Neglected rupture of the quadriceps tendon after removal of a bracing of the patella: Case report

Introduction: Ruptures of the quadriceps tendon are rare, disabling injuries compromising the knee extension mechanism. Tendon plasty procedures are proposed with the aim of obtaining a solid repair allowing rehabilitation to begin quickly. In cases of old ruptures, tendon retraction and tissue degeneration sometimes prevent satisfactory direct tendon repair from being obtained. Observation: We report the case of a young patient, 19 years old, who underwent removal of osteosynthesis equipment for a fracture of the patella. The evolution is marked by an iatrogenic rupture of the quadriceps tendon which has gone unnoticed. Technique: Positioned in the supine position, using the old approach, a retraction of the quadriceps tendon was revealed with a displacement of the quadriceps tendon at the upper edge of the patella and a tendon defect of 5 centimeters. We performed VY lengthening of the quadriceps tendon using the Codivilla method with reconstruction of the tendon defect. Discussion: Ruptures of the quadriceps tendon are rare, often occurring over the age of 40. Traumatic ruptures are the result of significant stress on the extensor system of the knee. The type of lesion may correspond to a rupture at the level of the tendon body or to a quadriceps collapse often occurring on a previously weakened degenerative tendon and includes a tendon tearing at the upper pole of the patella with a periosteal sleeve sometimes taking away the pre-patellar fibrous part. The treatment of a neglected rupture of the quadriceps tendon is always surgical. A tendon plasty should not be systematically performed. Conclusion: Ruptures of the quadriceps tendon are a rare entity both in current practice and in the literature, ignorance of which leads to inveterate lesions. Several types of plasty are described in the literature, including VY lengthening plasty of the quadriceps tendon using the Codivilla method.