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Extensor mechanism ruptures.

Reha N Tandogan1,2, Esref Terzi1,3, Enrique Gomez-Barrena4

  • 1Department of Orthopedics & Traumatology, Halic University, Istanbul, Turkey.

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|May 31, 2022
PubMed
Summary
This summary is machine-generated.

Surgical repair is recommended for complete extensor mechanism ruptures. Augmentation is advised for poor tendon quality or chronic tears, with high return-to-activity rates reported for native injuries.

Keywords:
knee extensor mechanismpatellar tendon rupturequadriceps tendon rupturetotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Biomaterials Science

Background:

  • Native patellar tendon injuries typically affect younger individuals, contrasting with quadriceps tendon ruptures.
  • Risk factors for tendon injury include local (tendinopathy, cortisone injections) and systemic conditions (obesity, diabetes, renal failure, certain medications).
  • Bilateral disruptions are more frequently associated with these risk factors.

Purpose of the Study:

  • To review surgical repair and augmentation strategies for native and total knee arthroplasty (TKA) extensor mechanism disruptions.
  • To compare outcomes between native tendon injuries and those occurring after TKA.
  • To evaluate the efficacy of different augmentation techniques and salvage procedures.

Main Methods:

  • Review of surgical outcomes for native patellar and quadriceps tendon tears.
  • Analysis of factors influencing outcomes in TKA patients with extensor mechanism disruption.
  • Assessment of augmentation techniques (autograft, allograft, synthetics) and salvage procedures.

Main Results:

  • Complete extensor mechanism disruptions necessitate surgical intervention.
  • Primary repair shows good outcomes in young patients with acute tears and good tendon quality.
  • Augmentation is recommended for poor tendon quality, chronic tears, or defects, improving outcomes.
  • High return-to-work/sport rates (>95%) are observed in native tendon injuries with low re-rupture rates (<5%).
  • Extensor mechanism disruptions post-TKA present challenges (older age, comorbidities, local factors) leading to inferior outcomes compared to native injuries.
  • Augmentation is advisable in all TKA cases.
  • Salvage procedures like allografts offer acceptable outcomes for complex, multiply operated knees.

Conclusions:

  • Surgical repair is the standard for complete extensor mechanism ruptures.
  • Augmentation strategies are crucial for optimizing outcomes, particularly in cases with compromised tendon quality or chronic injuries.
  • Extensor mechanism injuries in TKA patients have poorer prognoses, underscoring the need for augmentation and specialized salvage techniques.