Rupture of the patellar tendon after total knee arthroplasty is a
rare and debilitating complication. Proper surgical management of
this condition remains controversial. The purpose of this study
was to review the results of reconstruction of a ruptured patellar
tendon with an Achilles tendon allograft following total knee arthroplasty.
We reviewed our experience with the use of a fresh-frozen Achilles
tendon allograft with an attached calcaneal bone graft to restore
extensor function in nine patients with patellar tendon rupture
following total knee arthroplasty (five primary and four revision).
All patients were examined clinically and radiographically at an
average of twenty-eight months.
The average knee and functional scores improved from 26 and 14
points, respectively, before the surgery to 81 and 53 points after
the surgery. The average extensor lag decreased from 44°
preoperatively to 3° postoperatively, and the average range
of motion of the knee increased from 88° to 107°.
Two grafts failed in the early postoperative period. Both were repaired
successfully. Radiographs showed an average proximal patellar migration
of 17.8 mm, which did not appear to affect extensor function.
This short-term follow-up study showed that once an Achilles allograft
has healed, it can serve as a reliable reconstruction of a ruptured
patellar tendon following total knee arthroplasty. This technique
may be particularly suited for patients in whom the extensor mechanism
was compromised by multiple prior operations. Continued follow-up
is necessary to determine the long-term durability of these results.