Elbow is the most common joint to dislocate in children. Posterior dislocation is most common.
Simple dislocations are those without fracture.
Complex dislocations are those that occur with an associated fracture
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
Elbow is the most common joint to dislocate in children. Posterior dislocation is most common.
Simple dislocations are those without fracture.
Complex dislocations are those that occur with an associated fracture
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
Basics of patellofemoral instability for postgraduates. Gives brief introduction about patellofemoral joint anatomy, causes, examintaion and treatment for patellofemoral instability
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
Knee injuries for MBBS (undergraduate students). This presentation deals with injuries to the bones and ligaments around the knee as well as gives a brief overview on the dislocations of the knee and patella.
Supracondylar humerus fracture & complication for MBBS studentsYash Oza
Fracture classification, xray, complication, reduction method, surgery, cast, vascular injury, nerve injury, all the Undergraduate students should know is included
A brief introduction to the topic cerebral palsy, prepared by Dr Yash Oza, PG resident in MS Orthopaedics
Etiology, Classification, assessment, diagnosis, treatment
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
2. Introduction
• Patients with
• loss of active knee extension
• as a result of trauma
• without signs of a patellar fracture
• may have a disruption of the extensor mechanism.
• Injuries to the extensor mechanism can include
• quadriceps or patellar tendon ruptures,
• patellar dislocations, or
• tibial tubercle avulsions.
Can rule out
with the xray
3. Patellar and Quadriceps Tendon
Rupture
• Anatomy
• Quadriceps femoris muscle has
four parts: rectus femoris, vastus
lateralis, vastus medialis, and
vastus intermedius.
• The quadriceps tendon inserts
onto the base of the patella. Distal
to the patella, it continues as
the patellar ligament.
4. Origins Rectus femoris: anterior
inferior iliac spine, superior
margin of the acetabulum of
hip bone
Vastus medialis: intertrochant
eric line of femur
Vastus lateralis: linea aspera,
greater trochanter of femur
Vastus intermedius: anterior
surface of shaft of femur
Insertions Tuberosity of the tibia (via the
patellar ligament)
Innervation Femoral nerve (L2-L4)
Actions Hip joint: Thigh flexion (rectus
femoris only)
Knee joint: Leg extension
5. • Patellar Tendon
• Average 4mm thick, but
widens to 5-6mm at
insertion in to tibial
tuberosity
• Merges with Medial &
Lateral retinaculum
• Blood Supply
• Fat pad vessels supply
posterior aspect of tendon
via Med. & Lat. Inferior
Geniculate A.
• Retinacular vessels supply
Anterior portion of tendon
via Lat. IG & Recurrent Tibia
A.
• Proximal & distal insertion
area are relatively avascular
and are a common site of
rupture
Patel
lar
tend
on
Lat.IG &
Rec.TA
Med.IG &
Lat.IG
Relatively avascular
Relatively avascular
Ant. Post.
6. • Biomechanics
• Greatest force is applied at 60 degree flexion
• 3-4 times force at @ insertion as compared to
midsubstance
• While climbing stairs forces through patellar tendon is
x3.2 times body weight
7. Mechanism of Injury
• Quadriceps and patellar tendon ruptures are
typically low-energy injuries.
• Typically, the patient sustains a forceful quadriceps
contraction against a fixed or sudden load of full
body weight with the knee in a flexed position.
• In high-energy injuries it may accompany ACL tear
in 12.5% cases.
8. Clinical Presentation
• Age Group commonly involved
• Patellar tendon ruptures : <40 years old
• quadriceps tendon ruptures : >40 years of age
• Quadriceps tendon ruptures occur more commonly
in patients with systemic disease or degenerative
changes.
• Bilateral quadriceps tendon rupture may occur in
patients with systemic illness and obesity. Bilateral
rupture of the patellar tendon can occur but is less
frequent.
9. • History of jumping,squatting or stumbling.
• Pain with an associated tearing or popping
sensation is typical, as is the inability to bear
weight.
• Painful passive knee flexion
• Lack of active knee extension or the inability to
maintain the passively extended knee against
gravity
• Patellar tendon ruptures extend completely through the
retinacular tissue resulting in complete loss of knee
extension.
• In Quadriceps tendon ruptures some extension still may
be possible as whole retinacular tissue is not involved.
10. • Immediately after injury, a defect may be palpable
at the level of the rupture.
• However, when the diagnosis is delayed, the
tendon defect may not be palpable secondary to
consolidation of the hematoma and early scar
formation.
• A traumatic hemarthrosis is common after extensor
mechanism injuries.
