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.

Introduction: Large cysts of the proximal tibial metaphysis are an uncommon radiological finding amongst the elderly presenting to an arthroplasty clinic. We present two cases of such pathology in elderly patients. These were both associated with advanced degenerate disease in the knee.

In view of the size of the lesions these were both fully investigated with pre-operative radiology and an image guided biopsy. The first case was found to be a large degenerate myxoid cyst involving the majority of the tibial plateau. The second case appeared similar radiologically yet was a large metastasis from a bladder cancer. The only history offered by the after this had been established was that she had had a benign polyp removed some years previously.

Management: When dealing with unusual features of disease a cautious approach should be recommended. Both patients underwent staging investigations and biopsy prior to knee replacement surgery. In each case it was possible to graft the defect and using revision prostheses a good outcome has been achieved.

Conclusion: Large cysts appearing in association with degenerate disease of the knee are uncommon. Whilst these will often be related to the underlying arthritis this is not always the case and appropriate care should be taken to establish a diagnosis prior to surgery.