Outcomes After Knee Joint Extensor Mechanism Disruptions: Is It Better to Fracture the Patella or Rupture the Tendon?

*Department of Orthopaedic Surgery †Department of Orthopaedics, NYU Hospital for Joint Diseases, New York, NY.
Journal of orthopaedic trauma (Impact Factor: 1.8). 11/2012; 26(11):648-51. DOI: 10.1097/BOT.0b013e31824a3bb5
Source: PubMed


: The purpose of this study was to compare the outcome after the operative treatment of patella fractures (PFs) as compared with those of quadriceps tendon and patella tendon (PT) ruptures.
: This pertains to a retrospective case control.
: The setting was in academic teaching hospitals.
: Ninety-four patients with 99 extensor mechanism disruptions were treated operatively. Of these, 50 (50%) were PFs; 36 (37%) were quadriceps ruptures; and 13 (13%) were PT ruptures.
: The patients were evaluated at 6 and 12 months and were tested for range of motion, quadriceps circumference and strength, SF36, Lysholm, and Tegner outcome scores by independent observers. Radiographs of the knee were obtained to assess bony healing, posttraumatic arthritis, and heterotopic ossification
: A minimum of 12-month follow-up (range 12-81 months) was available for 76 patients (77%). PFs were seen more commonly in women (P < 0.001) and PT ruptures tended to occur in younger males (P < 0.001), with no difference in the body mass index. Thigh circumference was significantly smaller than normal in PFs at 1 year as compared with tendon injuries. At latest follow-up, there were no significant differences noted with respect to knee range of motion, radiographic arthritis, Tegner, Lysholm, or SF36 scores.
: There were no significant differences with regard to outcome in patients sustaining these injuries.
: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

6 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred.
    No preview · Article · Aug 2013 · The journal of knee surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report the outcomes of repair or reconstruction of high-energy, open knee extensor disruption or loss due to combat-related injuries. Retrospective review. Tertiary (Level/Role V) Military Treatment Facility. Fourteen consecutive patients who sustained 17 complex, open knee extensor mechanism injuries during combat operations between March2003 and May 2012. Primary repair or staged allograft extensor reconstruction following serial debridement and closure or soft tissue coverage. Final knee range of motion, extensor lag, ambulatory ability and assist devices, and complications requiring reoperation or salvage procedure. The open knee extensor mechanism injuries required a mean of 11 procedures per injury. At a mean final follow-up of 39 months (range, 12-89), all patients achieved regular community ambulation, with 36% requiring assist devices due to concomitant or bilateral injuries. Average knee flexion was 92° and 35% of extremities had an extensor lag > 10°; however, six of nine extremities with allograft reconstructions had extensor lags of < 10°, and five had no extensor lag. The presence of a major peri-articular or patellar fracture was significantly associated with the knee requiring a subsequent extensor mechanism allograft reconstruction procedure. One extremity each underwent knee arthrodesis or transfemoral amputation due to severe infection. High-energy, open knee extensor mechanism injuries are severe and rarely occur in isolation, but limb salvage is generally successful following multiple procedures. Patients who required staged allograft reconstruction, despite high complication rates, generally had favorable results. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    No preview · Article · Apr 2014 · Journal of orthopaedic trauma
  • [Show abstract] [Hide abstract]
    ABSTRACT: Injuries to the extensor apparatus of the knee joint have an incidence of 0,5% to 6%. Although previous studies have described the advantages and disadvantages of operative treatment in cases of patellar tendon rupture, patella fracture or quadriceps tendon lesions, a report on the reconstruction of the extensor apparatus after traumatic loss of the patella, the patellar tendon, the tibial tuberosity and parts of the lateral quadriceps muscle is absent from the literature. We present the case of a young motorcyclist who underwent a reconstruction of the extensor apparatus using autologous tendon grafts. At a 24-month follow-up, the patient has a nearly physiological range of motion of the knee joint and is able to cope well with everyday life.
    No preview · Article · Jun 2014 · The Knee
Show more