Chronic Quadriceps Tendon Rupture After Total Knee Arthroplasty Augmented With Synthetic Mesh

Abstract

Tear of the quadriceps tendon after revision or primary total knee arthroplasty is a rare complication, but when it occurs, this injury has serious functional consequences. In complete tears, the outcome of direct repair is unpredictable, and several authors recommend that the suture should be reinforced. Several techniques have been described, including the use of autografts, allografts, and synthetic mesh. The goal of this study was to assess the outcomes of a reconstruction technique augmented with synthetic mesh. A retrospective study was performed involving 3 patients who had chronic partial quadriceps tendon tear after total knee revision. In 2 cases, proximal quadriceps release was performed. When conservative management failed, surgical reconstruction with suture reinforced with synthetic mesh was attempted. The knee was immobilized in full extension for 6 weeks after the surgical procedure. A minimum follow-up of 12 months was required to assess results. All reconstructions showed clinical success at a mean follow-up of 19 months. Mean Knee Society Score improved from 55.7 to 87.3, with average postoperative extensor lag of 3.3° (range, 0°-10°). The mean visual analog scale pain score was 2.3 (range, 0-4). No complications were reported. Synthetic mesh has previously been shown to be an effective treatment for patellar tendon repairs after total knee replacement, but there have been few articles on quadriceps rupture. Surgical reconstruction with synthetic mesh is a viable option that provides good functional outcomes in chronic quadriceps tendon rupture after total knee arthroplasty. [Orthopedics. 2017; 40(1):38-42.].

Retrieval analysis of a failed synthetic mesh extensor mechanism reconstruction after total knee arthroplasty

“…Ormaza et al. [14] reported 3 repairs with satisfactory range of motion and function outcome at a mean follow-up of 19 months. Cumulatively, these studies report a 55% success rate (11/20) using mesh augmentation of quadriceps repair after TKA.…”

“…Ormaza et al. described reinforcement of the quadriceps tendon repair with a polyethylene terephthalate mesh tube, which is then passed from proximal to distal through the patellar tendon sheath and distally secured with sutures [14] .…”

Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

“…(2007) Kazimoglu et al 1 F 37 Two consecutive falls 60 days Bilateral QT ruptures Chronic renal failure, with hemodialysis for 2 years Tycron transpatellar suture anchors None [ 28 ] Autologous hamstring tendon used for revision of quadiceps tendon tears. (2013) McCormick et al 1 M 38 Primary tear: playing basketball Re-tear: fall from standing height 1°: immediatly 2°: 300 days after the rerupture Complete QT rerupture None Bilateral hamstring autograft through a QT weave and a transosseous patellar repair None [ 44 ] Chronic Quadriceps Tendon Rupture After Total Knee Arthroplasty Augmented With Synthetic Mesh. (2017) Ormaza et al 3 2 M 1 F 67,5 One patient experienced trauma 1 year after TKA revision surgery; one patient 6 months after TKA revision surgery; one patient 2 years after TKA revision surgery 148 days Full thickness One of them had a hystory of hemochromatosis End-to-end sutures No.…”

“…(2013) McCormick et al 1 Male 38 None [ 38 ] Polypropylene mesh augmentation for complete quadriceps rupture after total knee arthroplasty. (2016) Nodzo et al 7 2 M 5 F 56 Diabetes, rheumathoid arhtritis, chronic pulmonary disease with steroid use, HCV, drug abuse, smoke, chronic renal failure [ 44 ] Chronic quadriceps tendon rupture after total knee arthroplasty augmented with synthetic mesh. (2017) Ormaza et al 3 2 M 1 F 70 Hemochromatosis [ 35 ] Knee osteoarthritis with chronic quadriceps tendon rupture treated with total knee arthroplasty and extensor mechanism allograft reconstruction: a case report.…”

Chronic Quadriceps Tendon Rupture Reconstruction with Sartorius Muscle Transfer: A Report of Five Cases

“… 4 Reconstruction of chronic quadriceps tendon injuries (CQTI) is challenging and has poor outcomes. 4 , 5 Various reconstruction techniques have been described, with relatively high failure rates reported with allografts and synthetic grafts. 6 , 7 The poor results with simple repairs necessitate augmentation with all CQTI surgical management.…”