Extensor Mechanism Disruption in Knee Dislocation

Abstract

Disruption of the knee extensor mechanism is a challenging injury with no clear consensus on optimal treatment. Although rare in the setting of knee dislocations, these injuries should not be overlooked. Acute, complete rupture of either the quadriceps or patellar tendon necessitates primary repair with or without augmentation. Surgical management may also be required in the setting of a partial tear if a significant extensor lag is present or nonoperative treatment has failed. Tendon augmentation is used during primary repair if the native tissue is inadequate or after a failed primary repair. The purpose of this study is to evaluate extensor mechanism disruption incidence, injury patterns, associated injuries, and surgical options, including a novel tendon augmentation technique. This procedure consists of primary patellar or quadriceps tendon repair with semitendinosus autograft augmentation utilizing a distal or proximal patellar socket. Advantages of repair with tendon augmentation include accelerated rehabilitation, decreased risk of patellar fracture from transverse or longitudinal bone tunnels, and less hardware complications. We recommend consideration of this technique for selected cases of acute extensor mechanism disruption in the setting of tibiofemoral dislocation.

Keywords

extensor mechanism disruption - knee dislocation

• References

• 1 Kuechle DK, Stuart MJ. Isolated rupture of the patellar tendon in athletes. Am J Sports Med 1994; 22 (5) 692-695
• 2 Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am 1981; 63 (6) 932-937
• 3 Matava MJ. Patellar tendon ruptures. J Am Acad Orthop Surg 1996; 4 (6) 287-296
• 4 Marder RA, Timmerman LA. Primary repair of patellar tendon rupture without augmentation. Am J Sports Med 1999; 27 (3) 304-307
• 5 Larson RV, Simonian PT. Semitendinosus augmentation of acute patellar tendon repair with immediate mobilization. Am J Sports Med 1995; 23 (1) 82-86
• 6 Hsu KY, Wang KC, Ho WP, Hsu RW. Traumatic patellar tendon ruptures: a follow-up study of primary repair and a neutralization wire. J Trauma 1994; 36 (5) 658-660
• 7 Levy M, Goldstein J, Rosner M. A method of repair for quadriceps tendon or patellar ligament (tendon) ruptures without cast immobilization. Preliminary report. Clin Orthop Relat Res 1987; (218) 297-301
• 8 Gokce A, Ekici H, Erdogan F. Arthroscopic reconstruction of a ruptured patellar tendon: a technical note. Knee Surg Sports Traumatol Arthrosc 2008; 16 (6) 581-584
• 9 Dhinsa BS, Bhamra JS, James C, Dunnet W, Zahn H. Patella fracture after medial patellofemoral ligament reconstruction using suture anchors. Knee 2013; 20 (6) 605-608
• 10 Casey Jr MT, Tietjens BR. Neglected ruptures of the patellar tendon. A case series of four patients. Am J Sports Med 2001; 29 (4) 457-460
• 11 El-Desouky II, Mohamed MM, Al Assassi M. Primary repair of ruptured patellar tendon augmented by semitendinosus. J Knee Surg 2014; 27 (3) 207-213
• 12 Mihalko WM, Vance M, Fineberg MJ. Patellar tendon repair with hamstring autograft: a cadaveric analysis. Clin Biomech (Bristol, Avon) 2010; 25 (4) 348-351
• 13 Moretti L, Vicenti G, Abate A, Pesce V, Moretti B. Patellar tendon rerupture in a footballer: our personal surgical technique and review of the literature. Injury 2014; 45 (2) 452-456
• 14 Harris JD, Fazalare JJ, Phieffer LS, Flanigan DC. Patellar tendon reconstruction with semitendinosus-gracilis autograft. J Knee Surg 2013; 26 (Suppl. 01) S19-S24
• 15 Van der Bracht H, Verdonk R, Stuyts B. Augmentation of a patellar tendon repair with an autologous semitendinosus graft. Acta Orthop Belg 2009; 75 (3) 417-419
• 16 Greis PE, Lahav A, Holmstrom MC. Surgical treatment options for patella tendon rupture, part II: chronic. Orthopedics 2005; 28 (8) 765-769 , quiz 770–771
• 17 Wissman RD, Verma S, Kreeger M, Robertson M. Extensor mechanism injuries in tibiofemoral dislocations. J Comput Assist Tomogr 2009; 33 (1) 145-149
• 18 Coates M, Stewart N, Morganti V, Twaddle B. Magnetic resonance findings in knee dislocation: pictorial essay. Australas Radiol 2000; 44 (4) 373-384
• 19 Yu JS, Goodwin D, Salonen D , et al. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. AJR Am J Roentgenol 1995; 164 (1) 135-139
• 20 Andersen RC, Wilson KW, Bojescul JA, Mickel TJ, Gordon WT, Potter BK. Open, combat-related loss, or disruption of the knee extensor mechanism: treatment strategies, classification, and outcomes. J Orthop Trauma 2014; 28 (11) e250-e257
• 21 Ozkan C, Kalaci A, Tan I, Sarpel Y. Bilateral dislocation of the knee with rupture of both patellar tendons. A case report. Knee 2006; 13 (4) 333-336
• 22 West JL, Keene JS, Kaplan LD. Early motion after quadriceps and patellar tendon repairs: outcomes with single-suture augmentation. Am J Sports Med 2008; 36 (2) 316-323
• 23 Bhargava SP, Hynes MC, Dowell JK. Traumatic patella tendon rupture: early mobilisation following surgical repair. Injury 2004; 35 (1) 76-79
• 24 Bushnell BD, Tennant JN, Rubright JH, Creighton RA. Repair of patellar tendon rupture using suture anchors. J Knee Surg 2008; 21 (2) 122-129
• 25 Leung KS, Yip KM, Shen WY, Leung PC. Reconstruction of extensor mechanism after trauma and infection by transposition of the Achilles tendon: report of technique and four cases. J Orthop Trauma 1994; 8 (1) 40-44
• 26 Negrin LL, Nemecek E, Hajdu S. Extensor mechanism ruptures of the knee: Differences in demographic data and long-term outcome after surgical treatment. Injury 2015; 46 (10) 1957-1963
• 27 Ravalin RV, Mazzocca AD, Grady-Benson JC, Nissen CW, Adams DJ. Biomechanical comparison of patellar tendon repairs in a cadaver model: an evaluation of gap formation at the repair site with cyclic loading. Am J Sports Med 2002; 30 (4) 469-473
• 28 McLaughlin HL. Repair of major tendon ruptures by buried removable suture. Am J Surg 1947; 74 (5) 758-764
• 29 Kelikian H, Riashi E, Gleason J. Restoration of quadriceps function in neglected tear of the patellar tendon. Surg Gynecol Obstet 1957; 104 (2) 200-204
• 30 Karahasanoğlu I, Yoloğlu O, Cıtlak A, Kerimoğlu S, Turhan AU. [Biomechanical examination of patellar tendon ruptures repaired with a tendon graft: an experimental study]. Eklem Hastalik Cerrahisi 2014; 25 (1) 47-51
• 31 Nguene-Nyemb AG, Huten D, Ropars M. Chronic patellar tendon rupture reconstruction with a semitendinosus autograft. Orthop Traumatol Surg Res 2011; 97 (4) 447-450