Quadriceps Tendon Ruptures After Total Knee Arthroplasty

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

Publikationsverlauf

Eingereicht: 07. Mai 2024

Angenommen: 12. April 2025

Accepted Manuscript online:
14. April 2025

Artikel online veröffentlicht:
14. Mai 2025

• 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
• 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
• 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
• 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
• 5 Hak DJ, Sanchez A, Trobisch P. Quadriceps tendon injuries. Orthopedics 2010; 33 (01) 40-46
• 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
• 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
• 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
• 9 Rosenberg AG. Management of extensor mechanism rupture after TKA. J Bone Joint Surg Br 2012; 94 (11, Suppl A): 116-119
• 10 Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty. J Arthroplasty 1987; 2 (02) 135-140
• 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
• 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
• 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
• 14 Bates MD, Springer BD. Extensor mechanism disruption after total knee arthroplasty. J Am Acad Orthop Surg 2015; 23 (02) 95-106
• 15 Tandogan RN, Terzi E, Gomez-Barrena E, Violante B, Kayaalp A. Extensor mechanism ruptures. EFORT Open Rev 2022; 7 (06) 384-395
• 16 Vyas P, Cui Q. Management options for extensor mechanism discontinuity in patients with total knee arthroplasty. Cureus 2020; 12 (07) e9225
• 17 Bisogno MR, Scuderi GR. Management of extensor mechanism disruption after total knee arthroplasty. Orthop Clin North Am 2022; 53 (03) 277-286
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 27 Springer BD, Della Valle CJ. Extensor mechanism allograft reconstruction after total knee arthroplasty. J Arthroplasty 2008; 23 (7, Suppl): 35-38
• 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
• 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
• 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
• 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