Quadriceps rupture associated with a proximal quadriceps release in total knee arthroplasty. A report of three cases.

Abstract

Complex primary and revision total knee arthroplasties often require extensile surgical approaches. The problems of scarring, stiffness, and distorted anatomy add to the challenges of reconstructing osseous defects and stabilizing the implant. Wide surgical exposure is clearly required to achieve a well-functioning prosthesis, but the benefits of such an approach must be weighed against the risk of complications. Surgical techniques to reflect the extensor mechanism involve either soft-tissue transection proximal to or osteotomy distal to the patella. Numerous studies have detailed the efficacy of and the minimal morbidity associated with a V-Y quadricepsplasty, a quadriceps snip, and a tibial tubercle osteotomy 1-4. All of these procedures provide extensile exposure and are associated with good functional outcomes 1-4. Insall originally described the quadriceps snip as a proximal-lateral continuation of the incision at the apex of the quadriceps arthrotomy 5. To our knowledge, however, postoperative rupture has not been previously mentioned in reports on the quadriceps snip or its modifications. In an effort to increase understanding of potential complications, we present the cases of three patients who had a complete rupture of the quadriceps tendon in the early postoperative period after a knee arthroplasty involving a proximal quadriceps release. All three patients were informed that data concerning their cases would be submitted for publication. Case 1. A fifty-three-year-old laborer who had a history of multiple surgical procedures related to a football injury sustained thirty years previously presented with a painful knee. The man had previously undergone reconstruction of the medial collateral ligament as well as multiple arthroscopic debridements. At the time of examination, the patient weighed 106 kg and walked with an antalgic gait. He had a 4-cm longitudinal medial incision line and a more anterior 5-cm incision line, both of which were well healed. …