Updated: 3/1/2021

TKA Extensor Mechanism Rupture

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Topic
Review Topic
0
0
N/A
N/A
Questions
4
0
0
0%
0%
Evidence
7
0
0
0%
0%
Cases
2
0%
Techniques
3
Topic
https://upload.orthobullets.com/topic/12310/images/extensor_mechanism_rupture.jpg
Introduction
  • incidence
    • 0.17% to 2.5%
  • 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
        • patellar tendon avulsion < 30%
        • complete quadriceps tendon rupture with adequate soft tissues
    • 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
    • knee arthrodesis 
      • indications
        • salvage option for multiple failures of extensor mechanism reconstruction, especially if complicated by infection

Please rate topic.

Average 3.2 of 17 Ratings

Technique Guides (3)
Questions (4)

(SBQ16HK.1) A 67-year-old active male with a prior total knee arthroplasty presents to clinic with inability to extend his knee after falling while exiting a bus 4 months ago. On examination, he has full passive range of motion but can only extend to 85°. His radiograph is depicted in Figure A. What is the most effective long-term treatment for this patient to regain function? Tested Concept

QID: 211119
FIGURES:
1

Primary quadriceps tendon repair with transosseous tunnels

9%

(117/1345)

2

Primary quadriceps tendon repair with suture anchors

9%

(122/1345)

3

Primary patellar tendon repair

1%

(9/1345)

4

Extensor mechanism reconstruction

78%

(1046/1345)

5

Revision total knee arthroplasty with rotating hinge device

3%

(40/1345)

L 2 B

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(OBQ06.198) A 54-year-old woman is at physical therapy 3 months after a total knee arthroplasty when she feels a pop and develops increased pain in her knee. She continues therapy for another 3 months but reports weakness and frequent buckling. On exam, she has full passive extension but a 60 degree extensor lag. A lateral radiograph is shown in Figure A. What is the treatment of choice? Tested Concept

QID: 384
FIGURES:
1

Reconstruction with a bone-tendon allograft

69%

(1069/1555)

2

Repair augmented with hamstring autograft

28%

(438/1555)

3

Continued therapy and strengthening

1%

(21/1555)

4

Arthrodesis

1%

(10/1555)

5

Treatment with orthotics for support

1%

(10/1555)

L 3 D

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Evidence (10)
VIDEOS & PODCASTS (1)
CASES (2)
EXPERT COMMENTS (1)
Private Note