Early quadriceps tendon rupture after primary total knee arthroplasty

Chhapan, Jigar; Sankineani, Sukesh Rao; Chiranjeevi, T; Reddy, M V; Reddy, Diwakar; Reddy, A V Gurava

doi:10.1016/j.knee.2017.12.002

Cited by 23 publications

(8 citation statements)

References 7 publications

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“…The main limitation in our study was the lack of information regarding the possibility that the patient had undergone a total knee arthroplasty (TKA). QTR is a rare although devastating complication after TKA that occurs most commonly during the first months after surgery [4, 7]. Whereas spontaneous QTR is usually an endpoint in the tendon degeneration process, the predisposing factors after TKA include a possible iatrogenic injury to the tendon during surgery.…”

Section: Discussionmentioning

confidence: 99%

The increasing incidence of surgically treated quadriceps tendon ruptures

Reito

Paloneva

Mattila

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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PurposeDue to increased life expectancy and a more active life style of the older people, we hypothesised that the incidence of quadriceps tendon rupture (QTR) is higher than previously reported. The objective of this nationwide population-based study was to investigate the annual incidence of QTR in patients who underwent operative treatment in Finland between 1997 and 2014.MethodsThe Finnish National Hospital Discharge Register was searched for all adult patients who had undergone surgical treatment for QTR during the study period. Population-based annual incidence and incidence trends for surgically treated QTR were calculated.ResultsDuring the study period, 1343 QTR surgeries were performed. Of these, 90% were performed on male patients. The incidence of QTR increased by 411% from 0.55 to 2.82 per 100,000 person-years from 1997 to 2014. The average yearly increase in the number of surgeries was 9.0%. In male patients, the incidence of QTR increased by 490% and in female patients by 121%. The mean age of the male patients increased during the study period from 50 to 59 years.ConclusionsBased on the data from the Finnish National Hospital Discharge Register, the annual incidence of QTR increased by over 400% during the 18-year study period. The average age of the patients also increased. Because QTR is only very rarely treated without surgery, the results of our study can be considered to be a reliable estimate of the increase in the incidence of this condition. There is an urgent need to establish the risk factors associated with QTR and to also establish the optimal surgical technique.Level of evidenceIV.Electronic supplementary materialThe online version of this article (10.1007/s00167-019-05453-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The increasing incidence of surgically treated quadriceps tendon ruptures

Reito

Paloneva

Mattila

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…1 Ruptures of the patellar and quadriceps tendons are less frequent causes of extensor mechanism disruption than patellar fracture. [2][3][4] Surgical repair of the extensor mechanism is the widely accepted treatment to improve function and restore the ability to actively extend the knee; however, there is limited information reported in the literature on postoperative complications and risk factors for complications following extensor mechanism repair. [5][6][7][8][9] The cost of health care in the United States has steadily grown in the last several decades.…”

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confidence: 99%

Risk Factors for Infection and Revision Surgery following Patellar Tendon and Quadriceps Tendon Repairs: An Analysis of 3,442 Patients

et al. 2021

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Disruption of the extensor mechanism is debilitating with surgical repair being the accepted treatment. The incidence of infection and reoperation after extensor mechanism repair are not well reported in the literature. Thus, the objective of the current study was to (1) determine the incidence of surgical site infection and reoperation within 1 year of primary extensor mechanism repair and (2) identify independent risk factors for infection and reoperation following patellar and quadriceps tendon repair. A retrospective review of the 100% Medicare Standard Analytic files from 2005 to 2014 was performed to identify patients undergoing isolated patellar tendon repair and quadriceps tendon repair. Diagnosis of infection within 1 year of operative intervention and revision repair were assessed. Extensor mechanism injuries in the setting of total knee arthroplasty and polytrauma were excluded. Multivariate logistic regression analysis was performed to evaluate risk factors for postoperative infection and reoperation within 1 year. Infection occurred in 6.3% of patients undergoing patellar tendon repair and 2.6% of patients undergoing quadriceps tendon repair. Diabetes mellitus (odds ratio [OR] = 1.89, p = 0.005) was found to be an independent risk factor for infection following patellar tendon repair. Reoperation within 1 year occurred in 1.3 and 3.9% following patellar tendon and quadriceps tendon repair, respectively. Age less than 65 years (OR = 2.77, p = 0.024) and obesity (OR = 3.66, p = 0.046) were significant risk factors for reoperation after patellar tendon repair. Hypertension (OR = 2.13, p = 0.034), hypothyroidism (OR = 2.01, p = 0.010), and depression (OR = 2.41, p = 0.005) were significant risk factors for reoperation after quadriceps tendon repair. Diabetes mellitus was identified as a risk factor for infection after patellar tendon repair. Age less than 65 years, peripheral vascular disease, and congestive heart failure were risk factors for infection after quadriceps tendon repair. The current findings can be utilized to counsel patients regarding preoperative risk factors for postoperative complications prior to surgical intervention for extensor mechanism injuries.

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“…Additionally, quadriceps ruptures may manifest from iatrogenic causes of quadriceps pathology such as a history of total knee arthroplasty (TKA), revision TKA, intra-articular corticosteroid injections, systemic steroid use, and extensile approaches used in the setting of revision or obesity 4, 6. There is limited evidence suggesting that early repair of a primary quadriceps tendon rupture may allow for good short- and mid-term outcomes, 7 whereas others have reported variable postoperative improvements 8 . Although no single technique has been determined as superior for repair of these defects, quadriceps tendon reconstruction with augmentation has been associated with fewer complications and better postoperative outcomes compared with simple suture repair 9 .…”

Section: Discussionmentioning

confidence: 99%

Trapezoidal Achilles Tendon Allograft Plug for Revision Quadriceps Tendon Repair With a Large Tendon Defect

Kunze

Burnett

Shinsako

et al. 2019

Arthroscopy Techniques

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Revision quadriceps tendon repair presents a challenging problem for the treating surgeon because of associated anatomic defects such as large tendon-gap deficits and preexistent poor tissue quality. Current methods for revision quadriceps tendon repair use tendon autograft, which may predispose to additional morbidity because the repair relies only on soft tissue fixation. In this Technical Note, we describe a technique for revision of a failed quadriceps tendon repair with a large tendon gap using a trapezoidal plug Achilles tendon allograft. This technique constitutes a safe and effective approach to revising failed primary quadriceps tendon repairs, is suitable for large-gap defects, and has the ability to withstand large force transmissions.

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Early quadriceps tendon rupture after primary total knee arthroplasty

Cited by 23 publications

References 7 publications

The increasing incidence of surgically treated quadriceps tendon ruptures

The increasing incidence of surgically treated quadriceps tendon ruptures

Risk Factors for Infection and Revision Surgery following Patellar Tendon and Quadriceps Tendon Repairs: An Analysis of 3,442 Patients

Trapezoidal Achilles Tendon Allograft Plug for Revision Quadriceps Tendon Repair With a Large Tendon Defect

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