Extensor tendon ruptures after total knee arthroplasty

Abstract

Extensor tendon rupture is a rare but serious complication after total knee arthroplasty (TKA) that impairs active knee extension, thereby severely affecting knee function. Surgery is usually required. Surgical options range from simple suturing to allograft reconstruction of the entire extensor mechanism and include intermediate methods such as reconstruction using neighbouring tendons or muscles, synthetic ligament implantation, and partial allograft repair. Simple suturing carries a high failure rate and should therefore be routinely combined with tissue augmentation using a neighbouring tendon or a synthetic ligament. After allograft reconstruction, outcomes are variable and long-term complications common. Salvage procedures for managing the most severe cases after allograft failure involve reconstruction using gastrocnemius or vastus flaps. Regardless of the technique used, suturing must be performed under tension, with the knee fully extended, and rehabilitation must be conducted with great caution. Weaknesses of available case-series studies include small sample sizes, heterogeneity, and inadequate follow-up duration. All treatment options are associated with substantial failure rates. The patient should be informed of this fact and plans made for a salvage option. Here, the main techniques and their outcomes are discussed, and a therapeutic strategy is suggested.

Late reconstruction of the patellar tendon in rheumatoid arthritis using bone-patellar tendon-bone allograft

“…It is very important to ensure that the tension on the graft is adequate. Otherwise, there will be a flexion deficit if the tension is excessive or inability to properly extend if the tension is insufficient [12]. The persistence of patella alta after surgery, as in our case, has been reported [7], [15].…”

“…There are various types of grafts and it is of a paramount importance to choose wisely. Despite their limited availability and higher risk of infection, synthetic allografts have been used in patellar tendon reconstruction [11], [12]. Achilles tendon and BTB allografts have also been studied [12], [13].…”

“…Despite their limited availability and higher risk of infection, synthetic allografts have been used in patellar tendon reconstruction [11], [12]. Achilles tendon and BTB allografts have also been studied [12], [13]. Several studies investigated the utilization of contralateral semitendinosus tendon with or without the gracilis tendon and BTB autografts with various success rates [7], [9].…”

Periprosthetic fractures of the knee: a comprehensive review

“…If there is a stable implant but a disrupted extensor mechanism, the fracture involves one of the poles of the patella. To avoid fragmentation of the residual bone, it is advised to leave the implant in place and reconstruct the extensor apparatus [36]. If there is a more severe fracture that involves loosening of the implant, then the condition of the bone stock should be examined.…”

Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

“…The repair is tensioned and the sutures tied over the superior pole of the patella. Use of this simple suture technique has been associated with failure rates requiring reoperation as high as 66% in rupture after TKA [2,17,34], but no failure data have been clearly reported for suture repair of acute ruptures of native knees. The feared complication of catastrophic repair failure historically has led many surgeons to recommended a period of postoperative knee immobilization in extension to decrease the strain across the repair [13,20,22,30,33,37]; however, the benefits of early motion have been shown to include adhesion reduction, improved knee motion, and promotion of tendon healing with earlier remodeling of collagen fibers and increased collagen filaments crosslinking and strength [8-10, 21, 24, 31, 38].…”