11. • History of Prodromal symptoms :
fever, malaise, headache
• In general, healthy tendons do not rupture. Tensile
overload of the extensor mechanism usually leads
to # patella which is considered the weakest link.
• Thus Patellar tendon ruptures have been
considered the end stage of long-standing chronic
tendon degeneration.
• So Prodromal Symptoms are frequently associated
with tendon rupture.
• Complaint of chronic pain is also present at site of
the injury.
12. • Risk factor for Quadriceps/Patellar Tendon Rupture
• Rheumatoid
• SLE
• Diabetes –( Patellar Tendon more association)
• Chronic Renal Failure
• Systemic corticosteroid therapy
• Anabolic steroid use with Heavy Exercise –( Quadriceps
Tendon more association)
• Local steroid injection
• Chronic patellar tendonitis
• Fluoroquinolone antibiotics
13. Imaging
• Xray
• An AP and lateral plain radiograph
should be obtained in all patients.
• Patellar Tendon Rupture :
• The unopposed pull of the
quadriceps muscle will result in
proximal migration of the patella.
• Patella alta - position of the patella is
considered higher than normal
• position of the patella superior to
Blumensaat's line on the lateral
radiograph
• Insall-Salvati Index - normal value
between 0.8-1.2 . If the ratio is
higher than there is patella alta
14. Blumensaat's
line should extend to
inferior pole of the
patella at 30 degrees
of knee flexion
Blumensaat line is a line
which corresponds to the
roof of the intercondylar
fossa of the femur as seen
on a lateral radiograph of
the knee joint.
15. • Xray findings suggestive of a quadriceps tendon
rupture include
• obliteration of the quadriceps tendon shadow,
• a suprapatellar mass,
• suprapatellar calcific densities
• an inferiorly displaced patella.
16. Degenerative spurring (“tooth sign”), as seen on a lateral
view, may indicate significant changes in the quadriceps
mechanism
17. •USG
• High-resolution ultrasonography has been
recognized as an effective method of
examining the patellar and quadriceps
tendons in both acute and chronic
injuries.
• Routinely done method to confirm
diagnosis.
18. • MRI is very effective but expensive, method of
diagnosing.
• It is not recommended in the evaluation of most
suspected extensor mechanism injuries, but may
be helpful in patients with neglected tears or
partial tendon injuries or high-energy injury.
Normal
Quadriceps Rupture Patellar Tendon Rupture
19. Initial Management
• RICE
• A traumatic hemarthrosis is common after
tendon ruptures.
• Ice, compression, elevation, and anti-
inflammatory medications can be used to treat
local symptoms.
• Role of Knee aspiration
• no studies have shown a benefit for knee aspiration in
these injuries,
• aspiration of a tense hematoma WAS considered to
reduce pain and promote recovery.
20. Treatment Options :
Conservative & Operative
Indication Relative Contraindication
• Incomplete ruptures
are usually managed
conservatively if full
active extension is
present
• If Medically unfit for
surgery
• Open injury
• Extensor lag
• Loss of knee extensor
function
Conservative Treatment
21. Conservative Treatment
• The limb is initially immobilized with the knee in full
extension for 4 to 6 weeks,
• after which, protected range of motion and
strengthening are begun.
• Initially, flexion of greater than 90 degrees is
avoided to reduce stress on the tendon.
• Restrictions are removed once the patient achieves
good quadriceps muscle control and is able to
perform a straight-leg raise without discomfort.
22. • Nonsurgical management of a complete quadriceps
or patellar tendon rupture generally yields poor
results
• long-term disability in gait and weakness.
• Untreated complete ruptures will result in
ambulation with a stiff-knee gait or circumduction
to allow the foot to clear the ground during the
swing phase of gait.
• Patients will also complain of knee buckling and
difficulty in climbing stairs.
• And Loss of extensor mechanism function is an
indication for surgery.
Outcome of conservative treatment
23. Operative Treatment
• Operative treatment is indicated for all tendon
ruptures in which extensor mechanism function is
compromised.
24. Patient positioning
• Supine positioning
• A small bump under the hip is helpful for external
rotation of the limb
• Another small bump that can be
• moved below the knee for slight flexion or
• under the ankle for knee extension
25. Surgical Approach
• An extensile straight midline
incision
• inferior patella to 5 cm
proximal to the quadriceps
tendon rupture
• superior patella to the tibial
tubercle for patellar tendon
ruptures.
