Giant cell tumor of the tendon sheath extending around the patellar tendon and invading the knee joint and tibia: A case report
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The current report presents the case of a 41-year-old male exhibiting a giant cell tumor of the tendon sheath (GCT-TS) arising from the patellar tendon sheath. Plain radiography and magnetic resonance imaging revealed a well-localized mass that wrapped around the patellar tendon, and extended from the subcutis into the infrapatellar fat pad and tibia. Following histopathological determination of the diagnosis, a piecemeal resection was performed. Nodular-type GCT-TS occurs less frequently in large joints compared with the small joints of the fingers and toes. The current report presents the unique features of a case of GCT-TS extending around the patellar tendon, and invading into the knee joint and proximal tibia bone.Keywords:
Tendon sheath
Quadriceps tendon
Infrapatellar fat pad
Patellar ligament
Infrapatellar fat pad
Vascularity
Patellar ligament
Fat pad
Quadriceps tendon
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Abstract Following knee surgery, especially after anterior cruciate ligament (ACL) reconstruction, a small percentage of patients complain about significantly decreased patellar mobility accompanied by anterior knee pain, sometimes severe. The limited mobility and knee pain usually do not disappear even with aggressive physical therapy. Arthroscopic exploration of these knees reveals a closure of the patellar tendon-tibial (PTT) interval, i.e., severe fibrous adhesion of the patellar tendon to the anterior aspect of the tibia, the formation of fibrous tissue between the quadriceps tendon and the femur, and a ‘closed-off’ suprapatellar pouch. Other investigators have also noted such adhesion (Paulos et al., 1987 & 1994; Jacobson et al., 1989), and Hughston (1985) attributed the tendon adhesion to the scarring of infrapatellar and suprapatellar fat pad caused by the surgery. While the adhesions are important clinical problems associated with knee surgery, no study to date, other than our experimental study on patellar tendon contracture, has quantitatively investigated the effect of these adhesions on knee kinematics and contact forces (Ahmad et al., 1997). In this study, we use a 3-D mathematical model of the knee joint to analyze the effects of the patellar tendon adhesion (PA) to the anterior tibia, and the quadriceps tendon adhesion (QA) to the anterior femur. Our objective, therefore, is to demonstrate the effects of these types of post-operative adhesions on patellofemoral joint mechanics.
Quadriceps tendon
Infrapatellar fat pad
Patellar ligament
Anterior knee pain
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Infrapatellar fat pad
Patellar ligament
Quadriceps tendon
Fat pad
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Rupture of the patellar tendon following TKA is fortunately an uncommon complication with an incidence of 0.2-4% (Abril et al. 1995). Numerous options have been reported for treating this complication, including primary suture into a bone trough (Abril et al. 1995), autogenous tendon transfer (Cadambi and Engh 1992), and use of an artificial ligament (Fujikawa et al. 1994). Allograft patellar tendon has also been utilized either retaining the host patella and using a bone-tendon-bone graft or excising the host patella and using a quadriceps tendon-patella-patellar tendon-tibial tubercle graft (Emerson et al. 1990, Emerson et al. 1994, Zanotti et al. 1995, Booth et al. 1999). All of these techniques require structural integrity of the proximal tibia in the area of the tibial tubercle in order to attach the repair or graft to restore continuity of the extensor mechanism. When there is massive osteolysis and bone loss involving the proximal tibia, the situation becomes more complex and the previously described techniques are not advisable. In such cases, function can be obtained with a composite allograft of proximal tibia-patellar tendon-patella-quadriceps tendon. We describe a technique for dealing with this difficult clinical situation.
