Leeds-Keio Ligament for the Reconstruction of Delayed Patella and Quadriceps Tendon Rupture: Time to Revisit?

Ruptures of the knee extensor apparatus in elderly individuals or following total knee replacement present a significant functional limitation and surgical challenge. The Leeds-Keio ligament, a synthetic graft, has been historically used for reconstruction but has seen declining popularity with advancements in biological grafts. This study revisits the application of the Leeds-Keio ligament in managing chronic and complex extensor mechanism ruptures. It is a retrospective review of five patients (mean age 73.6 years) who underwent surgical reconstruction of the ruptured patella or quadriceps tendons with the Leeds-Keio ligament between 2022 and 2025. The surgical technique involved a figure-of-eight configuration to bridge or augment the repair. The postoperative protocol included initial immobilisation followed by a progressive rehabilitation program. All patients achieved satisfactory functional recovery with independent mobilisation at the latest follow-up, with some exhibiting mild residual extension lag. The diverse presentations included one case with a chronic 10 cm gap quadriceps tendon rupture that required quadriceps V-Y plasty and bridging with Leeds-Keio ligament. Three cases with patella tendon ruptures after total knee arthroplasty (TKA) had patella tendon reconstruction with the Leeds-Keio ligament, and notably, two TKA dislocations required revision to a hinged knee prosthesis for stability. Another case involved a re-ruptured primary patella tendon repair four weeks post surgery that needed reconstruction with a Leeds-Keio ligament. No major complications, such as deep infection or graft failure, were observed in this small series. The Leeds-Keio ligament may be a viable option for reconstructing complex chronic patella and quadriceps tendon ruptures in elderly patients, including revision scenarios and those with concomitant TKA complications, providing satisfactory early functional outcomes. Careful patient selection and individualised treatment strategies are essential to optimise outcomes.