Li TJ, Sun JY, Du YQ, Shen JM, Zhang BH, Zhou YG. Early patellar tendon rupture after total knee arthroplasty: A direct repair method. World J Clin Cases 2022; 10(31): 11349-11357 [PMID: 36387798 DOI: 10.12998/wjcc.v10.i31.11349]
Corresponding Author of This Article
Yong-Gang Zhou, PhD, Chief Physician, Department of Orthopedics, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100048, China. ygzhou301@163.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Tie-Jian Li, Jing-Yang Sun, Yin-Qiao Du, Jun-Min Shen, Bo-Han Zhang, Yong-Gang Zhou, Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing 100048, China
Tie-Jian Li, Jing-Yang Sun, Yin-Qiao Du, Jun-Min Shen, Bo-Han Zhang, Yong-Gang Zhou, Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing 100853, China
Author contributions: Li TJ and Sun JY contributed equally to this article; Li TJ and Sun JY designed and performed the research and wrote the paper; Zhou YG designed the research and supervised the report; Du YQ designed the research and contributed to the analysis; Shen JM and Zhang BH provided clinical advice.
Institutional review board statement: The Ethics Committee of General Hospital of Chinese People’s Liberation Army approved the study protocol. All the study participants provided written informed consent for the study.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that they have no competing interests for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Gang Zhou, PhD, Chief Physician, Department of Orthopedics, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100048, China. ygzhou301@163.com
Received: February 4, 2022 Peer-review started: February 4, 2022 First decision: June 15, 2022 Revised: July 28, 2022 Accepted: September 27, 2022 Article in press: September 27, 2022 Published online: November 6, 2022 Processing time: 265 Days and 1 Hours
Abstract
BACKGROUND
Patellar tendon rupture after total knee arthroplasty (TKA) is a catastrophic complication. Although the occurrence of this injury is rare, it can lead to significant dysfunction for the patient and is very tricky to deal with. There has been no standard treatment for early patella tendon rupture after TKA, and long-term follow-up data are lacking.
AIM
To introduce a direct repair method for early patella tendon rupture following TKA and determine the clinical outcomes and complications of this method.
METHODS
During the period of 2008 to 2021, 3265 consecutive TKAs were retrospectively reviewed. Twelve patients developed early patellar tendon rupture postoperatively and were treated by a direct repair method. Mean follow-up was 5.7 years. Demographic, operative, and clinical data were collected. The clinical outcomes were assessed using the Western Ontario and McMaster Universities (WOMAC) score, the Hospital for Special Surgery (HSS) score, knee range of motion, extensor lag, and surgical complications. Descriptive statistics and paired t test were employed to analyze the data.
RESULTS
For all 12 patients who underwent direct repair for early patellar tendon rupture, 3 patients failed: One (8.3%) for infection and two (17.6%) for re-fracture. The two patients with re-fracture both underwent reoperation to reconstruct the extensor mechanism and the patient with infection underwent revision surgery. The range of motion was 109.2° ± 10.6° preoperatively to 87.9° ± 11° postoperatively, mean extensor lag was 21° at follow-up, and mean WOMAC and HSS scores were 65.8 ± 30.9 and 60.3 ± 21.7 points, respectively.
CONCLUSION
This direct repair method of early patellar tendon rupture is not an ideal therapy. It is actually ineffective for the recovery of knee joint function in patients, and is still associated with severe knee extension lag and high complication rates. Compared with the outcomes of other repair methods mentioned in the literature, this direct repair method shows poor clinical outcomes.
Core Tip: This direct repair method of early patella tendon rupture showed unsatisfactory clinical results in this group of patients, and it was actually ineffective for the recovery of knee joint function in patients. Therefore, we suggested that direct repair should not be the preferred method to treat early patella tendon rupture, but other reconstruction methods should be boldly chosen. Our experience would be instructive for clinicians to treat early patella tendon rupture.
