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Knee: J. R. W. Hardy, M. Chimutengwende-Gordon, and I. Bakar Rupture of the quadriceps tendon: AN ASSOCIATION WITH A PATELLAR SPUR J Bone Joint Surg Br 2005; 87-B: 1361-1363 [Abstract] [Full text] [PDF]

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Author's reply:

John RW Hardy   (18 January 2006)

Radiology of Quadriceps tendon rupture

Harish V Kurup, Preethy Nath   (27 October 2005)

Author's reply: 18 January 2006
John RW Hardy, Consultant Surgeon BUPA Bristol Send letter to journal: Re: Author's reply: John{at}JohnHardy.co.uk John RW Hardy	Author's reply: Sir, I am delighted with Mr Kurup's interest in our paper. To answer his questions: 1. I thank him for spotting the error in table III, which occurred during the final stages of Production. However, the percentage is correctly quoted in the text; the sensitivity of spurs in picking up a rupture of the quadriceps tendon is 23 of 29 (79.3%). 2. This was indeed a retrospective study. The crux of the problem lies in the ability of the doctor to diagnose the quadriceps tendon rupture in A&E where radiology is available and used but ultrasound is not. Ultrasound might be sensitive and specific as an investigative tool but it is not available or cost-effective in this scenario. 3. None had an inferior pole spur. It is my experience that the pathology of patellar tendonitis and jumper’s knee occur in a younger age group and they are due to fatigue failure of the patellar tendon origin. I do not know the aetiology of the superior pole spur in our older population but this is being further investigated. J. HARDY,BSc,MD,FRCS(Orth) Consultant Surgeon, BUPA, Bristol, UK.
Radiology of Quadriceps tendon rupture 27 October 2005
Harish V Kurup, Specialist Registrar in Orthopaedics Ysbyty Gwynedd, Bangor LL57 2PW, Preethy Nath Send letter to journal: Re: Radiology of Quadriceps tendon rupture harishvk{at}yahoo.com Harish V Kurup, et al.	Sir, We read this article with great interest. We have some questions: 1. Table III: The last column gives the number of patients with a patellar spur in quadriceps tendon rupture as 23 and the percentage inside brackets as 29. Is the percentage not 79.3% (23 out of 29)? 2. The authors have looked at patients with extensor mechanism failures retrospectively. What investigation was done in these patients at the time of presentation to confirm the diagnosis? Ultrasound has been described as the most sensitive and specific investigation.1 If that is so, do we need to do an X-ray to look for the spur? The incidence of a superior pole patellar spur in the general population has been reported as 8.4%.2 3. Three patients with patellar tendon rupture in this series had an antero-superior spur. Did any of them have an inferior pole spur? Patellar tendonitis and jumper’s knee are predisposing events in a patellar tendon rupture.3 Harish Kurup, Specialist Registrar Ysbyty Gwynedd, Bangor, North Wales, LL57 2PW. Preethy Nath, SHO in Medicine. References: 1. Bianchi S, Zwass A, Abdelwahab IF, Banderali A. Diagnosis of tears of the quadriceps tendon of the knee: value of sonography. AJR Am J Roentgenol 1994;162:1137-40. 2. Yang BY, Sartoris DJ, Resnick D, Clopton P. Calcium pyrophosphate dihydrate crystal deposition disease: frequency of tendon calcification about the knee. J Rheumatol 1996;23:883-8. 3. Ferretti A, Puddu G, Mariani PP, Neri M. The natural history of jumper's knee. Patellar or quadriceps tendonitis. Int Orthop 1985;8:239-42.