Patellar Tendon Rupture Following Total Knee Arthroplasty

Background: Patellar tendon rupture following Total Knee Arthroplasty (TKA) is rare. There is no consensus on optimal treatment. Methods: All patients who underwent a primary repair of a traumatic patellar tendon rupture following a TKA between 2008 and 2016, were retrospectively reviewed. Patient information, implant, repair type (anchor vs. bone tunnel), graft use, and complications were recorded. Results: Twenty-six patients met our inclusion criteria. The average age was 69.7+11 years. There were 19 females (73.1%). The average time from TKA to PT rupture was 13.6 months (range: 0- 135 months). The average incidence was 62.32 per 100,000 TKA. PT was repaired with anchors (A) in 9 (4 with a graft) and trans-osseous tunnels (TO) in 12 (5 required graft), and 5 with other methods. There was a significant improvement in KSS from 61 to 83 (P=0.023). There was a significant difference in time from PT tear to surgery in patients with grafts (42 days) and those without grafts (6 days) (P<0.001). Compared to A repair, TO had 2.39 times odds of re-tear (95% CI: 0.38,15.4; P=0.354) and 1.37 times odds of infection (95% CI:0.074,25.6; P=0.83). Repairs with a graft had a 1.90 times odds of re-tear (95% CI: 0.29, 12.19; P=0.49) and 6.3 time odds of infection (95% CI 0.26, 166.7; P=0.25). Conclusion: Surgical repair of PT tears following TKA leads to significant clinical improvement, regardless of the fixation method or graft use. We found no difference in outcomes between A and TO repairs and or with graft use.

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Neglected patellar tendon rupture after revision total knee arthroplasty

Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology ◽

10.1016/j.asmart.2017.05.073 ◽

2017 ◽

Vol 9 ◽

pp. 41

Author(s):

Cheng-yo Yen

Keyword(s):

Total Knee Arthroplasty ◽

Patellar Tendon ◽

Knee Arthroplasty ◽

Tendon Rupture ◽

Revision Total Knee Arthroplasty ◽

Patellar Tendon Rupture ◽

Total Knee ◽

Neglected Patellar Tendon Rupture

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Traumatic dissociation of the tibial insert with patellar tendon rupture after high-flex posterior-stabilized Genesis II total knee arthroplasty

Revista Brasileira de Ortopedia (English Edition) ◽

10.1016/j.rboe.2017.05.001 ◽

2018 ◽

Vol 53 (5) ◽

pp. 632-635

Author(s):

Sanjay Agarwala ◽

Mayank Vijayvargiya

Keyword(s):

Total Knee Arthroplasty ◽

Patellar Tendon ◽

Knee Arthroplasty ◽

Tendon Rupture ◽

Posterior Stabilized ◽

Patellar Tendon Rupture ◽

Tibial Insert ◽

Total Knee ◽

Genesis Ii

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Arthrodesis with Retrograde Intramedullary Nail for Recurrent Infected Total Knee Arthroplasty with Patellar Tendon Rupture: A Case Report and Literature Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00050 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0005

Author(s):

Chi-Yang Liao ◽

Chun-Li Lin

Keyword(s):

Total Knee Arthroplasty ◽

Patellar Tendon ◽

Knee Arthroplasty ◽

Tendon Rupture ◽

Revision Arthroplasty ◽

Left Knee ◽

Resection Arthroplasty ◽

Patellar Tendon Rupture ◽

Infected Total Knee Arthroplasty ◽

Total Knee

Patellar tendon rupture after total knee arthroplasty is a rare, but often catastrophic complication. In addition, infection is also a dreaded complication after total knee arthroplasty. We report an 84-year-old female that has late infected total knee arthroplasty with patellar tendon rupture treated with resection arthroplasty and then subsequent arthrodesis with retrograde intramedullary nail. Case Presentation: The 84-year-old female underwent left total knee arthroplasty 2 years ago and revision arthroplasty last year after trauma. She presented to the emergency department with painful disability of left knee. The septic arthritis of left knee was confirmed by bacterial culture through arthrocentesis which yielded methicillinsensitive staphylococcus aureus. Patellar tendon rupture was also noted by loss of extension mechanism and patella alta in plain films. Despite attempts on open debridement and parenteral antibiotics, the infection did not settle. Resection arthroplasty with vancomycin- impregnated cement spacer implantation was performed following by 4-week parenteral antibiotics therapy. The ESR and CRP level of serum improved gradually. Arthrodesis of left knee with retrograde locking intramedullary femoral nail through single incision of the knee was performed. Protected weight bearing was allowed in one week after arthrodesis. The patient discharged 2 weeks later without recurrent infection, but leg length discrepancy about 2cm was noted. Discussion: Patellar tendon rupture after total knee arthroplasty is a rare but disabling complication whose management is often difficult. It was reported that incidence of patellar tendon rupture in literature varies between 0.3- 12.4% for primary total knee arthroplasty and between 1-15% for revision total knee arthroplasty. Contributing factors are excessive dissection and knee manipulation, and trauma. In the literature, various different operative techniques and rehabilitation programs have been described indicating the lack of a golden standard treatment protocol. However, in patients with a total knee arthroplasty, the results have been discouraging. Reconstruction of the patellar tendon can be utilized semitendinosus-gracilis graft with an interference screw and a staple fixation in treating acute ruptures, whereas allografts and synthetic mesh are indicated for chronic cases. Nevertheless, treatment outcomes for ruptured patellar tendon are not good. Gold standard treatment of infected total knee arthroplasty was resection arthroplasty with antibiotic-impregnated bone cement spacer and parenteral antibiotics therapy and then second stage revision total knee arthroplasty until the infection is eradicated. The patella tendon repair and second revision arthroplasty were not suggested by Jake et al. Patellar tendon rupture is best treated with primary repair, but infected prosthetic knee with patellar tendon rupture seemed to be more difficult to manage. Arthrodesis but not revision arthroplasty may be the best choice after infection control to improve the patient’s level of function.

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