Simultaneous Bilateral Extensor Mechanism Disruptions: More Than Double the Trouble?

Area of Science:

• Orthopaedic Surgery
• Trauma Care
• Reconstructive Surgery

Background:

• Simultaneous bilateral extensor mechanism disruption (BEMD) is a rare injury with poorly defined outcomes.
• Understanding comorbidities and complications is crucial for managing BEMD.

Purpose of the Study:

• To compare clinical outcomes, comorbidities, and complications between patients with BEMD and unilateral extensor mechanism disruption (UEMD).
• To establish a clearer understanding of the BEMD patient profile and associated risks.

Main Methods:

• Retrospective review of adult patients with quadriceps or patellar tendon ruptures (2012-2017).
• Comparison of BEMD (n=14) versus UEMD (n=221) using statistical analysis (Student's t-tests, Fisher's exact tests).

Main Results:

• BEMD patients had higher BMI, ASA scores, and worse PROMIS physical function scores.
• BEMD group experienced longer hospital stays (4x) and higher repair failure rates (3x) compared to UEMD.
• Despite worse initial outcomes, all BEMD patients achieved ambulation, and most returned to work.

Conclusions:

• Simultaneous BEMD is rare (6% of series) but associated with significantly more comorbidities and poorer outcomes than UEMD.
• Orthopaedic surgeons must maintain high awareness of increased risks and complications in BEMD patients.
• While challenging, BEMD patients can achieve functional recovery and return to work.