HSS Journal ®

, Volume 9, Issue 2, pp 195–199 | Cite as

Novel Treatment of a Failed Quadriceps Tendon Repair in a Diabetic Patient Using a Patella-Quadriceps Tendon Allograft

Case Report

Abstract

Recurrent quadriceps tendon rupture is a debilitating condition that may be challenging to treat, especially in the presence of systemic disease such as diabetes mellitus (Bedi et al., J Shoulder Elbow Surg 19:978–988, 2010; Chbnou and Frenette, Am J Physiol Regul Integr Comp Physiol 5:R952–R957, 2004; Chen et al., J Shoulder Elbow Surg 5:416–421, 2003). Many surgical treatment protocols have been proposed (Azar, in Canale and Beatty, eds., Campbell’s Operative Orthopedics, Mosby/Elsevier, Philadelphia, PA, 2008; Ilan et al., J Am Acad Orthop Surg 3:192–200, 2003; Rodeo and Izawa, in Garrett et al., eds., Principles and Practice of Orthopedic Sports Medicine, Lippincott Williams & Wilkins, Philadelphia, PA, 2000). We report the case of a diabetic male with multiple treatment failures. He ultimately sustained a good outcome following treatment with a novel surgical technique that utilized a patella quadriceps tendon allograft. Tendon allograft-to-native bone healing had previously failed in this patient, so we used a bone-tendon construct allograft to provide an allograft bone-to-native bone healing site. Now, 13 months postoperative, the patient has increased strength, minimal pain, 20 ° of extensor lag and 130 ° of flexion.

References

  1. 1.
    Azar FM. Chapter 46: Traumatic disorders. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, PA: Mosby/Elsevier; 2008:2737.Google Scholar
  2. 2.
    Bedi A, Fox AJ, Harris PE, Deng XH, Ying L, Warren RF, Rodeo SA. Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. J Shoulder Elbow Surg. 2010.Google Scholar
  3. 3.
    Chbinou N, Frenette J. Insulin-dependent diabetes impairs the inflammatory response and delays angiogenesis following Achilles tendon injury. Am J Physiol Regul Integr Comp Physiol. 2004;5:R952–7.CrossRefGoogle Scholar
  4. 4.
    Chen AL, Shapiro JA, Ahn AK, Zuckerman JD, Cuomo F. Rotator cuff repair in patients with type I diabetes mellitus. J Shoulder Elbow Surg. 2003;5:416–421.CrossRefGoogle Scholar
  5. 5.
    DeFranco MJ, Derwin K, Iannotti JP. New therapies in tendon reconstruction. J Am Acad Orthop Surg. 2004;5:298–304.Google Scholar
  6. 6.
    Evans PD, Pritchard GA, Jenkins DH. Carbon fibre used in the late reconstruction of rupture of the extensor mechanism of the knee. Injury. 1987;1:57–60.CrossRefGoogle Scholar
  7. 7.
    Getgood A, Bollen S. What tissue bankers should know about the use of allograft tendons and cartilage in orthopaedics. Cell Tissue Bank. 2010;1:87–97.CrossRefGoogle Scholar
  8. 8.
    Ilan DI, Tejwani N, Keschner M, Leibman M. Quadriceps tendon rupture. J Am Acad Orthop Surg. 2003;3:192–200.Google Scholar
  9. 9.
    Levy M, Goldstein J, Rosner M. A method of repair for quadriceps tendon or patellar ligament (tendon) ruptures without cast immobilization. preliminary report. Clin Orthop Relat Res. 1987;218:297–301.PubMedGoogle Scholar
  10. 10.
    Longo UG, Lamberti A, Maffulli N, Denaro V. Tendon augmentation grafts: A systematic review. Br Med Bull. 2010:165–188.Google Scholar
  11. 11.
    Maffulli N, Longo UG, Maffulli GD, Khanna A, Denaro V. Achilles tendon ruptures in diabetic patients. Arch Orthop Trauma Surg. 2010.Google Scholar
  12. 12.
    Rodeo SA, Izawa K. Chapter 39: Diagnosis and treatment of knee tendon injury. In: Garrett WE, Speer KP, Kirkendall DT, Kitkowski MD, eds. Principles and Practice of Orthopaedic Sports Medicine. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:687.Google Scholar
  13. 13.
    Truong DT, Dussault RG, Kaplan PA. Fracture of the os peroneum and rupture of the peroneus longus tendon as a complication of diabetic neuropathy. Skeletal Radiol. 1995;8:626–628.Google Scholar
  14. 14.
    Valdes MA, Thakur NA, Namdari S, Ciombor DM, Palumbo M. Recombinant bone morphogenic protein-2 in orthopaedic surgery: A review. Arch Orthop Trauma Surg. 2009;12:1651–1657.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2012

Authors and Affiliations

  1. 1.Weill Cornell Medical CollegeNew YorkUSA
  2. 2.Sports Medicine and Shoulder ServiceHospital for Special SurgeryNew YorkUSA

Personalised recommendations