Knee Osteoarthritis with Chronic Quadriceps Tendon Rupture Treated with Total Knee Arthroplasty and Extensor Mechanism Allograft Reconstruction

Piatek, Allison Z; Lee, Patrick; DeRogatis, Michael J; Boyajian, David A; Issack, Paul S.

doi:10.2106/jbjs.cc.17.00277

Cited by 4 publications

(11 citation statements)

References 8 publications

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“…(2017) Ormaza et al 3 2 M 1 F 67,5 One patient experienced trauma 1 year after TKA revision surgery; one patient 6 months after TKA revision surgery; one patient 2 years after TKA revision surgery 148 days Full thickness One of them had a hystory of hemochromatosis End-to-end sutures No. 5 Ethibond and reinforcement with MUTARS synthetic mesh None [ 35 ] Knee osteoarthritis with chronic quadriceps tendon rupture treated with total knee arthroplasty and extensor mechanism allograft reconstruction: a case report. (2018) Piatek et al 1 M 51 Traumatic fall 90 days Chronic full-thickness and QT retraction Tricompartmental knee osteoarthritis TKA + complete knee extensor mechanism allograft None [ 45 ] Delayed reconstruction of a quadriceps tendon.…”

Section: Resultsmentioning

confidence: 99%

“…(2016) Nodzo et al 7 2 M 5 F 56 Diabetes, rheumathoid arhtritis, chronic pulmonary disease with steroid use, HCV, drug abuse, smoke, chronic renal failure [ 44 ] Chronic quadriceps tendon rupture after total knee arthroplasty augmented with synthetic mesh. (2017) Ormaza et al 3 2 M 1 F 70 Hemochromatosis [ 35 ] Knee osteoarthritis with chronic quadriceps tendon rupture treated with total knee arthroplasty and extensor mechanism allograft reconstruction: a case report. (2018) Piatek et al 1 M 51 Tricompartmental knee osteoarthritis [ 45 ] Delayed reconstruction of a quadriceps tendon.…”

Section: Resultsmentioning

confidence: 99%

“…Tendon augmentation with an allograft was used in 13 patients (13%), mostly in QTRs after prior TKA, and Achilles tendon (AT) bone block allografts were most frequently used (ten patients, 11%): Wise et al and Lim et al treated six and three patients respectively with an Achilles tendon allograft, showing better results compared to the full extensor mechanism allograft reported by Burnett et al [ 31 ] Even though the Achilles tendon is often considered the most suitable allograft option, the patients included in the current study treated with AT allografts reported an average 12° extensor lag at follow-up, with graft failure from deep infection in one case (1%) [ 32 – 34 ]. Complete extensor-mechanism allografting was performed in two patients (2%), with no extension lag, full active extension, and no further complications except for a skin ulcer in one case [ 22 , 35 ]. One patient (1%) was treated with a tibialis anterior allograft, showing good functional results at the latest follow-up [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…(2006) Leopardi et al 1 M 28 Car accident 210 days Full-thickness tear of the quadriceps tendon proximal to the superior pole of the patella Anabolic steroid use QT reconstruction using gracilis and semitendinosus autograft [ 42 ] Neglected ipsilateral simultaneous ruptures of patellar and quadriceps tendon (2015) Karahasanoglu et al 1 M 40 Fall from a standing height 730 days Chronic full-thickness and QT retraction Ipsilateral patellar tendon rupture Peroneus longus autograft [ 43 ] Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure. (2007) Kazimoglu et al 1 F 37 Two consecutive falls 60 days bilateral QT ruptures Chronic renal failure, with hemodialysis dependence for 2 years Tycron transpatellar suture anchors [ 35 ] Knee osteoarthritis with chronic quadriceps tendon rupture treated with total knee arthroplasty and extensor mechanism allograft reconstruction: a case report. (2018) Piatek et al 1 M 51 Traumatic fall 90 days Chronic full-thickness and QT retraction Tricompartmental knee osteoarthritis TKA + complete knee extensor mechanism allograft [ 45 ] Delayed reconstruction of a quadriceps tendon.…”

Section: Discussionmentioning

confidence: 99%

“…(2018) Wise et al 6 3 M 3 F 68 Full extensor mechanism [ 22 ] Bilateral extensor mechanism allograft reconstruction for chronic spontaneous rupture: a case report and review of the literature. (2019) Lamberti et al 1 F 51 480 days [ 35 ] Knee osteoarthritis with chronic quadriceps tendon rupture treated with total knee arthroplasty and extensor mechanism allograft reconstruction: a case report. (2018) Piatek et al 1 M 51 90 days Fig.…”

