# Key Factors Influencing Surgical Outcomes in Quadriceps Tendon Rupture: A 16-Year Case Series From a High-Volume Tertiary Trauma Centre

## TL;DR

This study examines factors affecting surgical outcomes for quadriceps tendon ruptures, finding that diagnostic methods and time to surgery influence results, but surgical techniques do not.

## Contribution

The study identifies key clinical factors influencing outcomes in quadriceps tendon rupture repair over a 16-year period at a high-volume trauma center.

## Key findings

- X-ray and ultrasound combination is most sensitive for diagnosis, but X-ray-only reduces surgery wait times.
- Time to surgery averaged 11 days, with no significant difference in recovery outcomes between surgical techniques.
- Male predominance and age-related risk are confirmed, with no impact of surgical method on post-operative range of motion.

## Abstract

Background

Quadriceps tendon rupture (QTR) causes significant functional impairment, with recent studies showing an increasing incidence of these injuries. A delay in diagnosis significantly impacts outcomes, necessitating prompt diagnosis and treatment. This case series, spanning 16 years at a tertiary centre, examines factors influencing surgical outcomes, focusing on evaluating the correlation between diagnostic methods, time to surgery (TTS), surgical techniques and post-operative outcomes.

Methods

We conducted an observational retrospective cohort study with data collected from a trauma registry and physiotherapy records. Study variables were identified through a literature search and expert consultation. Data were gathered based on pre-, intra- and post-operative factors that could impact patient outcomes. Pearson correlation and analysis of variance (ANOVA) were used for statistical analysis; statistical significance was defined as p < 0.05.

Results

Forty-six patients (predominantly men, aged 50-70 years) were included, with falls on a flexed knee the most likely aetiology. Choice of imaging significantly influenced TTS (p = 0.0148). A combination of X-ray and ultrasound scan (USS) proved most sensitive for diagnosis, although X-ray-only diagnosis resulted in shorter surgery wait times. TTS averaged 11 days, with over 52% waiting >72 hours. More than 90% of tears were osteotendinous, with transosseous tunnels (TT) (63%) being the predominant approach. No significant difference was seen in post-operative range of motion (ROM) or recovery time between surgical techniques.

Conclusion

This series evaluates the impact of imaging modalities, surgical methods and TTS on functional outcomes post-QTR repair. Our results reinforce the male predominance and age-related risk of QTR. Comparable outcomes were observed across different surgical techniques, and surprisingly, early and delayed surgeries showed no differing effect on post-operative outcomes. We highlight the delay to surgery when USS is involved in the diagnostic workup. Future research should investigate whether optimising clinical assessment and X-ray interpretation can negate the need for USS in diagnosis, thereby reducing wait times.