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The Journal of Bone and Joint Surgery (American) 84:1354-1361 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Reconstruction of a Ruptured Patellar Tendon with Achilles Tendon Allograft Following Total Knee Arthroplasty

Lawrence S. Crossett, MD, Raj K. Sinha, MD, PhD, V. Franklin Sechriest, MD and Harry E. Rubash, MD

Investigation performed at the Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Lawrence S. Crossett, MD
Raj K. Sinha, MD, PhD
V. Franklin Sechriest, MD
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 5200 Centre Avenue, Suite 415, Pittsburgh, PA 15232. E-mail address for R.K. Sinha: sinhark{at}msx.upmc.edu

Harry E. Rubash, MD
Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, White Building, Room 601, Boston, MA 02114

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.


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