title: Management of extensor mechanism rupture after TKA.
abstract: Disruption of the extensor mechanism in total   knee arthroplasty may occur by tubercle avulsion, patellar or quadriceps   tendon rupture, or patella fracture, and whether occurring intra-operatively   or post-operatively can be difficult to manage and is associated   with a significant rate of failure and associated complications.   This surgery is frequently performed in compromised tissues, and   repairs must frequently be protected with cerclage wiring and/or   augmentation with local tendon (semi-tendinosis, gracilis) which   may also be used to treat soft-tissue loss in the face of chronic   disruption. Quadriceps rupture may be treated with conservative   therapy if the patient retains active extension. Component loosening   or loss of active extension of 20° or greater are clear indications   for surgical treatment of patellar fracture. Acute patellar tendon   disruption may be treated by primary repair. Chronic extensor failure   is often complicated by tissue loss and retraction can be treated   with medial gastrocnemius flaps, achilles tendon allografts, and   complete extensor mechanism allografts. Attention to fixing the   graft in full extension is mandatory to prevent severe extensor   lag as the graft stretches out over time.
authors.affiliation: Rush University Medical Center, 1611 West Harrison Avenue, Suite 300, Chicago, Illinois 60612, USA. aarongbone@gmail.com
authors.forename: A G
authors.initials: AG
authors.lastname: Rosenberg
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D010329:Patella / Q000293:injuries* / Q000601:surgery; D017847:Patellar Ligament / Q000293:injuries* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012421:Rupture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D013708:Tendon Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome