TKA - Approach to Extensor Mechanism Rupture
Factors Associated with Extensor Mechanism Rupture
1. Tight knee with peel-off of the tibial insertion of the patellar tendon
2. Lateral release is a risk factor for quad tendon rupture - ? devascularization phenomenon ?
3. Previous surgery
4. Closed knee manipulation
5. Tibial tubercle osteotomy for realignment
The key thing to note is that the treatment for this problem is unsatisfactory as a whole. Prevention is the key!
Management
Primary suture repair of a patellar tendon rupture is INEFFECTIVE.
Augment with semitendinosis or Achilles tendon + calcaneous allograft (ATOC graft by Harry Rubash)
Or extensor mechanism allograft if patellar bone stock and soft tissues are deficienty
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