膝関節炎を伴った大腿四頭筋腱付着部部分断裂の1例

Partial Tear of the Quadriceps Tendon at its Patella Insertion with Arthritis in the Knee. Case Report

　膝関節炎を伴った大腿四頭筋腱付着部部分断裂の1例について経験した．症例は49歳の男性で，飛び越えようとしたパイプ柵に右膝が屈曲位に当たり転倒し，その後から徐々に疼痛の増悪を認め歩行困難となった．初診時，右膝は伸展位に固定され，他動で屈曲させようとすると膝蓋上部に激痛を訴えた．MRIでは大腿四頭筋膝蓋骨付着部に腫瘤を認めた．関節鏡で同部位に肉芽形成と四頭筋腱付着部の部分断裂を認めた．鏡視下に腱断端部を新鮮化した後，切開し断裂部を膝蓋骨上縁後方に作成した骨孔に縫着させた．膝関節炎の所見は腱の部分断裂による慢性炎症が原因と考えられた．

　We report a case of partial rupture of the quadriceps tendon at its patellar insertion and arthritis of the knee joint.　The patient was a 49-year-old man who struck his right knee on a pipe fence as he attempted to jump over it with his right knee in flexion and fell to the ground.　The pain in his knee gradually increased, and he difficulty walking.　During the initial examination, his right knee was in extension, and he complained of acute suprapatellar pain when he attempted to flex his knee.　MRI revealed a mass in the quadriceps tendon at its patellar insertion.　Arthroscopic examination of the knee joint revealed a partial tear of the quadriceps tendon and granulation at its patellar insertion.　The tendon was thoroughly debrided arthroscopically until healthy tendon was encountered.　Next, the quadriceps tendon was incised, and the torn part of the tendon was reattached anatomically through drill holes created in the posterior aspect of the superior pole of the patella.　The arthroscopic appearance of the arthritic knee was consistent with chronic inflammation caused by partial rupture of the tendon.