Patellar Tendon Rupture

　　1、Etiology

　　Since the injury to the extensor mechanism usually occurs when the knee is suddenly屈曲 and the quadriceps muscle is suddenly and forcefully contracted, and at this time, the patella is the fulcrum of the entire extensor mechanism on the femoral condyle, therefore, the injury to the extensor mechanism is more common in patellar fractures, while the rupture of the quadriceps tendon and patellar tendon is relatively rare.

　　2、Pathogenesis

　　Complete rupture of the patellar tendon is not very common. The typical traumatic mechanism is that when the knee is suddenly屈曲 without preparation (such as when kneeling and falling), the patellar tendon is suddenly and forcefully contracted to protect, leading to degeneration or rupture of the weak patellar tendon.

　　The injured area is bruised and swollen, the meridians are blocked, and the Qi and blood are stagnant. The treatment during this period focuses on promoting blood circulation and removing blood stasis, and promoting Qi flow and dispersion. According to traditional Chinese medicine, 'if the blood stasis does not disappear, the bones cannot regenerate' and 'if the blood stasis is removed, new bones will grow'. It can be seen that reducing swelling and removing blood stasis is the primary factor for fracture healing. In severe cases, complications such as blood stasis accumulation may occur, which is difficult to disperse, leading to a prolonged course of the disease, slowing down the growth of callus, and affecting the recovery of joint function in the future.

　　It occurs more frequently in people over 40 years old, and the rupture site is often near the superior margin of the patella. After the injury, the patient has typical extension difficulties of the knee, patellar tenderness, patellar bursa hematoma, and discontinuity of the quadriceps tendon, leading to a feeling of emptiness.

　　The initial surgical treatment is the main link. This disease is caused by traumatic factors, so paying attention to safety in production and life is the key to preventing this disease. In social production activities, through the harmonious operation of people, machines, materials, environment, and methods, various potential accident risks and injury factors in the production process are always kept under effective control, and the lives and physical health of the workers are effectively protected.

　　1. The diet for quadriceps tendon rupture is good for the body

　　Adopt a light diet as the main, and rationally match the diet. Eat more protein-rich foods such as fish, eggs, and soy products, and appropriately increase calcium. Drink more water, eat more vegetables and fruits such as green vegetables, celery, and bananas.

　　2. What foods should be avoided if you have a biceps brachii tendon rupture

　　Avoid spicy foods: such as chili, mustard, etc. Smoking and drinking should be戒除.

　　First, treatment

　　1. Fresh quadriceps:To achieve satisfactory repair results, it is necessary to complete the repair surgery within 48 hours after the injury. Generally, two surgical options can be chosen: tenotomy-to-tenotomy suture, and tenotomy-to-bone suture. Since the rupture almost always occurs in the area of degenerative changes, surgical repair requires the use of fascial strips or other methods to strengthen it. It is also possible to use a triangular inverted lingual quadriceps tendon fascia flap for repair surgery.

　　(1) Surgical method for tenotomy-to-tenotomy repair: Make an anterior longitudinal median incision, about 20cm long, to expose the ruptured tendons. Remove the hematoma, extend the knee joint to bring the two ends close together, and at the same time, use a gauze forceps to pull the proximal end towards the distal end. After trimming the tendon ends, suture them with No. 10 silk thread or high-strength nylon thread. From the proximal part of the tendon, make a triangular flap in front, 2-3mm thick, with each side 7.5cm long, and a base width of 5cm, retaining its base on the proximal end. Turn the top of this triangular flap towards the distal side across the fracture, and suture it at an appropriate position. To reduce the tension at the suture site, suture the sides of the tendon and patella from the proximal end to the distal end with wire suture technique, and the wire comes out of the skin and is fixed exactly at the distal plane of the patella. The extracted wire can be fixed on a button outside the skin.

　　(2) Surgical Methods for Tendon to Bone Repair: The exposure method is the same as above. After debridement, two parallel fine bone tunnels are drilled longitudinally on the patella. The ends of the quadriceps femoris tendon are sutured to the superior pole of the patella with high-strength nylon thread. Repair the surrounding soft tissues. This method is suitable for cases where there is no residual tendinous tissue at the distal end.

　　2. Old Traumatic Quadriceps Femoris:Treatment of Tendon Rupture The repair of the quadriceps femoris tendon rupture for several months or years is difficult. If the two ends can be opposed, it can be repaired in the same way as a fresh quadriceps femoris结节 rupture. However, it is often found that there is a large defect between the two ends, and it is necessary to use fascia lata for repair.

　　For severe shortening of the quadriceps femoris that cannot be opposed, V-Y tendinous lengthening surgery can also be adopted. Make a reverse 'V' shaped fascial flap near the distal end of the quadriceps femoris muscle, and divide the triangular flap into front and back sections from the coronal plane. The front flap is 1/3 of the full thickness, and the back flap is 2/3. Pull the reverse 'V' shaped flap downward to align the two ends of the quadriceps femoris tendons, and suture them with silk thread. Then, flip the front flap to the distal end and suture it. Finally, suture the back flap and the open part of the 'V' shaped top of the quadriceps femoris tendon. To reduce the tension at the suture site, it is beneficial to use tension-reducing wire suture technique.

　　II. Prognosis

　　The surgical treatment results for the old traumatic quadriceps femoris knee rupture are not as satisfactory as those for acute injury. Although the stability of the knee joint has been restored and there has been a certain degree of recovery in mobility, the extension strength of the knee is rarely completely restored. Therefore, it is of certain significance to emphasize postoperative rehabilitation training, including electrical impulse stimulation therapy for the quadriceps femoris, and other treatments.