Updated: 6/11/2021

TKA Extensor Mechanism Rupture

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Evidence
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  • 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
          • 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
Technique Guides (3)
Flashcards (4)
Cards
1 of 4
Questions (5)

(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?

QID: 211119
FIGURES:
1

Primary quadriceps tendon repair with transosseous tunnels

9%

(143/1581)

2

Primary quadriceps tendon repair with suture anchors

9%

(143/1581)

3

Primary patellar tendon repair

1%

(10/1581)

4

Extensor mechanism reconstruction

78%

(1227/1581)

5

Revision total knee arthroplasty with rotating hinge device

3%

(45/1581)

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?

QID: 384
FIGURES:
1

Reconstruction with a bone-tendon allograft

69%

(1110/1616)

2

Repair augmented with hamstring autograft

28%

(456/1616)

3

Continued therapy and strengthening

1%

(23/1616)

4

Arthrodesis

1%

(11/1616)

5

Treatment with orthotics for support

1%

(10/1616)

L 3 D

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