Polypropylene mesh augmentation for complete quadriceps rupture after total knee arthroplasty

• Complete quadriceps disruption is a rare and devastating complication after total knee arthroplasty.
• Polypropylene mesh augmentation offers limited functional outcomes, but does improve postoperative pain control.
• Polypropylene mesh should not be used in patients with a previous history of periprosthetic infection.

IntroductionPolypropylene mesh has previously been shown to be an effective treatment for failed patellar tendon repairs after total knee arthroplasty (TKA), but there have been few reports of this synthetic mesh used in complete quadriceps rupture after TKA.MethodsWe retrospectively reviewed seven consecutive cases in six patients with complete quadriceps tears after TKA who had their quadriceps tendon repaired with suture and polypropylene mesh augmentation. All but two patients had previously failed primary suture repair. Patient outcomes were evaluated using the Knee Society Score. Standardized anterior-posterior (AP), lateral and merchant radiographs were evaluated preoperatively and at final follow-up.ResultsSeven knees in six patients were evaluated with a mean follow-up of 34 ± 10 (range 24 to 49 months) months. There were only four clinical successes defined as an extensor lag less than 30°. Of the functioning knees at final follow-up (n = 5) the overall extensor lag in this group did significantly improve from 50 ± 13° to 20 ± 15° (range 5 to 40°) (p = .01). Mean postoperative flexion at final follow-up was 115 ± 8°. Mean Knee Society Score for function improved from 20 ± 30 to 45 ± 54 (p = .03) as did the mean Knee Society Score for pain (44 ± 18 vs. 74 ± 78, p = .02).DiscussionPolypropylene mesh offered limited postoperative functional results when used as an augment to the multiply operated knee that sustains a complete quadriceps rupture after TKA, but did allow for significant improvement in postoperative pain outcomes.Level of EvidenceIV