Tendon Injuries of the Knee
Tendon injuries are common in the knee. The most commonly affected structure is the extensor mechanism. The main pathologies are tendonitis of the patella and ruptures of the patellar and quadriceps tendons, although other tendonopathies have rarely been
- PDF / 267,482 Bytes
- 9 Pages / 504.57 x 720 pts Page_size
- 63 Downloads / 214 Views
Tendon Injuries of the Knee Alexander D. Liddle and E. Carlos Rodríguez-Merchán
Abstract
Tendon injuries are common in the knee. The most commonly affected structure is the extensor mechanism. The main pathologies are tendonitis of the patella and ruptures of the patellar and quadriceps tendons, although other tendonopathies have rarely been described around the knee. Patellar tendinopathy can be difficult to treat, but the mainstay of treatment is physiotherapy, with injectable and surgical treatment reserved for recalcitrant cases. The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasonography (US) and magnetic resonance imaging (MRI) when the diagnosis is equivocal further aids diagnosis, however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears are special cases requiring reconstructions with allograft, synthetic grafts or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, heterotopic ossification, infection, stiffness and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair. A.D. Liddle University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK e-mail: [email protected]
E.C. Rodríguez-Merchán (*) Department of Orthopaedic Surgery, “La Paz” University Hospital-IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain e-mail: [email protected]
© Springer International Publishing Switzerland 2017 E.C. Rodríguez-Merchán, A.D. Liddle (eds.), Joint Preservation in the Adult Knee, DOI 10.1007/978-3-319-41808-7_6
55
A.D. Liddle and E.C. Rodríguez-Merchán
56
Keywords
Knee • Tendon • Injuries • Diagnosis • Treatment
6.1
Introduction
The tendons about the knee, in particular those of the extensor mechanism, are subject to extreme loading during activities of daily living. As a result, tendon injuries are commonly encountered in both primary and secondary care. Tendon injuries can be subdivided into tendinopathy, which is related to low-intensity but repetitive traumatic phenomena, and acute rupture of the tendon, which may be a result of chronic tendinopathy. The commonest sites for tendon disorders about the knee are the extensor mechanism, with patellar te
Data Loading...
