05. Use of tourniquet and increased age (over 60 years) was not associated with failure. Stiffness (flexion < 90 degrees) was observed in three patients at follow up. Four out five failures were revised with TO + AL technique without complication.

Conclusion

This study shows that quadriceps tendon repair using a transosseous technique with neoligament augmentation is a safe and reliable technique. This is the largest retrospective study comparing failure rates across different repair techniques for QT rupture.