Management of Quadriceps Tendon Tear After Total Knee Arthroplasty: A Systematic Review

Although rare quadriceps tendon (QT) rupture after total knee arthroplasty (TKA) has debilitating complications, often resulting in significant extension deficits, limited mobility, and chronic pain. To address these complications, various surgical techniques have been developed, but a consensus on optimal management is lacking. This study aims to comprehensively review the different management techniques, outcomes, and complications in patients of TKA with QT tear.

As per PRISMA guidelines, systematic electronic search was conducted of PubMed, Embase, and Scopus databases. Data on demographics, surgical techniques, outcomes, and complications were extracted and analyzed.

11 studies with 132 knees in 126 patients were included. Among them, 10 studies were retrospective (Level III) and one was prospective (Level II). The mean age of patients was 54 years in the included studies, with a female predominance (60%). 5 studies included 35 knees with partial quadriceps tears, while the rest were complete tears. The most common cause was a fall leading to the tear. 7 knees with partial tear, and 1 knee with a complete tear were managed conservatively. Surgical techniques included suture-only repairs using various techniques (49 knees), V-Y turndown technique (46 knees), mesh augmentation (10 knees), and graft-based reconstruction (19 knees). The overall complication rate was 17.8%, with re-rupture and infection being the most common.

Surgical repair or reconstruction of QT rupture after TKA consistently improves extension lag and patient-reported outcomes though improvement in knee flexion may remain variable. V-Y turndown and graft-based reconstructions are frequently used, especially for chronic cases. Further high-quality, multi-centric studies are needed to establish standardized treatment protocols for this complex condition.

Level III.