Review Question - QID 384

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TKA Extensor Mechanism Rupture Treatment Operative QID: 384 (OBQ06.198)

QID 384 (Type "384" in App Search)

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?

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Reconstruction with a bone-tendon allograft

68%

1406/2056

Repair augmented with hamstring autograft

28%

582/2056

Continued therapy and strengthening

35/2056

Arthrodesis

12/2056

Treatment with orthotics for support

12/2056

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The patient has a chronic patellar tendon rupture following a TKA with marked extensor lag and patella alta on radiograph. A study by Barrack et al concluded that allograft reconstruction for the chronically-disrupted extensor mechanism after TKA could restore active extension and improve ambulatory function. In chronic cases, primary repair with or without local tissue augmentation have had disappointing results. Extensor mechanism injuries after TKA was reviewed by Parker et al. Patellar tendon ruptures are rare complications after TKA with an incidence reported <2.5%. Quadriceps tendon ruptures are even more rare with an incidence ~1%.