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Management of chronic quadriceps rupture with novel "chariot suture technique": A case report and review.

ABSTRACT: Quadriceps tendon is one of the important segment of knee extensor mechanism. Acute ruptures are more common than chronic ruptures and have better outcomes. Chronic ruptures are rare with lot of surgical challenges including tendon retraction, fibrosis, degenerative calcification. We present a rare case of a 48 year old male diabetic patient with history of fall eight months ago and chief complaint of inability to actively extend his left knee. Diagnosis was made clinically and was confirmed radiologically with MRI. Surgical management was done with the use of novel "Chariot Suture Technique". It involves use of three Krakow whipstitches with Ethibond No. 5 suture across the distal ruptured end of quadriceps tendon and their intraosseous passage through patella in longitudinal fashion followed by tying knot at the distal pole of patella. The formation of Chariot makes the construct stable. At one year follow up patient was actively able to extend the knee with good range of motion. The technique is relatively cost effective, has no donor site morbidity, easy to learn and practice.

SUBMITTER: Wadhwani J

PROVIDER: S-EPMC7919959 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Management of chronic quadriceps rupture with novel "chariot suture technique": A case report and review.

Wadhwani Jitendra J Vashishth Sumedha S Bansal Himanshu H

Journal of clinical orthopaedics and trauma 20200626

Quadriceps tendon is one of the important segment of knee extensor mechanism. Acute ruptures are more common than chronic ruptures and have better outcomes. Chronic ruptures are rare with lot of surgical challenges including tendon retraction, fibrosis, degenerative calcification. We present a rare case of a 48 year old male diabetic patient with history of fall eight months ago and chief complaint of inability to actively extend his left knee. Diagnosis was made clinically and was confirmed rad ...[more]

PMID: 33680820

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Project description:End-stage renal disease with spontaneous quadriceps tendon rupture (QTR) is a specific condition that differs from classic QTR. The tissue quality of the quadriceps tendon (QT), the rupture site, the mechanism of injury, and the pathophysiology of the rupture mechanism all have an effect on conventional QT repair procedures, with a higher likelihood of rerupture or failed repair construction. We believe that our technique provides repair-site stability, strong repair construction, increased contact surface healing, and a reduced chance of rerupture after QT repair. Furthermore, in most patients who have end-stage renal disease with QTR, misdiagnosis and/or underestimation occurs, resulting in proximal retraction of the QT and poor results; however, this technique can be performed with alternative procedures such as augmentation or QT lengthening. The suture bridge transosseous QT repair technique relies on biomechanics knowledge for better stability. Suture bridge repair concept can achieve better healing of all layers of the QT until returning to normal activity with no disability and an improved quality of life. Technique Video Video 1 The patient is positioned supine on the operating table, with the affected leg hanging in 90° of knee flexion. The midline incision is made around 8 cm from the proximal part of the quadriceps tendon (QT) to the patella. We debride the frayed soft tissue, refresh the good-quality tendon ends, and roughen the upper pole of the patella. Five No. 2.0 pins are used to drill transosseous patellar tunnels longitudinally, which comprise 3 anterior drill holes and 2 posterior drill holes in the patellar bone. No. 2 Ethibond is inserted in the 3 anterior patellar drill holes to prepare for shuttling of FiberTape, which will be sutured to the QT. Polydioxanone (PDS) is inserted in the 2 posterior patellar drill holes for shuttling of the No. 2 Ethibond. Two FiberTape sutures are placed through the middle part of the torn tendon by the Kessler repair technique. The distance of the suture is measured 2 to 3 cm proximal to the tear site. The 4 suture tails are passed through 3 parallel longitudinal tunnels within the patella. In the 2 posterior drilling tunnels of the patella, the 4 limbs of the No. 2 Ethibond suture are sutured in a retrograde manner from the deep part to the superficial part of the QT, where they are placed at a distance 2 cm proximal to the tear site. The anterior peritendinous portion of the QT is sutured with No. 1-0 Vicryl along the anterior of the patella with a figure-of-8 suture technique. The 4 FiberTape limbs are secured by a knot at the inferior pole of the patella with the knee in full extension. All the suture limbs from the posterior patellar drill holes are tied at the inferior patellar bone, which acts like a suture bridge. The retinaculum is sutured with No. 1-0 Vicryl by a figure-of-8 suture technique. After the repair, stability is confirmed when knee flexion of up to 90° can be achieved intraoperatively without causing tension.

Dataset Information

Management of chronic quadriceps rupture with novel "chariot suture technique": A case report and review.

Publications

Management of chronic quadriceps rupture with novel "chariot suture technique": A case report and review.

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