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10.1096/fj.11-183632 147
In addition, folate is necessary in the synthesis of dTMP from dUMP (, )
Missing by 7+ days means you've dropped below steady state and need to restart the weekly cycle
Epidemiology Incidence rare affects female Anatomic location quadriceps tendon rupture is more common than patella tendon rupture (2:1 ratio) Risk factors may see weakening of collagen structure systemic diseases local other Etiology Pathophysiology mechanism of injury tensile overload of the extensor mechanism most ruptures occur with knee in flexed position pathoanatomy 3 patterns of injury pathobiology rupture is usually the result of end stage or long-standing chronic tendon degeneration Associated conditions orthopedic conditions TKA extensor mechanism rupture Anatomy Extensor mechanism of the knee quadriceps tendon patella patellar tendon tibial tubercle infrapatellar fat pad retinacular structures (medial and lateral inferior geniculate arteries) Biomechanics Forces in patellar tendon ascending stairs is 3x body weight to rupture a normal tendon is 17x body weight Classification Anatomic incomplete tear intact extensor mechanism in some cases can be treated noperatively complete tear patella alta with palpable defect treated with surgical repair Presentation History history of jumping event with sudden quadriceps contraction with knee in a flexed position (e.g., jumping sports, missing step on stairs) patient will often hear/feel a popping sensation Symptoms infrapatellar pain immediate swelling difficulty weight-bearing Physical exam inspection elevation of patella height usually associated with a large hemarthrosis and ecchymosis localized tenderness palpable gap below the inferior pole of the patella motion reduced ROM of knee (and difficulty bearing weight) due to pain provocative tests straight leg raise Imaging Radiographs recommended views AP and lateral of the knee optional views merchant or skyline findings patella alta seen in complete rupture various measurements indicating patella alta MRI indications differentiate partial from complete tendon rupture most sensitive imaging modality findings site of disruption, tendon degeneration, patellar position, and associated soft tissue injuries Ultrasound indications suspected acute and chronic injuries findings effective at detecting and localizing disruption operator and user-dependent Diagnosis Complete tears can be confirmed by physical exam and radiographs for complete tears
Review: Microbial transformations of human bile acids
