Rupture of the quadriceps or patellar tendons can occur from forceful contraction of the quadriceps muscle or falling on a flexed knee. Patellar tendon rupture occurs most commonly in individuals under age 40 with a history of tendinitis or past steroid injections. Quadriceps tendon rupture is most frequent in the over 40 age group. 7 There is significant pain, diffuse swelling, and the patient is unable to extend a flexed knee against mild resistance in both instances. Depending on the tendon ruptured, a defect may be palpable above or below the patella. A "high-riding patella" may be seen on the lateral x-ray of the knee with patellar tendon rupture ( Fig
266-11). The treatment is surgical repair of the involved tendon22 within the first 7 to 10 days following rupture to achieve the best results. Orthopedic consultation in the emergency department is indicated.
Osteochondritis dissecans is a disorder in which a segment of articular cartilage and subchondral bone become partially or totally separated from the underlying bone. It is a rare condition of unknown etiology that has been thought to result from acute or chronic trauma. It typically is found in adolescents, is generally unilateral, and most often involves the nonweight-bearing lateral aspect of the medial femoral condyle. Patients generally complain of pain and swelling but typically do not recall any specific incident of trauma. The condition can be diagnosed on routine radiographs with tunnel views being particularly helpful. Treatment is conservative with protective weight-bearing if the epiphyses are still open. If the epiphyses are closed and the fragments are detached, the prognosis for healing is poor. Arthroscopy for the retrieval of loose bodies or arthrotomy for pinning or bone grafting of the detached lesions is suggested in this instance. 23
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