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Relationship Between Hypovascular Zones and Patterns of Ruptures of the Quadriceps Tendon
Horacio Yepes, MD1; Maolin Tang, MD2; Steven F. Morris, MD, MSc, FRCS(C)3; William D. Stanish, MD, FRCS(C)1
1 Fenwick Medical Centre, 5595 Fenwick Street, Suite 311, Halifax, NS B3H 4M2, Canada. E-mail address for H. Yepes: yepeshoracio@yahoo.ca. E-mail address for W.D. Stanish: wstanish@ns.sympatico.ca
2 Dalhousie University, Sir Charles Tupper Building, 13th Floor, Halifax, NS B3H 4H7, Canada. E-mail address: mltang001@hotmail.com
3 QEII Health Sciences Centre, 1796 Summer Street, Room 4443, Halifax, NS B3H 3A7, Canada. E-mail address: sfmorris@dal.ca
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Queen Elizabeth II Research Foundation, Halifax, Nova Scotia. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Dalhousie University, Halifax, Nova Scotia, Canada

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Oct 01;90(10):2135-2141. doi: 10.2106/JBJS.G.01200
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Background: Compromised vascularity and hypoxia have been proposed as risks for tendon ruptures. The density of vascularity of the quadriceps tendon may explain the pattern of ruptures of this muscle-tendon unit.

Methods: Twenty adult human cadavers underwent whole-body arterial perfusion with a mixture of lead oxide, gelatin, and water through the femoral artery. Thirty-three quadriceps tendons were dissected and radiographed, and each angiogram was analyzed with use of image statistical software.

Results: We consistently identified a hypovascular zone located between 1 and 2 cm from the superior pole of the patella. This finding correlates with the location of spontaneous ruptures of the quadriceps tendon reported in the literature. These findings indicate that the vascular supply of the quadriceps tendon is separated into three arcades, or arches, which are medial, lateral, and peripatellar.

Conclusions: Hypovascularity may determine the site of spontaneous ruptures of the quadriceps tendon.

Clinical Relevance: Understanding the vascular zones of the quadriceps tendon may facilitate the use of nonoperative as well as operative treatments to increase the vascularity of the tendon. An understanding of the vascular arcades may facilitate and enhance healing following reparative and reconstructive surgery on the tendon.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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