title: [Quadriceps tendon insufficiency and rupture : Treatment options in total knee arthroplasty].
abstract: Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic). Furthermore, the choice of treatment should take into account the quality and availability of primary tissue, the patient's general health, along with their likely functional requirements. Conservative treatment is often justified in partial ruptures with good results. Complete ruptures require surgical intervention and multiple operative techniques are described. Treatment options for acute ruptures include direct primary repair with autogenous or synthetic tissue augmentation. In the case of chronic insufficiency and a lack of soft-tissue surroundings, reconstruction with the aid of a muscle flap or allograft tissue can be considered. All surgical intervention techniques used so far have been fraught with complications and rarely lead to satisfactory results. A new surgical approach to the reconstruction and augmentation of the extensor mechanism consists of the use of a synthetic mesh. The technique is described here in detail.
authors.affiliation: Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. kathi.thiele@charite.de.
authors.forename: K
authors.initials: K
authors.lastname: Thiele
authors.affiliation: Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: von Roth
authors.affiliation: Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Pfitzner
authors.affiliation: Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Preininger
authors.affiliation: Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Perka
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013708:Tendon Injuries / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Allografts; Arthroplasty failure; Reconstructive surgical procedures; Risk factors; Tendon injuries