Risk Factors Associated With Quadriceps Tendon Extensor Mechanism Disruption Following Total Knee Arthroplasty

Shu Lin; David Sproul; Amil Agarwal; Andrew B Harris; Gregory J Golladay; Savyasachi C Thakkar

doi:10.1016/j.arth.2024.01.053

Risk Factors Associated With Quadriceps Tendon Extensor Mechanism Disruption Following Total Knee Arthroplasty

J Arthroplasty. 2024 Feb 6:S0883-5403(24)00078-0. doi: 10.1016/j.arth.2024.01.053. Online ahead of print.

Authors

Shu Lin¹, David Sproul², Amil Agarwal², Andrew B Harris³, Gregory J Golladay⁴, Savyasachi C Thakkar³

Affiliations

¹ Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida.
² Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia.
³ Adult Reconstruction Division, Johns Hopkins Department of Orthopaedic Surgery, Columbia, Maryland.
⁴ Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia.

PMID: 38331356
DOI: 10.1016/j.arth.2024.01.053

Abstract

Background: Quadriceps tendon extensor mechanism disruption is an infrequent but devastating complication after total knee arthroplasty (TKA). Our knowledge of specific risk factors for this complication is limited by the current literature. Thus, this study aimed to identify potential risk factors for quadriceps tendon extensor mechanism disruption following TKA.

Methods: A retrospective cohort analysis was performed using the PearlDiver Administrative Claims Database. Patients undergoing TKA without a prior history of quadriceps tendon extensor mechanism disruption were identified. Quadriceps tendon extensor mechanism disruption included rupture of the quadriceps tendon, patellar tendon, or fracture of the patella. Patients who had a minimum of 5 years of follow-up after TKA were included. A total of 126,819 patients were included. Among them, 517 cases of quadriceps tendon extensor mechanism disruption occurred (incidence 0.41%). Hypothesized risk factors were compared between those who had postoperative quadriceps tendon extensor mechanism disruption and those who did not.

Results: On multivariate analysis, increased Charlson Comorbidity Index (odds ratio (OR): 1.10, 95% confidence interval (CI) [1.07 to 1.13]; P < .001), obesity (OR: 1.49, 95% CI [1.24 to 1.79]; P < .001), and fluoroquinolone use any time after TKA (OR: 1.24, 95% CI [1.01 to 1.52]; P = .036) were significantly associated with quadriceps tendon extensor mechanism disruption.

Conclusions: Our study identified the incidence of quadriceps tendon extensor mechanism disruption following TKA as 0.41%. Identified risk factors for quadriceps tendon extensor mechanism disruption after TKA include an increased Charlson Comorbidity Index, obesity, and use of fluoroquinolones postoperatively.

Keywords: Charlson comorbidity index; fluoroquinolone; obesity; quadriceps tendon extensor mechanism disruption; total knee arthroplasty.