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<p>The extensor apparatus (quadriceps muscle and tendon, patella and patellar tendon) is of great importance for the function of the knee joint, and an insufficiency of the extensor apparatus has a&#xa0;significant impact on gait. Therefore, primary suture or refixation should always be attempted in the case of injuries to these tendons. However, failure of these surgical procedures presents the surgeon with major challenges, as the resulting defects are not easy to reconstruct. It is therefore important to use imaging (ultrasonography, magnetic resonance imaging, x‑ray) as part of the preoperative diagnostics to estimate the extent of the tendon dehiscence and defect and to rule out infection as a&#xa0;possible cause for suture failure (blood test, joint fluid aspiration if necessary). V‑Y&#xa0;plasty has proven to be an effective surgical technique for reconstructing retraction or defects in the quadriceps tendon. A&#xa0;V-flap is mobilized from the remaining tendon remnant, pulled distally and fixed by transosseous tunnels to the patella. The distalized V‑flap is then sutured side to side to the remaining quadriceps tendon. Large defects can be reconstructed using this technique, so that the use of autologous or allogeneic grafts to augment the repair is usually not necessary. In exceptional cases with severe patella baja, an additional lengthening of the patellar tendon may be necessary (“needling” or Z‑plasty). On the patellar tendon, however, there is usually not enough remaining tendon material available for defect reconstruction, so autologous or allogenic grafts are usually used to bridge the tendon defects. Due to their diameter and length, the autologous semitendinosus tendon or a&#xa0;peroneus longus split graft are suitable autologous grafts for this purpose. The tendons are anchored via drill holes in the patella and tibial tubercle. The patella height is adjusted beforehand with a&#xa0;patellotibial cerclage using an image intensifier (Caton index 0.8–1.2). The remaining tendon tissue is used, if possible, to cover the defect. Almost all defects of the patellar tendon can be satisfactorily reconstructed using this method.</p>

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Sehnenrekonstruktion zum Management chronischer Läsionen am Streckapparat

  • 期刊论文

  • 发表日期：

    2025年3月10日

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  • Wolf Petersen,
  • Johanna Schulze Borges,
  • Amelie Klaumünzer,
  • Leo Vincent Fricke,
  • Martin Häner

摘要

The extensor apparatus (quadriceps muscle and tendon, patella and patellar tendon) is of great importance for the function of the knee joint, and an insufficiency of the extensor apparatus has a significant impact on gait. Therefore, primary suture or refixation should always be attempted in the case of injuries to these tendons. However, failure of these surgical procedures presents the surgeon with major challenges, as the resulting defects are not easy to reconstruct. It is therefore important to use imaging (ultrasonography, magnetic resonance imaging, x‑ray) as part of the preoperative diagnostics to estimate the extent of the tendon dehiscence and defect and to rule out infection as a possible cause for suture failure (blood test, joint fluid aspiration if necessary). V‑Y plasty has proven to be an effective surgical technique for reconstructing retraction or defects in the quadriceps tendon. A V-flap is mobilized from the remaining tendon remnant, pulled distally and fixed by transosseous tunnels to the patella. The distalized V‑flap is then sutured side to side to the remaining quadriceps tendon. Large defects can be reconstructed using this technique, so that the use of autologous or allogeneic grafts to augment the repair is usually not necessary. In exceptional cases with severe patella baja, an additional lengthening of the patellar tendon may be necessary (“needling” or Z‑plasty). On the patellar tendon, however, there is usually not enough remaining tendon material available for defect reconstruction, so autologous or allogenic grafts are usually used to bridge the tendon defects. Due to their diameter and length, the autologous semitendinosus tendon or a peroneus longus split graft are suitable autologous grafts for this purpose. The tendons are anchored via drill holes in the patella and tibial tubercle. The patella height is adjusted beforehand with a patellotibial cerclage using an image intensifier (Caton index 0.8–1.2). The remaining tendon tissue is used, if possible, to cover the defect. Almost all defects of the patellar tendon can be satisfactorily reconstructed using this method.