Early patellar tendon rupture after total knee arthroplasty: A direct repair method

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.

Keywords: Direct repair; Patellar tendon fracture; Total knee arthroplasty; Reconstruction; High complication rates

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.