Abstract
The rupture of the patellar tendon after total knee arthroplasty (TKA) is rare but serious complication resulting in a severe dysfunction in the extension mechanism. There are a few reports on the treatment of this condition. However, there is still some controversy regarding the choice of proper management. There is no report of the patellar tendon augmentation or reconstruction in this condition in the Korean literature. We report a case of an old patellar tendon rupture in 70-year old patient that occurred at 5 months after a two stage revision for an infected TKA and was treated satisfactorily by delayed repair with augmentation using an Achilles allograft.
Figures and Tables
Fig. 1
(A, B) The immediate postoperative radiographs after revision total knee arthroplasty showing good alignment and no patellar alta. (C) The radiograph at 5 months postoperatively showed an anterior dislocation of the knee. (D) The radiograph after the reduction of the knee showed patella alta.
![jkoa-42-141-g001](/upload/SynapseData/ArticleImage/0043jkoa/jkoa-42-141-g001.jpg)
Fig. 3
(A) The patellar tendon was ruptured at the attachment site of tibial tuberosity. The distal portion of ruptured patellar tendon is connected with stretched fibrous scar tissue. (B) Modified Krackow's suture was applied to patellar tendon portion. The quadriceps-patella-patellar tendon complex was pulled down to the tuberosity area and secured under tension by passing the suture arms through the bony tunnel made at the tuberosity. (C) A rectangular bony trough was made at the proximal-medial aspect of the tibia. (D) The allograft was sutured to the underlying quadriceps tendon, soft tissue around the patella and patellar tendon with multiple nonabsorbable sutures.
![jkoa-42-141-g003](/upload/SynapseData/ArticleImage/0043jkoa/jkoa-42-141-g003.jpg)
Fig. 4
The radiographs and clinical photographs at the 3 years follow up after the reconstruction of the patellar tendon. (A) AP and (B) lateal radiographs showed a well integrated allograft. The clinical photographs showed active full extension (C) and 130 degree of active flexion (D) of the right knee.
![jkoa-42-141-g004](/upload/SynapseData/ArticleImage/0043jkoa/jkoa-42-141-g004.jpg)
References
1. Cadambi A, Engh GA. Use of a semitendinosus tendon autogenous graft for rupture of the patella ligament after total knee arthroplasty. A report of seven case. J Bone Joint Surg Am. 1992. 74:974–979.
2. Crossett LS, Sinha RK, Sechriest VF, Rubash HE. Reconstruction of a ruptured patellar tendon with achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am. 2002. 84:1354–1361.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
3. Emerson RH Jr, Head WC, Malinin TI. Reconstruction of the patellar tendon rupture after total knee arthroplasty with an extensor mechanism allograft. Clin Orthop Relat Res. 1990. 260:154–161.
4. Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty. J Arthroplasty. 1987. 2:135–140.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
5. Rand JA, Morrey BF, Bryan RS. Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res. 1989. 244:233–238.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
6. Sharkey PF, Hozack WJ, Booth RE Jr, Balderston RA, Rothman RH. Posteior dislocation of total knee arthroplasty. Clin Orthop Relat Res. 1992. 278:128–133.