Reconstruction of Chronic Quadriceps Tendon Rupture: The Quadriceps Advancement and Imbrication Technique

Sebastian Braun; Dimitrios A Flevas; Carolena Rojas Marcos; Friedrich Boettner; Peter K Sculco; Thomas P Sculco

doi:10.1016/j.arth.2024.02.038

Reconstruction of Chronic Quadriceps Tendon Rupture: The Quadriceps Advancement and Imbrication Technique

J Arthroplasty. 2024 Feb 22:S0883-5403(24)00138-4. doi: 10.1016/j.arth.2024.02.038. Online ahead of print.

Authors

Sebastian Braun¹, Dimitrios A Flevas², Carolena Rojas Marcos², Friedrich Boettner³, Peter K Sculco², Thomas P Sculco²

Affiliations

¹ Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York; Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany; Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Member of Freie Universität Berlin and Humboldt University Berlin, Berlin, Germany.
² Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York.
³ Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.

PMID: 38401612
DOI: 10.1016/j.arth.2024.02.038

Abstract

Background: Chronic extensor mechanism disruption after total knee arthroplasty (TKA) is a rare but challenging condition. There are several surgical approaches for quadriceps tendon repairs. In this report, we present a modified surgical technique for quadriceps tendon repair in chronic extensor mechanism disruption without the use of allografts or mesh augmentation.

Methods: We retrospectively reviewed 12 consecutive cases of chronic extensor mechanism with complete quadriceps tendon ruptures after TKA that underwent the advancement and imbrication technique. Patient outcomes were evaluated using the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, the range of motion and extensor lag measurements, and standardized lateral radiographs were reviewed for Insall-Salvati-Ratio preoperatively and at their most recent follow-up visit.

Results: There were 12 knees from patients who had a mean age of 72 years (range, 62 to 81) and were evaluated with a mean follow-up of 15.9 months (range, 11.4 to 50.9). The extensor lag significantly improved from 40.8 ± 31.9° (range, 10 to 90°) to 2.9 ± 6.9° (P = .014), the Insall-Salvati-Ratio significantly changed from 0.87 to 1.07 (P = .010), and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement showed a significant difference: a raw score of 13.0 ± 5.8 versus 8.7 ± 5.6 (P = .002) and an interval score of 54.1 ± 14.0 versus 66.2 ± 15.6 (P = .001).

Conclusions: Reconstruction of extensor mechanism in chronic quadriceps tendon ruptures after TKA with the advancement and imbrication technique showed excellent functional outcomes with no extensor lag and excellent restoration of motion. This technique can be combined with TKA revision surgery or used on its own. To ensure successful outcomes, the authors favor rigid immobilization for 12 weeks before starting mobilization.

Keywords: chronic quadriceps rupture; extensor mechanism failure; extensor mechanism reconstruction; quadriceps reconstruction; total knee arthroplasty.