Background: Early detection and treatment of extensor mechanism Rupture are essential for a long-term functional knee joint. In Chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired Patellar Tendon Rupture. Methods: This study included patients with Chronic Patellar Tendon Rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, wirh 12 cases of Chronic Patellar Tendon Rupture. Patients had a mean age of 34. 4 years (range 18-58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3-132). The mean time of follow-up was 6. 2 years (range 3-9). Cerclage wire reinforcements were applied in nine of the knees and three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles Tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22. 7/84. 5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of Chronic Patellar Tendon Rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

Ipsilateral fractures of the femur and tibia result in a flail knee joint condition referred to as “ floating knee” . Associated knee ligament injuries are common and have been reported to be frequently missed in initial evaluations. We report the diagnosis and treatment of the concomitant Patellar Tendon Rupture during fixation of the distal femur and proximal tibia fractures in a patient who presented with floating knee and a history of osteomyelitis. This case further highlights the paramount importance of careful assessment of the knee in patients who present with floating knee injuries. We also recommend that MRI and ultrasonography be used to prevent ignored Patellar Tendon Ruptures in such patients; particularly when physical exam is challenging or an intra-articular injury is present.

Background and Objective: There has been considerable debate regarding the best treatment of the Achilles Tendon Rupture. One of the nonoperative treatment method for Achilles Tendon Rupture is using the functional brace. The aim of this study was to evaluate the effect of the functional brace with/without Patellar Tendon bearing on treatment of patients with Achilles Tendon Rupture.Materials and Methods: In this semi experimental study, 17 patients with Achilles Tendon Rupture were recruited and randomly allocated into 2 groups: functional brace with Patellar Tendon bearing and functional brace without Patellar Tendon bearing. Pain, plantar and dorsi flexion strength and the required time for progressively increased dorsi flexion position in orthoses to reach the neutral position were measured. Data analyzed with SPSS-13, independent t-test and Smironov-Kolomogrov.Results: Three patients were excluded during follow up and finally this study was done on 14 patients. The difference of the pain intensity and the plantar and dorsi flexion, in each group, before and after the intervention was significant (P<0.05), but the difference between two groups after intervention in all variables was not significant.Conclusion: This study showed that both brace with/without Patellar Tendon bearing are effective on improvement of pain and the plantar flexion and dorsi flexion strength and also are effective in required time to reach the neutral position.

Background: Large defects in Chronic Achilles Tendon Ruptures are difficult to rapair. The purpose of this study was to evaluate the clinical and functional outcomes following reconstruction of the Chronic large gaps in Achilles Tendon ruture using free semitendinosus interposition Tendon grafting.Methods: In a case series study, eleven male patients with mean age of 30±4 years and average defect size of 8.31±1.96 cm in their old Achilles Tendon underwent reconstruction during 6 years in a teaching hospital in Tehran-Iran. Ipsilateral semitendinosus free Tendon graft was used for reconstruction. The cases were evaluated by Ankle-Hindfoot Scale of American Orthopaedic Foot and Ankle Society (AOFAS), and the Achilles Tendon Rupture Score (ATRS) to with a mean follow-up of 25.36±3.3 months.Results: The pre-operative AOFAS and ATRS of 70.4±5.3 and 31.7±5.7 preoperatively improved to 91.8±4.8 and 88.7±4.2 values. The ankle dorsiflexion showed a significant decline-postoperative value of 13.5±4.2 degrees compared to preoperative of 17.2±3.9 degrees (p=0.04). All the cases except a professional athlete, returned to their previous activities.Conclusion: This technique offers good clinical and functional results in patients with large defects and is associated with no donnersite morbidity. We recommend this technique for the reconstruction of the Chronic at Ruptures in patients with over 6 cm defects.

Traumatic bilateral Patellar Tendon Rupture (BPTR) is a rare injury with low levels of clinical suspicion, especially in young adults. Since early diagnosis of the BPTR is the cornerstone of a successful management, BPTR reports are valuable as they raise awareness of the careful clinical and radiologic workout in similar cases. Here, we present a case of BPTR in a 34-year-old male following a motorcycle accident. At the emergency department, the necessary examinations including clinical, physical, and radiologic tests were performed and BPTR was diagnosed accordingly. The patient underwent reconstruction surgery the day after the injury. At the last follow-up, the patient was able to perform active straight leg raise with 130° flexion and no extension lag. The superior results of BPTR reconstruction in this report further emphasize the importance of early diagnosis and repair of BPTR. Active straight leg raise test is necessary to perform for all patients with a history of an eccentric load of the knee extensor mechanism, and if positive, extensor mechanism Rupture should be strongly suspected.

Background: Bilateral Rupture of the Patellar Tendon is a very rare injury, which takes place in relation to Chronic systemic diseases. These injuries are known causes. Some of these causes are particular in Patellar Tendon Rupture and another are in quadriceps Tendon Rupture. Case presentation: 70-year-old diabetic man with simultaneous bilateral Patellar Tendon disruption of proximal insertion without trauma, receiving long-term hemodialysis. Conclusions: In the present study, we report a case of Patellar Tendon Rupture that has two differences with literature: first, renal failure is a known risk factor for quadriceps Tendon Rupture, and secondly, the prevalent age of Patellar Tendon Rupture is less than 40 years. Clinical picture, diagnosis, pathogenesis and treatment are discussed. Finally, the literature is reviewed based on previous studies.

Background: Spontaneous Rupture of Tendon is a rare disease that often occurs following an underlying disease or drug usage. However, the association of this condition with primary hyperparathyroidism has rarely been reported.Case: In a case-study, two cases of spontaneous Tendon Rupture associated with primary hyperparathyroidism are reviewed. The first one is a middle-aged woman that due to bilateral Patellar Tendon Rupture is operated for secondary repair and augmentation of Tendons. The second one is a middle-aged man with unilateral triceps brachii Tendon Rupture who has been operated for primary Tendon repair. Conclusion: Since paramount force is needed for Tendon Rupture, in spontaneous Tendon Rupture cases, patient evaluation for detecting underlying diseases and drug usage is necessary. In cases that the history of an underlying disease is not indicated, evaluation of serum level concentrations of Ca, P, ALP, and PTH is recommended for contraindication of primary hyperparathyroidism.