Updated: 9/6/2018

TKA Extensor Mechanism Rupture

Topic
Review Topic
0
0
Questions
4
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0
Evidence
5
0
0
Techniques
3
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 allograft
      • indications
        • complete laceration of patellar tendon without adequate patellar bone stock and deficient soft tissues
 

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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? Review Topic

QID: 384
FIGURES:
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1

Reconstruction with a bone-tendon allograft

69%

(846/1220)

2

Repair augmented with hamstring autograft

27%

(333/1220)

3

Continued therapy and strengthening

2%

(19/1220)

4

Arthrodesis

1%

(8/1220)

5

Treatment with orthotics for support

1%

(9/1220)

L 3

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