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J Knee Surg
DOI: 10.1055/a-2585-4863
Special Focus Section

Quadriceps Tendon Ruptures After Total Knee Arthroplasty

Gabrielle Swartz
1   LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
James T. Layson 
2   Department of Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, New York
,
Daniel Hameed
1   LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Jeremy A. Dubin
1   LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Sandeep S. Bains
1   LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Michael A. Mont
1   LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Ronald E. Delanois 
1   LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Giles R. Scuderi
2   Department of Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, New York
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Abstract

Quadricep tendon (QT) ruptures following total knee arthroplasty (TKA) represent a challenging complication with potentially severe consequences, including impaired function and the need for additional surgical intervention. This article reviews the relevant anatomic features, etiology, and risk factors of QT ruptures after TKA. The different treatment options and indications for nonoperative management, direct repair, augmented repair, extensor reconstruction with mesh, and complete extensor allograft reconstruction are reviewed.

Keywords

total knee arthroplasty - complications - management


Publication History

Received: 07 May 2024

Accepted: 12 April 2025

Accepted Manuscript online:
14 April 2025

Article published online:
14 May 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Chhapan J, Sankineani SR, Chiranjeevi T, Reddy MV, Reddy D, Gurava Reddy AV. Early quadriceps tendon rupture after primary total knee arthroplasty. Knee 2018; 25 (01) 192-194
    CrossrefPubMedSearch in Google Scholar
  • 2 Dobbs RE, Hanssen AD, Lewallen DG, Pagnano MW. Quadriceps tendon rupture after total knee arthroplasty. Prevalence, complications, and outcomes. J Bone Joint Surg Am 2005; 87 (01) 37-45
    PubMedSearch in Google Scholar
  • 3 Shichman I, Roof M, Askew N. et al. Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040-2060. JBJS Open Access 2023; 8 (01) e22
    PubMedSearch in Google Scholar
  • 4 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
    CrossrefPubMedSearch in Google Scholar
  • 5 Hak DJ, Sanchez A, Trobisch P. Quadriceps tendon injuries. Orthopedics 2010; 33 (01) 40-46
    CrossrefPubMedSearch in Google Scholar
  • 6 Andrikoula S, Tokis A, Vasiliadis HS, Georgoulis A. The extensor mechanism of the knee joint: an anatomical study. Knee Surg Sports Traumatol Arthrosc 2006; 14 (03) 214-220
    CrossrefPubMedSearch in Google Scholar
  • 7 Clark J, Stechschulte Jr DJ. The interface between bone and tendon at an insertion site: a study of the quadriceps tendon insertion. J Anat 1998; 192 (Pt 4): 605-616
    PubMedSearch in Google Scholar
  • 8 DeBell H, Pinter Z, Pinto M. et al. Vascular supply at risk during lateral release of the patella during total knee arthroplasty: a cadaveric study. J Clin Orthop Trauma 2019; 10 (01) 107-110
    CrossrefPubMedSearch in Google Scholar
  • 9 Rosenberg AG. Management of extensor mechanism rupture after TKA. J Bone Joint Surg Br 2012; 94 (11, Suppl A): 116-119
    CrossrefPubMedSearch in Google Scholar
  • 10 Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty. J Arthroplasty 1987; 2 (02) 135-140
    CrossrefPubMedSearch in Google Scholar
  • 11 Ng J, Balcells-Nolla P, James PJ, Bloch BV. Extensor mechanism failure in total knee arthroplasty. EFORT Open Rev 2021; 6 (03) 181-188
    CrossrefPubMedSearch in Google Scholar
  • 12 Lin S, Sproul D, Agarwal A, Harris AB, Golladay GJ, Thakkar SC. Risk factors associated with quadriceps tendon extensor mechanism disruption following total knee arthroplasty. J Arthroplasty 2024; 39 (07) 1840-1844.e1
    PubMedSearch in Google Scholar
