Early motion after quadriceps and patellar tendon repairs: outcomes with single-suture augmentation.

BACKGROUND: Complications of immobilization after quadriceps and patellar tendon repairs include decreased patellar mobility, limited flexion, persistent pain, muscle weakness, and patella baja. In contrast, early motion limits muscle atrophy, accelerates tendon healing, and prevents joint stiffness. HYPOTHESIS: Quadriceps and patellar tendon repairs protected with a "relaxing suture" are strong enough to safely permit early motion, full weightbearing, and brace-free ambulation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty quadriceps and 30 patellar tendon ruptures were treated with a primary repair augmented with a single No. 5 Ethibond suture, a postoperative regimen of controlled motion and full weightbearing at 7 to 10 days, and brace-free ambulation at 6 weeks after surgery. At a minimum follow-up of 12 months, results of surgery were assessed with the Lysholm knee rating system. RESULTS: Six weeks after surgery, 120 degrees of flexion and brace-free ambulation were the goals and were achieved at a mean of 7.2 and 7.7 weeks, respectively. By 6 months, all patients reached their preinjury levels of activity (eg, basketball, softball, Rocky Mountain tour guide), 40 had full active extension, and 10 lacked 3 degrees to 10 degrees of active extension. There were no postoperative complications. At a mean follow-up of 4 years (range, 1-12 years), the Lysholm scores averaged 92 points (range, 84-100 points), and there were 35 excellent, 15 good, and no fair or poor results. CONCLUSION: Quadriceps and patellar tendon repairs protected by a relaxing suture were strong enough to safely permit early motion, weightbearing, and brace-free ambulation while producing good and excellent results.

Augmentation of posterior wall acetabular fracture fixation using calcium-phosphate cement: a biomechanical analysis.

OBJECTIVE: This study investigates if the use of calcium phosphate cement as an adjunct to internal fixation for posterior wall acetabular fracture will result in acute restoration of joint loading parameters to the intact condition. METHODS: Ten fresh-frozen cadaveric pelves were used for this investigation. Simulated abductor mechanism was used to load the hip. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum for all experimental conditions. The hips were loaded under the following 4 conditions: 1) intact; 2) following posterior wall osteotomy; 3) following reduction and standard internal fixation; and 4) following reduction of the posterior wall using calcium phosphate cement, as a grout, in addition to internal fixation. A posterior wall fracture was created along an arc of 40-90 degrees about the acetabular rim. Extensometers were utilized to measure posterior wall fragment micromotion under conditions 3 and 4 above. Statistical analysis was performed using multivariate analysis of variance to assess the significance of the difference among and between conditions simultaneously for each region. Fragment motion data were analyzed using a 2-tailed t test. RESULTS: Fragment micromotion was reduced to 78 microm superiorly and 46 microm inferiorly with the use of calcium phosphate cement (P < 0.05). Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1201N) as compared to the intact condition (902N, P = 0.024). Following reduction and internal fixation, the load distributed to the superior acetabulum (1132N) was not statistically different from the displaced condition. Following the addition of calcium phosphate cement, the load seen at the superior region of the acetabulum (883N) was less than fixation without calcium phosphate cement and was not different from the intact state (P = 0.85). CONCLUSION: The use of calcium-phosphate cement as a fracture grout with internal fixation resulted in a partial restoration of joint loading parameters toward the intact state. Further work will be needed to determine if similar types of augmented articular fixation may result in a clinical benefit.