With the knowledge that things don’t turn out so well for those who experience a patellar or quadriceps tendon ruptures after total knee arthroplasty (TKA), a team of researchers set out to bring the orthopedic community closer on a consensus regarding optimal treatment.
The study, “Treatment of Extensor Tendon Disruption After Total Knee Arthroplasty: A Systematic Review,” was published in the February 27, 2019 edition of The Journal of Arthroplasty.
Timothy L. Miller, M.D., associate professor in the Department of Orthopaedic Surgery at The Ohio State University Wexner Medical Center and study co-author explained the genesis of the study to OTW, “We recently had a patient present with patellar tendon rupture after total knee replacement that required repair. However, she re-ruptured her repair and we were stumped as to how to counsel her and which treatment option would be the best going forward.”
“This case served as the impetus to research this topic. Furthermore, a recent conference was held among the sports medicine and total joint replacement faculty at our institution regarding the treatment of recurrent patellar tendon ruptures and post-total knee replacement extensor mechanism ruptures.”
“This included a discussion of the devastating effect that an extensor mechanism rupture, particularly patellar tendon rupture, has on the knee following total knee arthroplasty as well as the need for allograft reconstruction in this population. We were searching for a treatment algorithm for this injury and decided to embark on this project.”
First author Sravya P. Vajapey, M.D., a third-year orthopedic resident at The Ohio State University Wexner Medical Center expanded on Dr. Miller’s comments to OTW, “Repair of patellar tendon ruptures in post-arthroplasty knees has a high rate of complication including re-rupture and extensor lag of 30 degrees or more. Rate of extensor lag and other complications following allograft tendon reconstruction for patellar tendon rupture and quadriceps tendon repair are much lower than that of patellar tendon repair after total knee arthroplasty.”
For their study the authors found 28 articles that met their inclusion criteria. They noticed that the complication rate after repair of patellar tendon (63.16%) was higher than the complication rate after repair of quadriceps tendon (25.37%).
However, the researchers also noticed that the complication rate for patellar and quadriceps tendon tears after autograft, allograft, or mesh reconstruction was similar (18.8% vs 19.2%, respectively).
According to the authors, “The most common complication after extensor mechanism repair or reconstruction was extension lag of 30° or greater (45.33%). This was followed by re-rupture and infection (25.33% and 22.67%, respectively). Early ruptures had a higher overall complication rate than late injuries.”
Dr. Miller told OTW, “Our findings support the use of patellar tendon reconstruction in both acute and chronic patellar tendon ruptures following a total knee arthroplasty particularly given its lower complication rate compared with primary repair. Unlike patellar tendon ruptures, acute quadriceps ruptures following total knee arthroplasty do well with repair while chronic or recurrent quadriceps ruptures benefit most from reconstruction.”
Please contact me my husband has a patellar tendon rupture and we need help
We live in St. Louis and seen to 3 to 4 orthopedic surgeons and no one wants to do anything he has had total knee replacement and there was one attempt of a patella tendon allograft eight months ago but it was unsuccessful we are hoping that you may have some information and doctors that could help
Thank you
Candace, I have a similar problem that your husband has. I had a TKA revision in January 2019 and now have a quad tear that is in need of surgery. Like you, I have seen two surgeons with a third in the works. I live near St. Louis and would really like to see if anyone responded to you regarding treatment or doctors with experience in this type of repair. Any information would be appreciated.
I would like to know your status now
I am beginning to think perhaps faulty hardware.
And how are the surgeons or someone tracking the patients with tears after the replacement
Maybe we should group together?
And what about the authors of this paper. Can they assist
The best surgeons for this type of procedure are in Phoenix , AZ.
Ortho Arizona featuring Dr. Kenneth Schmidt did my repair. I had a full knee replacement and after two months I slipped and shredded my patellar tendon and quad tendon and muscle. I totally destroyed my leg. Dr.Schmidt did a stabilization surgery first, and a full re construction using a cadaver tendon 4 days later. I am three moths out and have no pain but an in a full leg brace and walk with a cane after three months on a walker and 4 weeks in a full leg cast. I will be in a full leg brace another month. If you need help, these guys are incredible.
I’m heading in to surgery 6/22/2021 for repair post TKA quad tendon rupture. I’m 4 weeks post TKA. DR. Wilmink did my original surgery and will do repair. Truly frustrating. I was kicking ass until physical therapist performed hyper flexion. I felt the pop and had bruising and pain. Back on oxy. The recovery time and experience look to be long and challenging.
I had total knee replacement and two months later a quad muscle repair. I was in a long leg cast for 6 weeks and now back in a brace because of the cast sliding. I got a pressure sore on my heel has to be debride. My surgeon and his team have been awesome
I had a total knee replacement in March of 2021. In Phoenix Az. It was a complete success. Three weeks later I tore my
Patella tendon just by getting up. I accidentally twisted my leg. I went to the doctor the next day and the day after that I was in surgery to have tendon repair surgery. It was 14 weeks and leg brace. I am now done with physical therapy. Still not 100%. But continue to improve every day. My biggest problem is my other knee needs to be replaced but since my first knee isn’t totally recovered I can’t have the second surgery yet.
In May 2023 RTKR, Oct 2023 right ankle arthrodesis. At 8 weeks PO ankle op I had no i sable signs of fusion. Week 9 stated bone stim. At 13 weeks Ct scan shows 30% fusion. Moved from non weight barring cast to air cast boot weight barring as pain allowed. I was trying to force my leg to bend in bed with the other leg. Prior to ankle fusion knee able flex 138. January 25, able to bend maybe 110. Noticed bump on knee cap. When I would bend the leg bump got biggger, pretty sure it’s the knee cap shifting to the outside. The outer side of the inside of the knee sore and pain prevents much movement. Pretty sure I have patella maltracking. Knee doc order x-rays and will have them taken Monday knee doc will have them Tuesday. Im 2.5 hrs away from him. Today January 28 i walked 64 steps without walker to toilet and got walker. I can go up stairs. Good leg up, pull op leg same as good legs step.
Question is how soon can I have Patella Surgery in light of not fully walking on ankle fusion and fusion hasnt fused. Do back at foot doc Feb 26. to have x-ray and see how fused the TT joint is. What would one recommend If x-rays indicate patella surgery. Surgery location is St Louis. Really struggling with this and lack a good support group to get through another surgery and longer time of being unable to drive.