Very High Early Failure Rate Following Primary Repair of Acute Extensor Mechanism Disruption After Total Knee Arthroplasty

Abstract

IntroductionExtensor mechanism disruption is a devastating complication following total knee arthroplasty (TKA). Despite its morbidity, there is no consensus regarding the optimal treatment strategy. We aimed to determine the survivorship, clinical outcomes, and improvement in patient-reported outcome measures (PROMs) after primary repair of acute extensor mechanism disruptions following primary or revision TKA. MethodsA retrospective review identified 41 acute extensor mechanism disruptions (33 primary TKAs and eight revision TKAs) from 2015 to 2021. The study group was 56% women, the mean BMI was 33, the mean age was 66 years, and the mean follow-up was three years. Extensor mechanism disruption occurred at the patellar tendon (n = 17), quadriceps tendon (n = 15), and patella (n = 9) at a mean of 10 months following TKA. Surgical management was primary repair (n = 30) or primary repair with augmentation (allograft or autograft) (n = 11). Kaplan-Meier analysis estimated survivorship. ResultsThe two-year survivorship free from all-cause reoperation was 72 and 23% following primary and revision TKA, respectively (P = 0.013). The two-year survivorship free from all-cause reoperation was 66% for primary repair versus 61% for primary repair with augmentation (P = 0.95). There were 17 (41%) patients who underwent reoperation, most commonly for re-rupture (n = 4) in two primary repairs and two primary repairs with augmentation (P = 0.288). Revision TKA (P = 0.049) and increased time from disruption to repair (P = 0.039) were risk factors for reoperation. The mean extensor lag did not significantly improve, nor did patients see improvement in their PROMs. ConclusionAfter primary and revision TKA, acute extensor mechanism disruption treated with primary repair with or without augmentation had very poor early survivorship free from all-cause reoperation. Patients should be counseled appropriately, and alternative surgical techniques should be considered.