Extensor mechanism failure in total knee arthroplasty

Ng, J.; Balcells-Nolla, Pau; James, Peter; Bloch, Benjamin V.

doi:10.1302/2058-5241.6.200119

Cited by 23 publications

(7 citation statements)

References 39 publications

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“…It should not be surprising, therefore, that 73% of the patients from the articles included in the current study suffered from cardiovascular and metabolic conditions, such as hypertension, diabetes, obesity, and chronic renal failure. Furthermore, previous surgery such as TKA can represent a risk factor, probably because of previous insult to the tendon structure [ 26 ]. Surgical treatment of chronic QTRs can be challenging because of the large defect and/or tissue degeneration in the substance of the tendon (Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background Chronic ruptures, ruptures following total knee arthroplasty (TKA), and re-ruptures of the quadriceps tendon (QT) are rare. A systematic review of the current literature was conducted on their treatment and outcome to provide evidence-based indications for their management. Methods We searched published articles in English on chronic ruptures of QT, QT ruptures that occurred after TKA, and re-ruptures in PubMed, Scopus, and Google Scholar up to January 2021. Twenty-five articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Data from 25 articles (97 patients) with a mean age of 57 were retrieved. Patients were classified into three groups depending on the type of rupture: 16 patients suffered chronic QTR, 78 a QTR after a TKA, and 9 patients reported a re-rupture. The most frequent surgical approaches were different for each group: Codivilla’s Y-V technique and end-to-end sutures were the most commonly used in the chronic tears group (62.5%), synthetic MESH was the most frequent choice in QTR after a TKA group (38 patients, 53%), while end-to-end sutures were the first choice in the re-rupture group (4 patients, 44%). Conclusions Complex ruptures of the QT can be chronic ruptures, re-ruptures, or ruptures occurring after TKA. The choice of the best surgical technique depends on the macroscopic quality of the tendon stumps rather than the timing of intervention. Evidence-based preventive and therapeutic strategies should be developed.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Therefore, treatment options consist of conservative management with a brace or cast immobilized in extension for 4-6 weeks with partial or full weight bearing allowed [11][12][13]21,23,28,31]. Surgical treatment includes open reduction and internal fixation (ORIF), revision of the patellar component, partial or total patellectomy with repair of the patellar or quadriceps tendon, and extensor apparatus reconstruction [11][12][13]21,23,24,28,29,[69][70][71].…”

Section: Diagnostic and Treatment Approach And Reported Outcomesmentioning

confidence: 99%

Patella Fracture After Total Knee Arthroplasty: A Review

Tsivelekas,

Pallis,

Lykos

et al. 2024

Cureus

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The management and underlying causes of patellar periprosthetic fractures (PPF) after total knee arthroplasty (TKA) constitute an issue of growing importance given the rising frequency of these procedures. Patella periprosthetic fractures, though relatively rare, pose significant challenges and are a frequent indication for revision surgeries. Despite a decrease in overall incidence, PPFs remain the second most common type of periprosthetic fractures after TKA. Several factors have been identified and associated with patient-specific factors, surgical technique errors, and implant-related causes. Currently extensor apparatus integrity, bone stock, and component loosening are the major concerns and indications for the selective treatment approach. In this study, a thorough review of the existing literature was performed summarizing the epidemiology, clinical manifestation, treatment approach, and functional outcome of PPF. This review aims to underline the significance of such predisposing factors, point out the severity of PPF, and offer insights into the optimal intra-and post-operative management of the patella.

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“…Therefore, appropriate bony resection and careful trialing is critical to prevent inadvertent patella fractures or extensor mechanism disruption. Acute patella tendon ruptures can occur intraoperatively while the surgeon is gaining exposure to a stiff knee 14 . Acute rupture may be treated with primary repair with drill holes or suture anchors for tibial tubercle or patella avulsions and primary end to end repair for midsubstance tears 14 .…”

Section: Risk Factorsmentioning

confidence: 99%

“…Acute patella tendon ruptures can occur intraoperatively while the surgeon is gaining exposure to a stiff knee 14 . Acute rupture may be treated with primary repair with drill holes or suture anchors for tibial tubercle or patella avulsions and primary end to end repair for midsubstance tears 14 . However, rerupture rates are high, so graft augmentation reconstruction is recommended 14 .…”

Section: Risk Factorsmentioning

confidence: 99%

Intraoperative Fractures Sustained During Total Knee Arthroplasty

et al. 2023

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While the occurrence of postoperative periprosthetic fractures around total knee arthroplasties (TKAs) are well reported, little is known about intraoperative fractures that occur during TKA. Intraoperative fractures during TKA can occur in femur, tibia, or patella. It is a rare complication with an incidence of 0.2% to 4.4%.» Risk factors of periprosthetic fractures include osteoporosis, anterior cortical notching, chronic corticosteroid use, advanced age, female sex, neurologic disorders, and surgical technique.» Fractures can potentially occur at any stage of the TKA including exposure, bone preparation, placement of trial components, cementation, insertion of the final components, and seating of the polyethylene insert. Forced flexion during trialing increases the risk for patella fracture, tibial plateau, or tubercle fractures especially when there is under resection of the bone.» Management guidelines for these fractures are lacking with current options being observation, internal fixation, the use of stems and augments, increasing constraint of the prosthesis, implant revision, and modifying the postoperative rehabilitation.» Finally, the outcomes of intraoperative fractures are not well reported in the literature.

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Extensor mechanism failure in total knee arthroplasty

Cited by 23 publications

References 39 publications

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

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

Patella Fracture After Total Knee Arthroplasty: A Review

Intraoperative Fractures Sustained During Total Knee Arthroplasty

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