Section: Discussionmentioning

confidence: 99%

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Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

et al. 2021

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Background Chronic ruptures, ruptures following total knee arthroplasty (TKA), and re-ruptures of the quadriceps tendon (QT) are rare. A systematic review of the current literature was conducted on their treatment and outcome to provide evidence-based indications for their management. Methods We searched published articles in English on chronic ruptures of QT, QT ruptures that occurred after TKA, and re-ruptures in PubMed, Scopus, and Google Scholar up to January 2021. Twenty-five articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Data from 25 articles (97 patients) with a mean age of 57 were retrieved. Patients were classified into three groups depending on the type of rupture: 16 patients suffered chronic QTR, 78 a QTR after a TKA, and 9 patients reported a re-rupture. The most frequent surgical approaches were different for each group: Codivilla’s Y-V technique and end-to-end sutures were the most commonly used in the chronic tears group (62.5%), synthetic MESH was the most frequent choice in QTR after a TKA group (38 patients, 53%), while end-to-end sutures were the first choice in the re-rupture group (4 patients, 44%). Conclusions Complex ruptures of the QT can be chronic ruptures, re-ruptures, or ruptures occurring after TKA. The choice of the best surgical technique depends on the macroscopic quality of the tendon stumps rather than the timing of intervention. Evidence-based preventive and therapeutic strategies should be developed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

et al. 2021

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Combined quadriceps tendon reconstruction and total knee replacement with computer navigation: a case report

et al. 2022

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Background Chronic quadriceps tendon rupture is technically challenging for surgeons due to scarring and tendon retraction. The presence of concurrent ipsilateral knee osteoarthritis compounds the issue even further. Although a combined presentation is rare, treatment options to manage each coexisting pathology simultaneously are scarcely reported. We describe the case of a 67-year-old Caucasian male who had such a presentation, and was subsequently treated with a one-stage extensor mechanism autograft reconstruction and total knee replacement with computer navigation. Case The patient was a 67-year-old male Caucasian, who had previously sustained an acute rupture of his right quadriceps tendon that was adequately repaired 6 months prior. Despite an initial satisfactory result, he reported deterioration in his mobility in the few months thereafter, with worsening knee pain. His comorbidities consisted of hypertension, asthma, and a body mass index of 40.4 kg/m2. Otherwise, there were no risk factors for tendon rerupture. Clinical examination later revealed a large palpable gap in the right suprapatellar region and weakness of active knee extension. No traumatic cause for this new presentation was identified. Suspicion of a chronic quadriceps tendon rupture was confirmed on radiological imaging, but the investigations also noted the presence of severe tricompartmental osteoarthritis of the ipsilateral, native knee joint. The combined procedure took place in one surgical sitting. The total knee replacement with patella resurfacing was performed first and assisted by computer navigation. The quadriceps tendon reconstruction was then conducted sequentially using the patient’s hamstring tendons (semitendinosus and gracilis). The tensile strength was reinforced with use of a Ligament Augmentation and Reconstruction System (LARS) ligament. Initial outcomes were excellent, and these results were maintained at 6 months postoperatively, with the patient reporting no pain and having full range of movement. Conclusion Our techniques used have not previously been reported, but are successful options in treating coexisting chronic quadriceps tendon rupture and ipsilateral knee osteoarthritis. The advantage of using computer navigation with an extramedullary femoral jig can lead to improved accuracy of bone cuts, which is important in the presence of anatomical disruption. Chronic failures of the extensor mechanism require different approaches depending on the inherent and underlying pathology. We feel that the multidisciplinary team approach to the management and use of two surgeons with differing expertise added to the successful outcome of this complex case.

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Chronic Quadricep Tendon Rupture Reconstruction with Poly-Tape and Achilles’ Tendon Allograft: A Case Report and Review of the Literature

Permutt,

Tsamados,

Patel

2023

JOCR

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Introduction: Chronic rupture of the quadriceps tendon is an uncommon but debilitating injury, seen only in 1.37/100,000 patients per annum. The problems associated with this injury are the inability to walk due to disruption of the extensor mechanism and pain. There is limited literature on the reconstruction methods for this injury. This study aims to provide a case report and review of similar cases, using artificial tape and allograft. Case Report: A 60-year-old male patient was operated on for chronic quadriceps tendon rupture after falling on his knee with forced flexion. The surgical management in our case consisted of mobilization of the proximal quadriceps tendon and muscle belly with a V-Y tendon plasty, advancement of the tendon, and repair using the Krakow technique through intraosseous patellar tunnels, augmented with Poly-Tape (Neoligaments©) and an Achilles’ tendon allograft. This was used due to poor patient tissue quality and the extent of the defect. We also searched the literature for chronic quadriceps tendon ruptures reconstruction using poly tape or Achilles’ tendon allograft. Conclusion: Chronic quadriceps tendon rupture repairs have relatively poor outcomes, and no surgical procedure has been proven to be the gold standard treatment. We believe the novel combination of Poly-Tape supplemented with Achilles’ tendon allograft produces a structurally competent reconstruction in patients with poor tissue quality and large defects and produced good results in our case report. Keywords: Poly-Tape, quadriceps tendon rupture, Achilles’ tendon allograft.

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Knee Osteoarthritis with Chronic Quadriceps Tendon Rupture Treated with Total Knee Arthroplasty and Extensor Mechanism Allograft Reconstruction

Cited by 4 publications

References 8 publications

Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

Combined quadriceps tendon reconstruction and total knee replacement with computer navigation: a case report

Chronic Quadricep Tendon Rupture Reconstruction with Poly-Tape and Achilles’ Tendon Allograft: A Case Report and Review of the Literature

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