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KNEE AND LEG Tendon Ruptures A fall on a flexed knee can cause excessive eccentric loading of the extensor

mechanism and rupture of the quadriceps or patellar tendon. A similar mechanism of injury can cause a patellar fracture. Quadriceps tendon ruptures generally occur in patients over 40 years old, while patellar tendon ruptures are more likely to occur in patients under 40 years of age. Predisposing factors to patellar tendon ruptures include diabetes mellitus, chronic renal failure, hyperthyroidism, gout, and multiple cortisone injections. A large effusion and a palpable defect are usually present. The patient cannot actively extend the knee against gravity. With rupture of the patellar tendon, lateral radiographs show a patella that is higher than normal. Surgical repair is the treatment of choice for both quadriceps and patellar tendon rupture. TENDON AND LIGAMENT INJURIES Achilles Tendon Rupture Rupture of the Achilles tendon typically occurs in middle-aged males who are participating in sports activities, especially basketball. The rupture typically occurs in a relatively avascular area 4 to 6 cm proximal to the tendon's insertion. A typical patient reports, I was starting to jump and felt a sudden onset of severe pain, like a gunshot went through my calf. However, the severe pain resolves, the patient can walk with a limp, and the injury may be mislabeled as a sprain. Examination shows tenderness in the area of the rupture. A palpable defect may be appreciated. The most sensitive and reliable sign is a positive Thompson test ( Figure 19-23 ).
Figure 19-23 Thompson Test

A delay in the diagnosis causes contraction of the muscle, difficulty in approximating the tendon, and compromised results. The advantages of nonoperative versus surgical repair are debatable. Nonoperative treatment starts with casting or bracing of the ankle in plantarflexion that is followed by gradual transition to the neutral position. The ruptured tendon is somewhat like a shredded mop, and operative repair does not achieve the tight approximation that is possible with a lacerated tendon. Decreased strength of the gastrocsoleus muscle and the possibility of re-rupture accompany each modality.
Greene, W.B. (2006). Netter s Orthopaedics. Philadelphia, PA: Elsevier

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