Early quadriceps tendon rupture after primary total knee arthroplasty

Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment.Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture.OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees.DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

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Quadriceps Tendon Rupture After Total Knee Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.d.01910 ◽

2005 ◽

Vol 87 (1) ◽

pp. 37-45 ◽

Cited By ~ 36

Author(s):

Ryan E. Dobbs ◽

Arlen D. Hanssen ◽

David G. Lewallen ◽

Mark W. Pagnano

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tendon Rupture ◽

Quadriceps Tendon ◽

Quadriceps Tendon Rupture ◽

Total Knee

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Extensor mechanism failure in total knee arthroplasty

EFORT Open Reviews ◽

10.1302/2058-5241.6.200119 ◽

2021 ◽

Vol 6 (3) ◽

pp. 181-188

Author(s):

Jimmy Ng ◽

Pau Balcells-Nolla ◽

Peter J. James ◽

Benjamin V. Bloch

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tendon Rupture ◽

Quadriceps Tendon ◽

Extensor Mechanism ◽

Lateral Release ◽

Patella Fracture ◽

Quadriceps Tendon Rupture ◽

Total Knee ◽

Mechanism Function

Extensor mechanism failure in total knee arthroplasty (TKA) can present as quadriceps tendon rupture, patella fracture or patella tendon rupture. Component malrotation, excessive joint line elevation and previous lateral release are some of the risk factors contributing to extensor mechanism failure in TKA. Partial quadriceps tendon rupture and undisplaced patella fracture with intact extensor mechanism function can be treated conservatively. Extensor mechanism failure in TKA with disruption of the extensor mechanism function should be treated operatively as it is associated with poor function and extensor lag. It is recommended that acute repair of patella or quadriceps tendon rupture are augmented due to the high risk of re-rupture. Chronic ruptures of the extensor mechanism must be reconstructed as repair has a high failure rate. Reconstruction can be performed using autograft, allograft or synthetic graft. Cite this article: EFORT Open Rev 2021;6:181-188. DOI: 10.1302/2058-5241.6.200119

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