International Orthopaedics

, Volume 42, Issue 11, pp 2591–2599 | Cite as

Partial extensor mechanism allograft reconstruction for chronic patellar tendon disruption shows superior outcomes in native knees when compared to same technique following total arthroplasty

  • Charles FiquetEmail author
  • Nathan White
  • Romain Gaillard
  • Elvire Servien
  • Philippe Neyret
  • Sébastien Lustig
Original Paper



Chronic patellar tendon disruption occurs mostly after total knee arthroplasty, and is a challenging complication to treat. We have previously described an original technique for reconstruction using extensor mechanism allograft. The goal of this study was to assess the results of this technique in TKA and native knees.


An observational, single centre, retrospective study was conducted. Nine patients in the TKA group and eight in the native knee group were included, all treated for chronic PT rupture. The operative technique included fresh-frozen allograft, in which the patella was fashioned into an hourglass shape and press-fit in a corresponding groove in the native patella. The primary outcome was failure of the graft defined by a residual extensor lag > 10°.


The mean age was 68 in the TKA group and 51 in the native group. The minimum follow-up was 24 months and the mean follow-up respectively 42 and 39 months. 33% of allografts failed in the TKA group where none failed in the native knee group, with a mean extension lag of 12.2° (0–30) and 1.25° (0–5), respectively. All but the three failures presented with an extension lag < 10°. Four cases of patellar bone block distal migration, less than 1 cm, were recorded in the native knee group without clinical repercussion.


The results of this original technique in the setting of chronic PT rupture were excellent for native knees at a minimum follow-up of 24 months. However, results were less satisfactory in the TKA group, due to the substantial rate of failure.

Level of Evidence III


Chronic patellar tendon disruption TKA Native knee Hourglass partial extensor mechanism allograft 



Total knee arthroplasty


Patellar tendon


Quadricipital tendon


Extensor mechanism allograft


Extensor mechanism


Anterior tibial tubercle


Extensor lag


Knee society score


Caton Deschamps Index




Body mass index



This study received no funding.

