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J Knee Surg 2025; 38(07): 360-366
DOI: 10.1055/a-2509-3559
Original Article

Intraoperative Patellar Tendon Injuries during Total Knee Arthroplasty: A Comprehensive Review of Incidence, Risk Factors, and Management Strategies

Evan Offord
1   UMass Chan Medical School, Worcester, Massachusetts
,
Innocent Njoku
2   Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
,
Nickelas Huffman 
2   Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
,
Ignacio Pasqualini
2   Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
,
Viktor E. Krebs
2   Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
,
Nicolas S. Piuzzi 
2   Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
,
Matthew E. Deren
2   Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Abstract

Patellar tendon rupture (PTR) is a rare and severe postoperative complication of total knee arthroplasty (TKA). Even rarer is the intraoperative occurrence of PTR during TKA. PTR is a major complication as it can lead to chronic disability, functional limitations, and postoperative morbidity. Therefore, surgical repair of the intraoperative PTR is typically pursued through one of the following three methods: (i) primary repair with direct suturing; (ii) direct suturing with cerclage augmentation, and (iii) direct suturing with either autograft or synthetic graft augmentation. In the case of an incomplete tear, direct repair with suture anchors for distal tears, and end-to-end repair with/without synthetic graft augmentation for mid-substance and proximal tears, is recommended. In the case of complete tears, if adequate tissue is present, direct repair with extensor mechanism reconstruction should be performed, regardless of the location of the tear. Furthermore, for complete tears with defective tissue, extensor mechanism reconstruction should be performed using mesh or allograft augmentation, regardless of the location of the tear. This review aims to provide a comprehensive and thorough overview of the prevention, diagnosis, management, and outcomes of intraoperative extensor mechanism injuries during TKA.

Keywords

total knee arthroplasty - extensor mechanism injuries - patellar tendon rupture


Publication History

Received: 12 March 2024

Accepted: 01 January 2025

Accepted Manuscript online:
03 January 2025

Article published online:
27 January 2025

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