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 reconstruction with synthetic polypropylene (ie. marlex mesh) has been shown to have improved 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
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - High Tibial Osteotomy Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Parapatellar Approach Derek T. Bernstein Stephen Incavo Recon - High Tibial Osteotomy Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique Derek T. Bernstein Stephen Incavo Recon - TKA Axial Alignment
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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: A Type & Select Correct Answer 1 Primary quadriceps tendon repair with transosseous tunnels 9% (163/1865) 2 Primary quadriceps tendon repair with suture anchors 9% (177/1865) 3 Primary patellar tendon repair 1% (13/1865) 4 Extensor mechanism reconstruction 78% (1448/1865) 5 Revision total knee arthroplasty with rotating hinge device 3% (50/1865) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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: A Type & Select Correct Answer 1 Reconstruction with a bone-tendon allograft 69% (1195/1738) 2 Repair augmented with hamstring autograft 28% (490/1738) 3 Continued therapy and strengthening 1% (26/1738) 4 Arthrodesis 1% (11/1738) 5 Treatment with orthotics for support 1% (10/1738) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
All Videos (7) Podcasts (1) Login to View Community Videos Login to View Community Videos ICJR 9th Annual Revision Hip & Knee Course Extensor Mechanism Reconstruction with Marlex Mesh (Surgical Technique Video) - Matthew P. Abdel, MD Matthew P. Abdel Recon - TKA Extensor Mechanism Rupture 8/24/2022 14 views 0.0 (0) Login to View Community Videos Login to View Community Videos ICJR 9th Annual Revision Hip & Knee Course TKA Extensor Mechanism Panel Discussion - David Mayman, MD David Mayman Matthew P. Abdel James Browne Nic Bedard Recon - TKA Extensor Mechanism Rupture 8/24/2022 4 views 0.0 (0) ICJR 9th Annual Revision Hip & Knee Course Coin Flips & Controversies: TKA Extensor Mechanism Disruption in 61F Matthew P. Abdel Bryan D. Springer Robert Meneghini Recon - TKA Extensor Mechanism Rupture A 6/10/2022 448 views 4.3 (3) Recon⎪TKA Extensor Mechanism Rupture Recon - TKA Extensor Mechanism Rupture Listen Now 10:25 min 6/4/2020 126 plays 0.0 (0) See More See Less
ICJR 9th Annual Revision Hip & Knee Course TKA Extensor Mechanism Disruption in 61F (C102051) Matthew P. Abdel Recon - TKA Extensor Mechanism Rupture A 5/4/2022 6109 22 30 TKA extensor mechanism failure in 74M (C101411) Wayne Moschetti Recon - TKA Extensor Mechanism Rupture E 3/28/2020 36 11 0 TKA Patellar Tendon Rupture in 72F (C101403) Shaun Patel Recon - TKA Extensor Mechanism Rupture B 3/22/2020 144 8 2