Download PDF
J Knee Surg 2022; 35(02): 215-221
DOI: 10.1055/s-0040-1715100
Original Article

Isokinetic Evaluation of Knee Strength and Endurance in Hemodialysis Patients Treated with the Transpatellar Tunnel Technique for Bilateral Spontaneous Quadriceps Tendon Ruptures

Fevzi Birişik
1   Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
,
Mehmet Ekinci
2   Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
,
Serkan Bayram
2   Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
,
Türker Şahinkaya
3   Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
,
Ömer Naci Ergin
2   Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
,
Ali Erşen
2   Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
,
Mehmet Aşık
2   Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

There are numerous surgical techniques described for treating acute quadriceps tendon rupture. We aim to evaluate the strength of the quadriceps tendon using isokinetic tests in hemodialysis patients treated with the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures. Additionally, functional and clinical results were investigated and compared with hemodialysis patients without a history of quadriceps tendon rupture. We retrospectively reviewed hemodialysis patients diagnosed with quadriceps tendon rupture who were operated between 2005 and 2015 at our institution. Eight patients with simultaneous bilateral quadriceps tendon rupture treated with the transpatellar tunnel technique (group 1; the operated group) and 10 patients with chronic renal failure without a history of quadriceps tendon rupture who underwent hemodialysis (group 2; the control group) were included in this study. The active range of motion (ROM), Lysholm and Tegner scores, knee flexor and extensor muscle strengths, and endurances were measured using an isokinetic dynamometer for each group and compared between the groups. The mean age was 44.6 and 40.2 years in groups 1 and 2, respectively. The mean follow-up was 58.6 (range, 24–140) months in group 1. The active ROM was 113.7 ± 9.7 degrees in group 1 and 130 ± 4.8 degrees in group 2 (p < 0.001). The mean Tegner score was not significantly different between the groups (1.87 ± 1.1 in group 1 vs. 2.6 ± 0.9 in group 2; p = 0.212). However, the Lysholm score was significantly higher in group 2 (93.2 ± 7.3 vs. 76.7 ± 13.8; p = 0.009). The mean extensor strength and endurance were significantly higher in group 2 than in group 1. The mean flexor strength and endurance were higher in group 1 than in group 2, but no significant difference was found. Although using the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures in hemodialysis patients can provide acceptable functional results, the ROM and strength particularly in extensor muscle might be significantly lower than control group. Level of evidence is Level III therapeutic case–control study.

Keywords

quadriceps tendon strength - isokinetic test - transpatellar tunnel - chronic renal failure

Note

The procedures were explained in detail and written informed consent was obtained from all the patients.


Ethical Approval

This study was approved by the Institutional Review Boards of our hospital.


Authors' Contributions

F.B. drafted the article, M.E. performed acquisition of data, S.B. written the article, T.Ş. performed the isokinetic test, Ö.N.E. conceived of the study, A.E. performed critical revision of the article, and M.A. performed critical revision of the article. All the authors read and approved the final article.




