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Updated: Feb 24 2024

TKA Extensor Mechanism Rupture

  • summary
    • TKA Extensor Mechanism Ruptures are traumatic periprosthetic injuries that consist of patellar tendon injuries or quad tendon injuries.
    • Diagnosis can be made clinically in a patient with history of a TKA who is unable to perform a straight leg raise. Radiographs may show patella alta or patella baja.
    • Treatment is generally surgical repair versus reconstruction depending on available patella bone stock and chronicity of injury. 
  • Epidemiology
    • Incidence
      • 0.17% to 2.5%
  • Etiology
    • Causes
      • intraoperative
        • avulsion from tibial tubercle
      • postoperative
        • manipulation
        • impingement
        • trauma
  • Presentation
    • Symptoms
      • knee pain and weakness
  • Imaging
    • Radiographs
      • patella alta or baja
  • Treatment
    • Nonoperative
      • knee immobilizer x6 weeks
        • indications
          • partial quadriceps tendon rupture
    • Operative
      • direct repair with suture
        • indications
          • partial patellar tendon avulsion (< 30%)
      • primary repair and augmentation with graft
        • indications
          • complete laceration of patellar tendon with adequate patellar bone stock
      • extensor mechanism reconstruction
        • indications
          • complete laceration of patellar tendon without adequate patellar bone stock and deficient soft tissues
          • chronic extensor mechanism (patella or quadricep tendon) disruption
          • reconstruction with synthetic polypropylene (ie. marlex mesh) has been shown to have similar clinical outcomes at a lower cost than allograft techniques 
      • knee arthrodesis
        • indications
          • salvage option for multiple failures of extensor mechanism reconstruction, especially if complicated by infection
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