Abstract
Intro: Quadriceps rupture following total knee arthroplasty is a devastating injury. Early operative repair is necessary to maintain the integrity of the extensor. Postoperative rehabilitation usually involves a prolonged period of immobilisation to allow the repair to consolidate. This immobilisation can cause irreversible stiffness in the patient with a total knee replacement. We present a method of rehabilitation to allow early range of motion.
Case Report: A 57 year old gentleman presented with bilateral tri-compartmental osteoarthritis, he had no other significant medical history. Bilateral synchronous total knee replacements were performed and the early post operative was unremarkable.
The patient fell whilst mobilising indoors at home during the fifth post operative week and sustained rapid hyperflexion injures to both knees. Ultrasound scans of the knees demonstrated bilateral discontinuities of the quadriceps mechanisms and a large fluid collection filling the defect.
The patient returned to the operating where a direct repair was achieved. Post operatively the patient was rested in bilateral cylinder casts until the sutures were removed at two weeks. For two week periods the knees were then mobilised in a hinged cast brace allowing 0–30, 0–60 and 0–90 degrees making the total time in cast 8 weeks
At the time of removal of the casts the patient had 110 degrees of flexion in the right leg and 85 degrees of flexion in the left. At six months postoperatively the patient flexes freely to over 100 degrees
Conclusion: Bilateral quadriceps ruptures in a relatively young patient can be managed with early repair and an aggressive rehabilitation regime. This case suggests that is possible to achieve a satisfactory outcome although the input required is significant.
Correspondence should be addressed to Roger Smith, Honorary Secretary, BASK c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London WC2A 3PN