5cm
26. Acute v/s Chronic Tendon Tear
• In acute cases end-to-end repair is possible
• But in chronic cases there is a large defect
preventing apposition of ends
• In quadriceps rupture >2weeks , a gap of 5cm is
formed due to muscle retraction.
• Various muscle release or lengthening procedures
may be required in chronic cases.
27. Suture repair through bone tunnel
• Passage of two heavy non-absorbable sutures into the tendon.
• Three parallel drill holes are then created from superior to
inferior through the patella.
• The sutures are passed through the drill holes and tied at the
inferior patella
REPAIR OF ACUTE RUPTURE OF THE QUADRICEPS TENDON
• Tensioning of suture to allow 90
to 100 degrees of passive flexion
has been recommended.
• The tendon should be repaired
adjacent to the articular surface
because if sutured to anterior
surface it will lead to tilting of
the patella.
28. Codivilla tendon lengthening and repair of quadriceps tendon
• An inverted V is cut through the full thickness of the proximal segment of the
quadriceps tendon
• A triangular flap is split into 2 part
• Anterior part of one third of its thickness and
• a posterior part of two thirds.
• Anterior part of the flap is turned distally and is sutured.
REPAIR OF CHRONIC RUPTURE OF THE QUADRICEPS TENDON
29. • The cylinder cast or knee brace for 6 weeks.
• Weight bearing with crutches is allowed at 3 weeks.
• After Cast removal range of knee motion from 0 to
60 degrees; the range is increased 10 to 15 degrees
each week.
• An aggressive strengthening program is essential
for good functional recovery.
POSTOPERATIVE CARE FOLLOWING
QUADRICEPS TENDON REPAIR :
30. SUTURE REPAIR OF ACUTE PATELLAR
TENDON RUPTURE
• The site of the tear (proximal, midsubstance,
or distal) will dictate the preferred surgical
repair technique.
• Most patellar tendon ruptures occur at the
insertion on the inferior pole of the patella as
an avulsion.
• It is done by passage of 3 heavy non-
absorbable sutures into the tendon.
• 4 parallel drill holes are then created from
inferior to superior in the patella.
• The sutures are passed through the drill holes
and tied at the superior pole of the patella.
31. If the patellar tendon is extensively
frayed, 2 running interlocking non-
absorbable sutures can be used to secure
the tendon.
• Use a suture retriever or Beath pin to
thread the suture strands through 3-
mm drill tunnels,
• one horizontally into the tibial tubercle
• two vertically into the patella
*If secure fixation cannot be obtained
with this method, augment the repair
with the semitendinosus or gracilis
tendon.
MERSILENE LOOP TENDON REPAIR
(ACUTE)
32. RUPTURES THROUGH THE SUBSTANCE
OF THE TENDON
• The tendon is split in 3 bundles. (2 with
long arm directed upwards & 1 downwards)
• Running interlocking sutures placed in
bundles
• 2 parallel vertical holes drilled in the patella
& 1 transverse hole drilled in the tibial
tuberosity.
• Sutures are passed through holes & tied.
• Repair the individual bundles side-to-side
after appropriate tendon length is
determined.
*If needed place a circumferential tension
suture of non-absorbable box wire.
(ACUTE)
33. SUTURE ANCHOR REPAIR OF PATELLAR
TENDON RUPTURE
• For proximal avulsion of the tendon
from the patella, place three suture
anchors equidistant along the inferior
pole of patella.
• Pull the suture through the anchor eyelet
Pass the one suture arm down and back
of the tendon stump in a locking Krackow
fashion, and pull the another arm to
reduce the tendon & Tie each suture
securely.
• For distal avulsion of the tendon, the
same procedure is used but the suture
anchors are placed in the tibial tubercle
(ACUTE)
34. POSTOPERATIVE CARE following repair
of acute patellar tendon repair
• Weight bearing is allowed with the knee braced in
full extension.
• Range of Motion is progressed as tolerated, with
the goal of
• 90 degrees of flexion by 4 to 6 weeks and
• full motion by 10 to 12 weeks.
• Isometric quadriceps contractions can be done
immediately after surgery,
• Progressing to straight-leg raises start at 6 weeks.
• Full return to activities after 6 months.
35. TREATMENT OF CHRONIC
RUPTURE OF PATELLAR TENDON
In chronic cases patella is retracted proximally
and may require extensive surgical release to draw it
distally to the appropriate level.
Before surgery, lateral radiographs of the
uninvolved extremity should be obtained with the
knee flexed to 45 degrees to evaluate patellar height;
• These are compared with radiographs of the
involved knee during surgery to determine the
appropriate tendon length.