Quadriceps tendon
Patellar ligament
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Infrapatellar fat pad
Arthrofibrosis
Fat pad
Quadriceps tendon
Patellar ligament
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Objective To provide anatomy data of the tendon of quadriceps femoris for reconstructing cruciate ligament of knee joint.Methods On 10 adult cadavaric lower limb specimens(20 knee joints),anatomic features of the patellar insertion of quadriceps femoris tendon were investigated.The length and width of the tendon of rmusculus rectus and the thickness of upper patellar pole were measured respectively.Results The patellar insertion width of rectus femoris was about(3.20±0.33)cm,and the original width(1.28±0.25)cm.The length of tendon tissue was(6.96±0.80)cm.The proximal four-fifths of rectus femoris was fully discrete,but the one-fifths of distal end fused with vastus lateralis and vastus intermedius,and formed the quadriceps femoris tendon,which inserted to the three-fourths upper pole anterior aspect of the patella.The average thickness of the upper pole of patella was(2.22±0.14) cm.Conclusions Given of the anatomic features of quadriceps femoris tendon,it is suitable for reconstructing the cruciate ligament of knee joint using this tendon.
Quadriceps tendon
Quadriceps femoris muscle
Patellar ligament
Rectus femoris muscle
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After knee trauma, radiographs showing patella alta supercede other signs that suggest patellar tendon rupture. However, without patella alta the diagnosis may be missed. A standard lateral radiograph with the knee flexed showed the infrapatellar fat pad as a dark band with a smooth contour. Our pilot study identified a disruption of the fat pad contour as a radiographic sign of tendon rupture. Two blinded reviewers independently analyzed randomly selected lateral radiographs of the knees of 14 patients with knee injuries. Seven patients had confirmed ruptures diagnosed at surgery, and the other patients had different diagnoses. There were 12 men and two women with an average age of 49 years (range, 20-81 years). One observer detected five of the seven disrupted tendons and six of the seven intact tendons. The other observer detected six of the seven disrupted tendons and all seven intact tendons. Disruption in the contour of the infrapatellar fat pad on routine lateral view radiographs was a reasonably reliable sign of patellar tendon rupture. Diagnostic accuracy should increase when used with the patient's history, physical examination, and other radiographic signs. Absence of this sign should not supersede other suggestive signs of patella tendon rupture.Diagnostic study, Level II (development of diagnostic criteria on consecutive patients--with universally applied reference "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.
Infrapatellar fat pad
Fat pad
Gold standard (test)
Patellar ligament
Quadriceps tendon
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Purpose Quadriceps fat pad is located posterior to the quadriceps tendon. Increased signal intensity of this fat pad is seen on routine knee magnetic resonance imaging (MRI) examinations, but the exact mechanism and related pathologies are not clear. In this study we aimed to evaluate the relationship between MRI signal intensity and morphological features of quadriceps fat pad, as well as various pathologies of the patellofemoral joint. Material and methods Sixty-one knees with quadriceps fat pad oedema out of 457 knee MRI examinations were included. Quadriceps fat pad signal intensity, dimensions, posterior indentation, and various parameters related to patellofemoral joint such as trochlear facet asymmetry, trochlear depth and sulcus angle, and the Insall-Salvati ratio were evaluated. Results There was no statistically significant correlation between quadriceps fat pad oedema intensity and its dimensions, but it was significant when compared to posterior indentation. There was no correlation between fat pad oedema and each of the pathologies. However, there was a significant correlation between the presence of fat pad oedema and the presence of at least one of the pathologies related to patellofemoral joint. Conclusions Quadriceps fat pad oedema detected in MRI examinations should warn the radiologist against the presence of various pathologies related to the patellofemoral joint.
Infrapatellar fat pad
Quadriceps tendon
Fat pad
Patellofemoral joint
Sulcus
Facet (psychology)
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The current report presents the case of a 41-year-old male exhibiting a giant cell tumor of the tendon sheath (GCT-TS) arising from the patellar tendon sheath. Plain radiography and magnetic resonance imaging revealed a well-localized mass that wrapped around the patellar tendon, and extended from the subcutis into the infrapatellar fat pad and tibia. Following histopathological determination of the diagnosis, a piecemeal resection was performed. Nodular-type GCT-TS occurs less frequently in large joints compared with the small joints of the fingers and toes. The current report presents the unique features of a case of GCT-TS extending around the patellar tendon, and invading into the knee joint and proximal tibia bone.
Tendon sheath
Quadriceps tendon
Infrapatellar fat pad
Patellar ligament
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Infrapatellar fat pad
Patellar ligament
Fat pad
Quadriceps tendon
Blood supply
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Citations (10)