Patellar Tendon Ruptures after Total Knee Arthroplasty

Abstract

Patellar tendon (PT) rupture following total knee arthroplasty (TKA) is a rare, but devastating complication. These injuries occur most frequently in the acute period following TKA due to trauma to the knee. PT ruptures that disrupt the extensor mechanism create a marked functional deficit, impacting every facet of daily life. In complete ruptures of the PT, repair or reconstruction is typically indicated; however, complication rates following intervention remain high. Operative intervention remains the mainstay of treatment, with only certain specific situations where nonoperative intervention is appropriate. Operative techniques are chosen based on the acuity, location of disruption, and status of the residual soft tissues. Treatment options include repair with or without augmentation or reconstruction. Augmentation does reduce the high risk of complications, bringing rates down from 63 to 25%. Augmentation options include autografts, allografts, synthetic grafts, or synthetic meshes. Despite advancements, outcomes are unpredictable and complications are common, highlighting the need for further research to improve treatment protocols. This article provides an overview of PT ruptures following TKA, the various treatment options, and the recommendations of the M.M., R.D., G.S. for each common type of PT injury encountered.

Keywords

total knee arthroplasty - complications - management

Publication History

Received: 07 May 2024

Accepted: 09 September 2024

Accepted Manuscript online:
11 September 2024

Article published online:
11 October 2024

• References

• 1 Nam D, Abdel MP, Cross MB. et al. The management of extensor mechanism complications in total knee arthroplasty. AAOS exhibit selection. J Bone Joint Surg Am 2014; 96 (06) e47
• 2 Schoderbek Jr RJ, Brown TE, Mulhall KJ. et al. Extensor mechanism disruption after total knee arthroplasty. Clin Orthop Relat Res 2006; 446 (446) 176-185
• 3 Papalia R, Vasta S, D'Adamio S, Albo E, Maffulli N, Denaro V. Complications involving the extensor mechanism after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3501-3515
• 4 Vajapey SP, Blackwell RE, Maki AJ, Miller TL. Treatment of extensor tendon disruption after total knee arthroplasty: a systematic review. J Arthroplasty 2019; 34 (06) 1279-1286
• 5 Browne JA, Hanssen AD. Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh. J Bone Joint Surg Am 2011; 93 (12) 1137-1143
• 6 Bates MD, Springer BD. Extensor mechanism disruption after total knee arthroplasty. J Am Acad Orthop Surg 2015; 23 (02) 95-106
• 7 Bisogno MR, Scuderi GR. Management of extensor mechanism disruption after total knee arthroplasty. Orthop Clin North Am 2022; 53 (03) 277-286
• 8 Vyas P, Cui Q. Management options for extensor mechanism discontinuity in patients with total knee arthroplasty. Cureus 2020; 12 (07) e9225
• 9 Dennis DA, Berry DJ, Engh G. et al. Revision total knee arthroplasty. J Am Acad Orthop Surg 2008; 16 (08) 442-454
• 10 Bonnin M, Lustig S, Huten D. Extensor tendon ruptures after total knee arthroplasty. Orthop Traumatol Surg Res 2016; 102 (01) S21-S31
• 11 Zhang T, Wahl A, Schneider M. et al. Biomechanical comparison of four- versus six-strand transosseous suture repair for patellar tendon rupture. J Knee Surg 2024; 37 (03) 193-197
• 12 Yalcin S, McCoy B, Farrow LD. et al. Do patellar tendon repairs have better outcomes than quadriceps tendon repairs? A prospective cohort analysis. J Knee Surg 2023; 36 (11) 1191-1199
• 13 Aracil J, Salom M, Aroca JE, Torro V, Lopez-Quiles D. Extensor apparatus reconstruction with Leeds-Keio ligament in total knee arthroplasty. J Arthroplasty 1999; 14 (02) 204-208
• 14 Courtney PM, Edmiston TA, Pflederer CT, Levine BR, Gerlinger TL. Is there any role for direct repair of extensor mechanism disruption following total knee arthroplasty?. J Arthroplasty 2018; 33 (7S): S244-S248
• 15 Lamberti A, Balato G, Summa PP, Rajgopal A, Vasdev A, Baldini A. Surgical options for chronic patellar tendon rupture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (05) 1429-1435
• 16 Gould HP, Rate IV WR, Harrell RA, Abbasi P, Fillar AL. Effect of poly-L-lactic acid mesh augmentation on cyclic gap formation in transosseous patellar tendon repair: a biomechanical study. J Knee Surg 2023; 36 (12) 1224-1229
• 17 Nathani A. Biologic augmentation of the subscapularis tendon during anatomic shoulder arthroplasty: a prospective case series utilizing dynamic ultrasound. J Orthopaed Exp Innovat 2022; 3 (02)
• 18 Johnson SM, Cherry JV, Thomas N, Jafri M, Jariwala A, McLeod GG. Clinical outcomes and ultrasonographic viability of GraftJacket® augmented rotator cuff repair: a prospective follow-up study with mean follow-up of forty-one months. J Clin Orthop Trauma 2020; 11 (Suppl. 03) S372-S377
• 19 Bragg JT, Shields MV, Salzler MJ. Intrasubstance patellar tendon repair with the addition of a bio-inductive implant. Arthrosc Tech 2022; 12 (01) e11-e15
• 20 Geers BA, Bishai SK. Chronic midsubstance patellar tendon and retinacular rupture: primary repair enhancement using bioinductive implant augmentation. Arthrosc Tech 2023; 12 (09) e1595-e1600
• 21 Balato G, De Franco C, Lenzi M, de Matteo V, Baldini A, Burnett RSJ. Extensor mechanism reconstruction with allograft following total knee arthroplasty: a systematic review and meta-analysis of Achilles tendon versus extensor mechanism allografts for isolated chronic patellar tendon ruptures. Arch Orthop Trauma Surg 2023; 143 (07) 4411-4424
• 22 Burnett RS, Butler RA, Barrack RL. Extensor mechanism allograft reconstruction in TKA at a mean of 56 months. Clin Orthop Relat Res 2006; 452 (452) 159-165
• 23 Deren ME, Pannu TS, Villa JM, Firtha M, Riesgo AM, Higuera CA. Meta-analysis Comparing allograft to synthetic reconstruction for extensor mechanism disruption after total knee arthroplasty. J Knee Surg 2021; 34 (03) 338-350
• 24 Shau D, Patton R, Patel S, Ward L, Guild III G. Synthetic mesh vs. allograft extensor mechanism reconstruction in total knee arthroplasty—a systematic review of the literature and meta-analysis. Knee 2018; 25 (01) 2-7
• 25 Masouros P, Papazotos N, Chatzipanagiotou G, Kourtzis D, Moustakalis I, Tzurbakis M. A staged procedure for the treatment of chronic patellar tendon ruptures after total knee arthroplasty. Eur J Orthop Surg Traumatol 2023; 33 (04) 1051-1056
• 26 Wood TJ, Leighton J, Backstein DJ. et al. Synthetic graft compared with allograft reconstruction for extensor mechanism disruption in total knee arthroplasty: a multicenter cohort study. J Am Acad Orthop Surg 2019; 27 (12) 451-457
• 27 Scuderi GR, De Muth BC. Management of patella tendon disruptions in total knee arthroplasty. In: Surgical Techniques in Total Knee Arthroplasty. New York, NY:: Springer; 2002: 519-523