CHALLENGING CASES: Treating Extensor Mechanism Failure in TKA

    Extensor mechanism complications in total knee arthroplasty (TKA) are devastating, with a prevalence of 0.17% to 2.5%. The surgical treatment options are repair of early failures or reconstruction of late or chronic failures.

    At the 2016 ICJR South/RLO Spring Hip & Knee Course Kim J. Chillag, MD, from Palmetto Health Orthopedics in Columbia, South Carolina, reviewed the treatment options and outcomes of surgical treatment of extensor mechanism failure in TKA.

    Surgical treatment is generally divided into early and late treatment. Although Dr. Chillag does not perform early surgical repairs, he said that in the literature, early repairs of extensor mechanism disruption generally do not do well, with high failure and complication rates.

    Dr. Chillag prefers to treat late or chronic failure of the extensor mechanism with allograft reconstruction. Patients who undergo this procedure do reasonably well, but they can have early or late complications as well.

    As described by surgeons from Mayo Clinic, late or chronic failures can also be treated with surgical repair using Marlex mesh, although Dr. Chillag warned attendees that these repairs are not as easy as they may seem.

    If the surgical repair or reconstruction fails, these are the options Dr. Chillag considers for the patient:

    • Walk with a walking aid
    • Re-reconstruction
    • Use of a drop lock knee brace
    • Arthrodesis
    • Amputation

    Click the image above to watch Dr. Chillag’s presentation.


    Dr. Chillag has no disclosures relevant to this presentation.


    1. Nam D; Abdel MP; Cross MB; LaMont LE; et al. The Management of Extensor Mechanism Complications in Total Knee Arthroplasty: AAOS Exhibit Selection. J Bone Joint Surg [Am] 2014;96-A:e47.
    2. Burnett RS, Berger RA, Paprosky WG, et al. Extensor mechanism allograft reconstruction after total knee arthroplasty: a comparison of two techniques. J Bone Joint Surg [Am] 2004;86-A:2694–2699.
    3. Dobbs RE, Hanssen AD, Lewallen DG, Pagnano MW. Quadriceps tendon rupture after total knee arthroplasty: prevalence, complications, and outcomes. J Bone Joint Surg [Am] 2005;87-A:37–45.
    4. Browne JA, Hanssen AD. Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh. J Bone Joint Surg Am.2011 Jun 15;93(12):1137-43