36. • Preoperative traction through a
K-wire placed transversely in the
patella was used
• But, better results can be
obtained with proximal release
of scar tissue and a modified
Thompson quadricepsplasty, if
necessary.
• Modified Thompson
quadricepsplasty is a Z-plasty
lengthening of the rectus
femoris tendon
37. If sufficient patellar
tendon is left for
repair,
augmentation with
the
semitendinosus or
gracilis tendon
may be indicated.
If the rupture is
several months old,
an allograft can be
used, and an
Achilles tendon
allograft is used.
38. ACHILLES TENDON ALLOGRAFT FOR
CHRONIC PATELLAR TENDON RUPTURE
• Use an oscillating saw to make a slot in
Tibial tuberosity
• Contour the bone attached to the Achilles
tendon to fit flush in the slot
• Split the Achilles tendon graft into three
branches, the central branch should be 8 to
9 mm in diameter.
• Central arm of graft is placed through 9 mm
longitudinal tunnel and then through
vertical slit in quadriceps tendon.
• Tunnel is placed centrally to avoid
penetration of articular cartilage.
• Graft is secured with multiple sutures.
39. POSTOPERATIVE CARE.
• Apply cylindrical cast post-OP. At 10 to 14 days, the cast
is removed for wound evaluation.
• A cylinder cast or locked brace is worn for 4 to 6 weeks.
• At 4 to 6 weeks, after removing cast Active and passive
range-of-motion exercises are begun.
• Weight bearing to tolerance with crutches is allowed
until sufficient motion and strength is gained.
• A progressive strengthening and range-of-motion
exercise program is essential to regain function.
40. HAMSTRING (SEMITENDINOSUS AND GRACILIS)
AUTOGRAFT AUGMENTATION FOR CHRONIC PATELLAR
TENDON RUPTURE
Technique for one-stage delayed reconstruction of patellar tendon.
A, Steinmann pin through transverse hole in patella is used for distal traction.
B, Proximally divided semitendinosus and gracilis tendons are placed through
holes and fixation wire is inserted.
C, With patella in normal position, fixation wire is secured and gracilis and
semitendinosus tendons are sutured to each other.
41. HAMSTRING AUTOGRAFT AUGMENTATION FOR
CHRONIC PATELLAR TENDON RUPTURE
A, Z-shortening of patellar tendon
and Z-lengthening of quadriceps
tendon.
B, Tack sutures are placed in tendons
after confirming patellar height
C&D, a transverse hole in patella is
made Semitendinosus and gracilis
tendons are harvested with tendon
stripper and sutured together.
E, Tendons are passed through
transverse hole in patella and sutured
together and also to underlying
patellar tendon.
42. POSTOPERATIVE CARE.
• At 2 weeks, the cast is removed for wound
evaluation and a new cylinder cast or locked brace
is applied.
• At 6 weeks, vigorous straight-leg raising with
weights and active flexion exercises are instituted.
43. Outcome
ACUTE QUADRICEPS TENDON REPAIR
• good to excellent results in 80% to 100% of
operatively treated quadriceps tendon ruptures
• Many different techniques of primary repair have
been described and no single technique has
demonstrated superiority.
• The only factor that has been associated with
inferior results is delay in timing of surgical repair of
greater than 2 to 3 weeks.
44. CHRONIC QUADRICEPS TENDON REPAIR
• Overall, less satisfactory than repair of an acute
tear
• Residual functional deficits present in most
patients.
• Some reported good to excellent results in patients
treated with their modification of the Codivilla
lengthening technique.
• More than half delayed repairs lost between 10 and
20 degrees of full active extension at final follow-up
in few studies.
45. ACUTE PATELLAR TENDON REPAIR
• Most series have reported between 70% and 100% good to
excellent results.
• The majority of patients who undergo early primary repair
achieve a functional range of motion and normal quadriceps
strength.
• Persistent quadriceps muscle atrophy commonly occurs, but
has not been correlated with loss of strength.
• No relationship has been demonstrated between the
configuration of the rupture, the method of repair, and clinical
outcome.
• An early repair within 2 to 3 weeks of injury is the only factor
that has been associated with better outcomes.
• In patients treated within 7 days ,96% had good to excellent
results.
• Patients with multiple injuries may have contributed to the
slightly lower success rate in some series.
46. CHRONIC OR NEGLECTED PATELLAR TENDON
RUPTURE
• A vey few series recommended preoperative
traction to overcome the contracted quadriceps
muscle so that the tendon ends could be re-
approximated.
• Results have generally been less satisfactory
compared to acute repair.