Primary repair of quadriceps tendon ruptures. Results of treatment.

Results of primary repair of 19 quadriceps tendon ruptures in 19 patients were studied. Average patient age was 47.4 years. Predisposition to the site of tear according to age was noted. Seventy-five percent (nine of 12) of patients older than 40 years of age had ruptures at the tendon-bone junction, and 71% (five of seven) of patients younger than 40 years had ruptures at the midtendinous area. Repair for injuries in the midtendon-musculotendinous junction consisted of debridement, freshening of the edges, and reapproximation. Ruptures in the tendon-bone junction required suturing through three to four holes drilled through the proximal pole of the patella. Postoperatively, patients were immobilized for six weeks. Excellent results were noted in all 17 patients who had early repair and good results in two patients who had delayed repair. Patient age, gender, mechanism of injury, site of rupture, and type of repair did not affect the outcome of treatment.

Effect of time of onset and depth of infection on the outcome of total knee arthroplasty infections.

The treatment results of 24 infected total knee arthroplasties with a minimum follow-up period of two years are presented. The most common pathogens were coagulase-positive staphylococci (50%), coagulase-negative staphylococci (29.2%), and enterococci (12.5%). Eleven patients with early postoperative infections (occurring within one month of prosthesis implantation) were treated with debridement, retention of the prosthesis, and intravenous antibiotics. Treatment was successful in all five patients with superficial infections not extending into the joint. In six patients with deep infections, treatment was successful in only two (33%), despite a longer course of antibiotic therapy (four to six weeks) and the use of tobramycin-impregnated polymethylmethacrylate beads. Three patients continued to have recurrent drainage, and one patient was subsequently successfully treated with a delayed exchange arthroplasty. Thirteen patients were diagnosed with late infections. One patient with a late, superficial infection and another with an acute (hematogenous seeding), deep infection were successfully managed with debridement and intravenous antibiotics. Prosthesis removal was not required. Eleven patients presented with late, deep infections. Of three patients who were treated without removal of the prosthesis, infection was arrested in only one. The remaining eight patients were treated with debridement, intravenous antibiotics, tobramycin-impregnated polymethylmethacrylate beads, and delayed exchange arthroplasty. The median interval to reimplantation was eight weeks (range, seven to 25 weeks). Treatment was successful in six cases (75%). The overall success rate in the treatment of total knee arthroplasty infections was 71%. In 19 patients with deep infections, treatment success was seen in 78% of patients treated with delayed exchange arthroplasty, but this value was only 40% in patients who were not treated with prosthesis removal.(ABSTRACT TRUNCATED AT 250 WORDS)