Acute quadriceps tendon rupture repaired by suture anchors: Outcomes at 7 years' follow-up in 25 cases.

INTRODUCTION: Acute quadriceps tendon rupture is rare. The gold-standard repair technique is transosseous patellar suture. Biomechanical studies have validated the use of anchors as an alternative. The present study sought to report long-term clinical and radiological results in a series of acute quadriceps tendon rupture repaired with anchors. The study hypothesis was that results are comparable to those of the gold-standard technique. METHODS: A retrospective continuous study included 25 knees with acute quadriceps tendon rupture, operated on by a single surgeon between 2007 and 2013: 22 patients; 17 males, 5 females; mean age, 64 years (range: 52-87 years). Modified Bunnell suture was performed, using either 2 anchors (19 knees) or 3 anchors (6 knees). Anchors were positioned under 20° flexion. The factors studied were: active range of motion, muscle strength, patient satisfaction, Lysholm score, return to work, and the radiological behavior of the anchors. RESULTS: At a mean follow-up of 7 years (range: 3-9 years), all but 1 patient had 0° active extension. Mean active flexion was 128° (range: 110-150°), and mean muscle strength was 4.9/5. Mean Lysholm score was 92. Subjective results proved satisfactory or very satisfactory in 23 cases. Working patients returned to work at a mean 4.2 months. There were no cases of anchor migration or of re-rupture. One poorly tolerated anchor was ablated at 2 years, without functional impact. CONCLUSION: Outcomes with anchors were comparable to those of the gold-standard technique. Anchors allow immediate rehabilitation, without risk of anchor migration. The technique provided satisfactory functional recovery. LEVEL OF EVIDENCE: IV, retrospective cohort study.

[Importance of bone grafting in open tibial fractures (Gustilo III)]. / Importance de l'apport osseux dans les fractures ouvertes (Gustilo III) de jambe.

The authors report a retrospective study of 6 cases treated over the period 1988-1993.The closure of the wound was achieved by means of 3 free flaps (2 provided bone and skin in a single flap and the third was a latissimus dorsi muscle flap) and 3 pedicular flaps.The fixation of the fracture was performed by an external fixator in all cases. In one third of the cases a secondary nailing was performed to obtain consolidation. A bone graft was needed in 2/3 of the cases (2 bone free flaps, 1 bone allograft, 1 cancellous autograft).