Korean J Sports Med.  2023 Sep;41(3):163-168. 10.5763/kjsm.2023.41.3.163.

Modified Transosseous Suture Technique for the Quadriceps Avulsion Fracture in Chronic Renal Failure: A Case Report

• Kang TB
• Shin WJ
• Kang BJ

• KMID: 2545831
• DOI: http://doi.org/10.5763/kjsm.2023.41.3.163

Abstract

In patients with chronic renal failure, spontaneous tendon rupture may occur due to degenerative changes in the tendon. Transosseous suture and suture anchor are commonly used for repair of quadriceps tendon rupture. But in chronic renal failure patients, the fixation of the repaired tendon is weak due to degenerative changes in the tendon, and decreased bone mineral density results in a relatively high rerupture rate. In this case, spontaneous quadriceps tendon rupture in a patient who has chronic renal failure with dialysis over 10 years was repaired with a newly designed transosseous suture method in order to increase contact of patella base and to reduce the rate of rerupture. Divide ruptured tendon arbitrarily into four layers using the anatomical structure of quadriceps tendon, then pull them out through the three vertical transosseous tunnels and tied them each. This procedure may be considered as another option in the case with high rerupture risk.

Keyword

Chronic renal failure; Quadriceps tendon rupture; Modified transosseous suture

Figure

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  Fig. 1 Preoperative gross clinical photograph that shows swelling of left knee joint without external wound.

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  Fig. 2 Preoperative lateral plain radiography (A) and computer tomography (B) of the left knee show mild inferior displacement of patella (patella baja Insall-Salvati ratio, 0.71) with avulsion bone fragment (arrows).

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  Fig. 3 Sagittal view of T2-weighted magnetic resonance imaging shows complete rupture of the quadriceps tendon and massive hemorrhage.

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  Fig. 4 Intraoperative findings. (A) The quadriceps tendon and extensor retinaculum were ruptured completely, and a massive hematoma was infiltrated. (B) The ruptured quadriceps tendon was divided arbitrarily into four layers. The medial, superior, and lateral portions were sutured using the Krackow technique and the intermediate portion was sutured using the Mason-Allen technique. (C) A transosseous suture was done via three vertical transosseous tunnels. (D) The extensor retinaculum and capsules were sutured.

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  Fig. 5 (A) Inferior displacement of patella was corrected in the postoperative lateral plane. (B) T2-weighted image shows repaired quadriceps tendon and the tendon is attached to the whole surface of patella.

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  Fig. 6 Quadriceps tendon (QT) measurements from preoperative (A) and postoperative (B) magnetic resonance images. Lines showpredetermined locations for measurements: proximal (QT-P), central (QT-C), distal (QT-D), and patellar base (PB).

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  Fig. 7 Patient’s postoperative status. The patient regained active extension of the left knee without deficit.

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  Fig. 8 Illustration of the surgical procedure. The ruptured quadriceps tendon was divided arbitrarily into four layers. The medial, superior, and lateral portions were sutured using the Krackow technique, and the intermediate portion was sutured using the Mason-Allen technique. The sutures were then passed through threevertical parallel tunnels. Fibrowires were tied the knot under the patella.

Reference

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