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Repairing a Chronic Quadricep Rupture and Knee Replacement

Updated: Mar 11, 2021

By Robert Ference, M.D., Orthopaedic Surgeon Recently, a man came in to see me because he could not straighten his leg and his ruptured quadricep muscle had resulted in chronic pain, debilitating weakness, and instability. During our conversation about his medical history, I learned that an orthopedic surgeon had tried to repair a quadricep rupture over three different surgeries following a total knee replacement eight years earlier. Unfortunately, quadriceps tendon repairs have been shown be ineffective following knee replacement surgery so my new patient had not been able to get much relief. To complicate his condition further, the eight year old implanted knee replacement device had loosened after several falls due to his instability, and he had ruptured the outside of his knee as well. This once active man had suffered for eight years, and now this medical case had become very complex. My solution for him was a rare, multifaceted surgery that would allow him to extend his leg and regain his strength and mobility using a mesh graft. To my knowledge, this was the first procedure of its kind in Michigan.

What is a quadricep tendon rupture?

Tendons are strong cords of fibrous tissue that attach muscles to bones. Your quadriceps are tendons that combine four muscles above your knee cap (patella) and are responsible for straightening your legs during walking, running, and jumping. On rare occasions, the quadricep tendon may rupture during sports injuries or if forcefully hit, especially in athletic individuals over forty. This injury is called a quadriceps tendon rupture. A ruptured quad [Figure 1, right] can cause extreme pain in some cases and may result in permanent disability when not treated for a long time. In the case of my new patient, his tendon had shortened too much throughout the eight years so it could not be re-attached to his kneecap without a tissue graft.

The Tissue Graft Repair of the Ruptured Quad

I transferred the outer quad to the inside, and the inner quad to the outside, by using a mesh graft that is typically used to repair hernias and abdominal ruptures. If you look at this X-ray of the side of his knee [Figure 2. left], you can see a space between the bone and the implanted device in the tibia bone. This space is the result of cementing the mesh graft in front of the tibial implant. I also revised his eight-year-old knee

replacement surgery and repaired the outside of his knee.

Results: Firing up muscles for the first time in nearly nine years One week following surgery, which took place this past February, this gentleman was able to raise a straight leg for the first time in nearly nine years. You can see in the

video to the right how he is now able to activate his quadricep muscles. With the ability to gain strength and stability, he is now on his way to a more active and healthy life again.

What to do if your quadricep muscle is

chronically injured

While rare, if you suspect you may have a quadricep tendon rupture or tear, make sure you discuss your symptoms with your physician. If you would like to come in for an appointment, or for a second opinion after a prior procedure, please call (248) 626-0135, or fill out the contact form at the bottom of my website, Robert Ference, M.D., Orthopaedic Surgeon Medical Director-Joint Plus Excel Orthopaedic Center, Farmington Hills, Michigan #kneepain #quadricepsrupture #kneereplacement #kneerevision #tendontear #tendonrupture #orthopedicsurgery

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