Publication History

Received: 06 January 2020

Accepted: 25 June 2020

Article published online:
24 August 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Neubauer T, Wagner M, Potschka T, Riedl M. Bilateral, simultaneous rupture of the quadriceps tendon: a diagnostic pitfall? Report of three cases and meta-analysis of the literature. Knee Surg Sports Traumatol Arthrosc 2007; 15 (01) 43-53
    CrossrefPubMedGoogle Scholar
  • 2 Trobisch PD, Bauman M, Weise K, Stuby F, Hak DJ. Histologic analysis of ruptured quadriceps tendons. Knee Surg Sports Traumatol Arthrosc 2010; 18 (01) 85-88
    CrossrefPubMedGoogle Scholar
  • 3 Kim YH, Shafi M, Lee YS, Kim JY, Kim WY, Han CW. Spontaneous and simultaneous rupture of both quadriceps tendons in a patient with chronic renal failure. A case studied by MRI both preoperatively and postoperatively. Knee Surg Sports Traumatol Arthrosc 2006; 14 (01) 55-59
    CrossrefPubMedGoogle Scholar
  • 4 Omar M, Haas P, Ettinger M, Krettek C, Petri M. Simultaneous bilateral quadriceps tendon rupture following long-term low-dose nasal corticosteroid application. Case Rep Orthop 2013; 2013: 657845
    PubMedGoogle Scholar
  • 5 Senevirathna S, Radha S, Rajeev A. Bilateral simultaneous rupture of the quadriceps tendon in a patient with psoriasis: a case report and review of the literature. J Med Case Reports 2011; 5: 331
    CrossrefPubMedGoogle Scholar
  • 6 Sıvacıoğlu S, Salduz A, Öztürk U, Bayram S, Birişik F. Simultaneous bilateral quadriceps tendon rupture in a patient with diffuse idiopathic skeletal hyperostosis after minimal trauma: eight-year follow-up. Case Rep Orthop 2018; 2018: 5047138
    PubMedGoogle Scholar
  • 7 Ilan DI, Tejwani N, Keschner M, Leibman M. Quadriceps tendon rupture. J Am Acad Orthop Surg 2003; 11 (03) 192-200
    CrossrefPubMedGoogle Scholar
  • 8 Konrath GA, Chen D, Lock T. et al. Outcomes following repair of quadriceps tendon ruptures. J Orthop Trauma 1998; 12 (04) 273-279
    CrossrefPubMedGoogle Scholar
  • 9 Lighthart WA, Cohen DA, Levine RG, Parks BG, Boucher HR. Suture anchor versus suture through tunnel fixation for quadriceps tendon rupture: a biomechanical study. Orthopedics 2008; 31 (05) 441
    CrossrefPubMedGoogle Scholar
  • 10 Vainionpää S, Böstman O, Pätiälä H, Rokkanen P. Rupture of the quadriceps tendon. Acta Orthop Scand 1985; 56 (05) 433-435
    CrossrefPubMedGoogle Scholar
  • 11 Hart ND, Wallace MK, Scovell JF, Krupp RJ, Cook C, Wyland DJ. Quadriceps tendon rupture: a biomechanical comparison of transosseous equivalent double-row suture anchor versus transosseous tunnel repair. J Knee Surg 2012; 25 (04) 335-339
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Petri M, Dratzidis A, Brand S. et al. Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons. Knee Surg Sports Traumatol Arthrosc 2015; 23 (04) 1039-1045
    CrossrefPubMedGoogle Scholar
  • 13 Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. Philadelphia, PA: FA Davis; 2016
    Google Scholar
  • 14 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedGoogle Scholar
  • 15 Ware Jr JE. SF-36 Health Survey: Manual and Interpretation Guide. Boston: Nimrod Press; 1993
    Google Scholar
  • 16 Çelik D, Çoban Ö. Short Form Health Survey version-2.0 Turkish (SF-36v2) is an efficient outcome parameter in musculoskeletal research. Acta Orthop Traumatol Turc 2016; 50 (05) 558-561
    CrossrefPubMedGoogle Scholar
  • 17 O'Shea K, Kenny P, Donovan J, Condon F, McElwain JP. Outcomes following quadriceps tendon ruptures. Injury 2002; 33 (03) 257-260
    CrossrefPubMedGoogle Scholar
  • 18 Plesser S, Keilani M, Vekszler G. et al. Clinical outcomes after treatment of quadriceps tendon ruptures show equal results independent of suture anchor or transosseus repair technique used - a pilot study. PLoS One 2018; 13 (03) e0194376
    CrossrefPubMedGoogle Scholar
  • 19 Rougraff BT, Reeck CC, Essenmacher J. Complete quadriceps tendon ruptures. Orthopedics 1996; 19 (06) 509-514
    PubMedGoogle Scholar
  • 20 Richards DP, Barber FA. Repair of quadriceps tendon ruptures using suture anchors. Arthroscopy 2002; 18 (05) 556-559
    CrossrefPubMedGoogle Scholar
  • 21 Puranik GS, Faraj A. Outcome of quadriceps tendon repair. Acta Orthop Belg 2006; 72 (02) 176-178
    PubMedGoogle Scholar
  • 22 Ramseier LE, Werner CM, Heinzelmann M. Quadriceps and patellar tendon rupture. Injury 2006; 37 (06) 516-519
    CrossrefPubMedGoogle Scholar
  • 23 Wenzl ME, Kirchner R, Seide K, Strametz S, Jürgens C. Quadriceps tendon ruptures-is there a complete functional restitution?. Injury 2004; 35 (09) 922-926
    CrossrefPubMedGoogle Scholar