Early quadriceps tendon rupture after primary total knee arthroplasty

Extensor mechanism disruption following total knee arthroplasty (TKA) is a rare complication and results in significant morbidity and severe functional limitations. Quadriceps tendon rupture in the early postoperative period after TKA is one limitation about which there is a significant paucity of available information.

In this retrospective study of 2404 patients who underwent primary TKA between June 2015 to May 2016, there were 10 quadriceps tendon ruptures in seven patients (three bilateral, four unilateral) presented within 3 months after surgery. The rupture was due to a sudden fall while walking or getting up from a chair. All seven patients presented with haematoma formation around the knee, inability to get up and inability to walk. Diagnosis was confirmed by ultrasonography and managed by exploration and end-to-end tendon repair by suturing.

In our study, incidence of quadriceps tendon tear in the early postoperative period (within 3 months) after TKA is 0.29% (seven of 2404). All patients had rupture within 90days of primary TKA; early primary repair was performed in all cases. All patients achieved preoperative range of motion without extension lag or restriction in range of movement within 6 months of repair of the quadriceps tendon.

Early identification and prompt treatment of quadriceps tendon injury followed by controlled postoperative rehabilitation results in excellent short-term and mid-term outcomes.