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Case Reports
. 2020 Jun 26:14:142-144.
doi: 10.1016/j.jcot.2020.06.009. eCollection 2021 Mar.

Management of chronic quadriceps rupture with novel "chariot suture technique": A case report and review

Jitendra Wadhwani  1 , Sumedha Vashishth  2 , Himanshu Bansal  1
Affiliations
Case Reports

Management of chronic quadriceps rupture with novel "chariot suture technique": A case report and review

Jitendra Wadhwani et al. J Clin Orthop Trauma. .

Erratum in

Abstract

Quadriceps tendon is one of the important segment of knee extensor mechanism. Acute ruptures are more common than chronic ruptures and have better outcomes. Chronic ruptures are rare with lot of surgical challenges including tendon retraction, fibrosis, degenerative calcification. We present a rare case of a 48 year old male diabetic patient with history of fall eight months ago and chief complaint of inability to actively extend his left knee. Diagnosis was made clinically and was confirmed radiologically with MRI. Surgical management was done with the use of novel "Chariot Suture Technique". It involves use of three Krakow whipstitches with Ethibond No. 5 suture across the distal ruptured end of quadriceps tendon and their intraosseous passage through patella in longitudinal fashion followed by tying knot at the distal pole of patella. The formation of Chariot makes the construct stable. At one year follow up patient was actively able to extend the knee with good range of motion. The technique is relatively cost effective, has no donor site morbidity, easy to learn and practice.

Keywords: Chariot suture technique; Chronic quadriceps rupture; Krakow whipstitches.

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Figures

Fig. 1
Fig. 1
a: Quadriceps tear just above the superior pole of patella in knee extension. b: Tear length increases with passive knee flexion, showing trochlear notch of distal femur.
Fig. 2
Fig. 2
Three Krakow whipstitches (lateral, middle and medial) passed through patellar intraosseous tunnel to distal pole of patella. (Chariot formation).
Fig. 3
Fig. 3
Repair of quadriceps tear with chariot suture technique and retinacular repair with multiple epitendinous sutures.
Fig. 4
Fig. 4
a: Full extension of left knee from front showing healed surgical scar mark. b: Active full extension of left knee from side at one year follow up. c: Active flexion of left knee from side, showing good range of motion at one year follow up.
See this image and copyright information in PMC

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