  • 13 Scuderi G, Scharf SC, Meltzer LP, Scott WN. The relationship of lateral releases to patella viability in total knee arthroplasty. J Arthroplasty 1987; 2 (03) 209-214
    CrossrefPubMedSearch in Google Scholar
  • 14 Bates MD, Springer BD. Extensor mechanism disruption after total knee arthroplasty. J Am Acad Orthop Surg 2015; 23 (02) 95-106
    CrossrefPubMedSearch in Google Scholar
  • 15 Tandogan RN, Terzi E, Gomez-Barrena E, Violante B, Kayaalp A. Extensor mechanism ruptures. EFORT Open Rev 2022; 7 (06) 384-395
    CrossrefPubMedSearch in Google Scholar
  • 16 Vyas P, Cui Q. Management options for extensor mechanism discontinuity in patients with total knee arthroplasty. Cureus 2020; 12 (07) e9225
    PubMedSearch in Google Scholar
  • 17 Bisogno MR, Scuderi GR. Management of extensor mechanism disruption after total knee arthroplasty. Orthop Clin North Am 2022; 53 (03) 277-286
    CrossrefPubMedSearch in Google Scholar
  • 18 Parker DA, Dunbar MJ, Rorabeck CH. Extensor mechanism failure associated with total knee arthroplasty: prevention and management. J Am Acad Orthop Surg 2003; 11 (04) 238-247
    PubMedSearch in Google Scholar
  • 19 Shi S-M, Shi GG, Laurent EM, Ninomiya JT. Modified V-Y turndown flap augmentation for quadriceps tendon rupture following total knee arthroplasty: a retrospective study. J Bone Joint Surg Am 2019; 101 (11) 1010-1015
    PubMedSearch in Google Scholar
  • 20 Oliva F, Marsilio E, Migliorini F, Maffulli N. Chronic quadriceps tendon rupture: quadriceps tendon reconstruction using ipsilateral semitendinosus tendon graft. J Orthop Surg Res 2023; 18 (01) 355
    PubMedSearch in Google Scholar
  • 21 Jimenez A, Bedeir YH, Hasselfeld KA, Hasselfeld KA, Branam BR. Novel repair of a quadriceps tendon rupture after a total knee arthroplasty using gracilis and semitendinosus autografts. Knee 2020; 27 (05) 1446-1450
    PubMedSearch in Google Scholar
  • 22 Forslund J, Gold S, Gelber J. Allograft reconstruction of a chronic quadriceps tendon rupture with use of a novel technique. JBJS Case Connect 2014; 4 (02) e42
    PubMedSearch in Google Scholar
  • 23 Wise BT, Erens G, Pour AE, Bradbury TL, Roberson JR. Long-term results of extensor mechanism reconstruction using Achilles tendon allograft after total knee arthroplasty. Int Orthop 2018; 42 (10) 2367-2373
    PubMedSearch in Google Scholar
  • 24 Auregan J-C, Lin JD, Lombardi JM, Jang E, Macaulay W, Rosenwasser MP. The hemisoleus rotational flap provides a novel superior autograft reconstructive option for the treatment of chronic extensor mechanism disruption. Arthroplast Today 2016; 2 (02) 49-52
    PubMedSearch in Google Scholar
  • 25 Morrey MC, Barlow JD, Abdel MP, Hanssen AD. Synthetic mesh augmentation of acute and subacute quadriceps tendon repair. Orthopedics 2016; 39 (01) e9-e13
    PubMedSearch in Google Scholar
  • 26 Ormaza A, Moreta J, Mosquera J, de Ugarte OS, Mozos JLML. Chronic quadriceps tendon rupture after total knee arthroplasty augmented with synthetic mesh. Orthopedics 2017; 40 (01) 38-42
    PubMedSearch in Google Scholar
  • 27 Springer BD, Della Valle CJ. Extensor mechanism allograft reconstruction after total knee arthroplasty. J Arthroplasty 2008; 23 (7, Suppl): 35-38
    PubMedSearch in Google Scholar
  • 28 Burnett RSJ, Berger RA, Paprosky WG, Della Valle CJ, Jacobs JJ, Rosenberg AG. Extensor mechanism allograft reconstruction after total knee arthroplasty. A comparison of two techniques. J Bone Joint Surg Am 2004; 86 (12) 2694-2699
    CrossrefPubMedSearch in Google Scholar
  • 29 Ricciardi BF, Oi K, Trivellas M, Lee YY, Della Valle AG, Westrich GH. Survivorship of extensor mechanism allograft reconstruction after total knee arthroplasty. J Arthroplasty 2017; 32 (01) 183-188
    CrossrefPubMedSearch in Google Scholar
  • 30 Brown NM, Murray T, Sporer SM, Wetters N, Berger RA, Della Valle CJ. Extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty. J Bone Joint Surg Am 2015; 97 (04) 279-283
    CrossrefPubMedSearch in Google Scholar
  • 31 Burnett RSJ, 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
    CrossrefPubMedSearch in Google Scholar