Compliance with ethical standards

Conflicts of interest

C. Fiquet: None

N. White: None

R. Gaillard: None

E. Servien: S&N consultant; institutional support: amplitude, Corin

P. Neyret: Royalties from Tornier; institutional support: none

S. Lustig: S&N, Medacta and Lepine consultant; institutional support: amplitude, Corin

Ethical approval

The Ethics Committee of the University Hospital of Lyon declares that the project titled “Partial Extensor Mechanism Allograft Reconstruction for chronic Patellar Tendon Disruption shows superior outcomes in Native Knees compared to same technique following Total Knee Arthroplasty (TKA)” submitted by Charles Fiquet et al., is ethically correct. Therefore, its execution is allowed.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Siwek CW, Rao JP (1981) Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am 63:932–937CrossRefGoogle Scholar
  2. 2.
    Bonnin M, Lustig S, Huten D (2016) Extensor tendon ruptures after total knee arthroplasty. Orthop Traumatol Surg Res 102:S21–S31CrossRefGoogle Scholar
  3. 3.
    Browne JA, Hanssen AD (2011) Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh. J Bone Joint Surg Am 93:1137–1143CrossRefGoogle Scholar
  4. 4.
    Ares O, Lozano LM, Medrano-Nájera C et al (2014) New modified Achilles tendon allograft for treatment of chronic patellar tendon ruptures following total knee arthroplasty. Arch Orthop Trauma Surg 134:713–717CrossRefGoogle Scholar
  5. 5.
    Wise BT, Erens G, Pour AE et al (2018) Long-term results of extensor mechanism reconstruction using Achilles tendon allograft after total knee arthroplasty. Int Orthop 86:2694–2697Google Scholar
  6. 6.
    Emerson RH, Head WC, Malinin TI (1994) Extensor mechanism reconstruction with an allograft after total knee arthroplasty. Clin Orthop Relat Res:79–85Google Scholar
  7. 7.
    Nazarian DG, Booth RE (1999) Extensor mechanism allografts in total knee arthroplasty. Clin Orthop Relat Res:123–129CrossRefGoogle Scholar
  8. 8.
    Brown NM, Murray T, Sporer SM et al (2015) Extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty. J Bone Joint Surg Am 97:279–283CrossRefGoogle Scholar
  9. 9.
    Ramseier LE, Werner CML, Heinzelmann M (2006) Quadriceps and patellar tendon rupture. Injury 37:516–519CrossRefGoogle Scholar
  10. 10.
    Cadambi A, Engh GA (1992) Use of a semitendinosus tendon autogenous graft for rupture of the patellar ligament after total knee arthroplasty. A report of seven cases. J Bone Joint Surg Am 74:974–979CrossRefGoogle Scholar
  11. 11.
    Milankov MZ, Miljkovic N, Stankovic M (2007) Reconstruction of chronic patellar tendon rupture with contralateral BTB autograft: a case report. Knee Surg Sports Traumatol Arthrosc 15:1445–1448CrossRefGoogle Scholar
  12. 12.
    McNally PD, Marcelli EA (1998) Achilles allograft reconstruction of a chronic patellar tendon rupture. Arthroscopy 14:340–344CrossRefGoogle Scholar
  13. 13.
    Fujikawa K, Ohtani T, Matsumoto H, Seedhom BB (1994) Reconstruction of the extensor apparatus of the knee with the Leeds-Keio ligament. J Bone Joint Surg (Br) 76:200–203CrossRefGoogle Scholar
  14. 14.
    Schliemann B, Grüneweller N, Yao D et al (2016) Biomechanical evaluation of different surgical techniques for treating patellar tendon ruptures. Int Orthop 40:1717–1723CrossRefGoogle Scholar
  15. 15.
    Robertson A, Nutton RW, Keating JF (2006) Current trends in the use of tendon allografts in orthopaedic surgery. J Bone Joint Surg (Br) 88:988–992CrossRefGoogle Scholar
  16. 16.
    Magnussen RA, Lustig S, Demey G et al (2012) Reconstruction of chronic patellar tendon ruptures with extensor mechanism allograft. Techn Knee Surg 11:34–40CrossRefGoogle Scholar
  17. 17.
    Fiquet C, Schneider A, Ballis R et al (2017) Reconstructing the chronically disrupted knee extensor mechanism after total knee arthroplasty: hourglass variant of the original partial allograft technique. Orthop Traumatol Surg ResGoogle Scholar
  18. 18.
    Dejour H, Denjean S, Neyret P (1992) Treatment of old or recurrent ruptures of the patellar ligament by contralateral autograft. Rev Chir Orthop Reparatrice Appar Mot 78:58–62PubMedGoogle Scholar
  19. 19.
    ElGuindy A, Lustig S, Servien E et al (2011) Treatment of chronic disruption of the patellar tendon in osteogenesis imperfecta with allograft reconstruction. Knee 18:121–124CrossRefGoogle Scholar
  20. 20.
    Malhotra R, Garg B, Logani V, Bhan S (2008) Management of extensor mechanism deficit as a consequence of patellar tendon loss in total knee arthroplasty: a new surgical technique. J Arthroplast 23:1146–1151CrossRefGoogle Scholar
  21. 21.
    Zanotti RM, Freiberg AA, Matthews LS (1995) Use of patellar allograft to reconstruct a patellar tendon-deficient knee after total joint arthroplasty. J Arthroplast 10:271–274CrossRefGoogle Scholar
  22. 22.
    Murgier J, Boisrenoult P, Pujol N et al (2015) Knee extensor mechanism allograft reconstruction following chronic disruption. Orthop Traumatol Surg Res 101:867–870CrossRefGoogle Scholar
  23. 23.
    Ricciardi BF, Oi K, Trivellas M et al (2017) Survivorship of extensor mechanism allograft reconstruction after total knee arthroplasty. J Arthroplast 32:183–188CrossRefGoogle Scholar
  24. 24.
    Lamberti A, Balato G, Summa PP et al (2016) Surgical options for chronic patellar tendon rupture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc:1–7Google Scholar
  25. 25.
    Burnett RSJ, Butler RA, Barrack RL (2006) Extensor mechanism allograft reconstruction in TKA at a mean of 56 months. Clin Orthop Relat Res 452:159–165CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Centre Albert Trillat, Service de Chirurgie OrthopédiqueHôpital Universitaire Lyon NordLyonFrance

Personalised recommendations