How Do I Treat a Pulled Quadricep?

Fresh quadriceps tendon rupture repair refers to the operation for the treatment of quadriceps tendon rupture.

Fresh quadriceps tendon rupture repair

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Fresh quadriceps tendon rupture repair refers to the operation for the treatment of quadriceps tendon rupture.

Orthopedics / Surgery for Muscle, Tendon and Bursal Diseases / Surgery for Muscle and Tendon Rupture / Surgery for Quadriceps Tendon Rupture

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Rupture of the quadriceps tendon is generally rare, and is usually caused by direct or indirect violence. The former often causes open complete rupture, the latter is more common than the former, and is more common in patients with middle-aged and elderly, obese, and quadriceps tendon already degenerative.

The quadriceps femoris is the most powerful muscle in the human body. Its main function is to extend the knee joint. When any part of the quadriceps tendon is completely broken, the injured limb loses the function of active knee extension. Strength weakened and joints became unstable. Beware of missed diagnosis.

Rupture of the quadriceps tendon can occur in any part of the tendon. When it is completely broken, it should be repaired as soon as possible. Depending on the location of the fracture, ruptured tendons can be used for direct sutures; fascial strips are used for direct sutures; stainless steel wires are taken out for sutures; Incomplete rupture can be treated with non-surgical treatment. Long leg tubular casts are fixed in the extended knee position for 4 to 6 weeks.

Surgery related anatomy.

Fresh quadriceps tendon rupture repair is suitable for:

1. Fresh quadriceps tendon rupture completely.

2. Elderly patients with incomplete rupture, who can tolerate surgery in general. Because the knee joint is unstable and weak, it is easy to fall, and more serious injuries are likely to occur.

1. Systemic conditions can not tolerate surgery.

2. Open injury combined with severe pollution or infection.

1. A thorough understanding of the condition, a careful examination and a clear diagnosis.

2. Take X-ray film of the knee joint to know whether there are other joint injuries and fractures in the knee joint.

Spinal or epidural anesthesia. In the supine position, the femur is tied with a tourniquet of the airbag.

Incision

Anterior medial knee approach was used. The incision starts from 8 to 10 cm above the knee joint, and extends down the inner edge of the quadriceps tendon to 1.5 cm from the upper edge of the metatarsal, and then around the inner edge of the metatarsal to the lower edge, and gradually approaches the midline and stops at the tibial tubercle. Inside edge.

2. Exposing the quadriceps tendon and patella

Cut the skin and subcutaneous tissue to expose the quadriceps tendon and patella. Remove the stump hematoma and the congestion and fluid in the epithelial sac, and trim the tendon section, pay attention to not too much, so as not to cause artificial tension.

3. Direct suture with fascia strips

For those who still have a certain tension after direct suture, drill the bone tunnel with a diameter of 3mm by hand drilling on both sides of the middle and lower planes of the patella, and cut a 1.5cm × 15cm wide fascia strip from the lateral side of the healthy femur and traverse the thigh. 1.5 to 2 cm above the cross-section of the cephalic muscle, the two ends were respectively drawn out from the sacral tunnel, straightened the knee joint, tightened the fascial strip, and sutured the fascial strip and intermittent suture of the quadriceps tendon after the cross-section was fully aligned.

4. Stainless steel wire extraction suture (McLlanghlin)

This method is relatively firm, and the limbs are placed under balanced suspension traction to allow early knee flexion of 30 ° -40 ° for functional exercises. 1 stainless steel screw with a length of 1 cm is screwed on the inner and outer edges of the junction of the middle and lower patella. Enter the nail upward to the centerline. Then use a thin stainless steel wire to traverse the proximal side of the quadriceps tendon and pull it down to align the broken tendon and fix the two ends to the screws. At the inner upper corner of the fixed wire, wear another pull-out wire grate, and pierce the skin on the inner side of the thigh. Another use of non-absorbent fine suture intermittent suture to strengthen the tendon.

5. Quadriceps tendon flap repair

Reveal the ruptured tendon and remove the hematoma. Straighten the knee joint to bring the two broken ends closer together. Use cloth pliers to pull the proximal end of the tendon distally. Trim the broken end of the tendon appropriately and sew. Then, from the proximal end of the tendon, a triangular flap is made from the front, with a thickness of 2.4 to 3.2 mm, a side length of 7.5 cm, and a base width of 5.0 cm. Keep its base at the proximal stump. The top of the triangular valve is turned over to the far end through the fracture, and suture is given.

6. fixed

In order to reduce the tension in the sutures, Bunnell withdrawing the sutures from the proximal end to the distal end of the tendon and the sacrum, respectively, was used to sew the sutures, and the wires were pulled out of the skin at the distal plane of the sacrum. The drawn wire can be fixed to a button on the outside of the skin, or directly out of the plaster and tightened outside the plaster.

7. Suture the skin

The incision is rinsed and the skin is sutured intermittently throughout.

1. Strict aseptic technique to prevent incision and knee joint infection.

2. The fascia strip is directly sutured to prevent damage to the articular surface when tunneling on the sacrum, and the two tunnel openings are parallel.

Postoperatively, the knee was fixed in a long tubular cast for 4 to 6 weeks. Move the knee joint after removing the cast. The plaster can be removed after 3 weeks of wire extraction and suture method, but the activities need to be performed on a tom rack or calf support. After 8 weeks, the wire and screws are removed.

Re-fracture after repair is the main complication. It is closely related to the injury, the patient's age and physique, and the choice of surgical method, but also has a clear relationship with reliable braking after surgery.