Summary

Early postoperative complication rates following primary repair of quadriceps and patellar tendon ruptures were high with infection, DVT, and reoperation rates of approximately 4.7%, 3%, and 9%. These findings emphasize the need for vigilant postoperative management and infection prevention strategies, as well as the potential need for augmentation repair strategies to reduce failure rates.

Abstract

Introduction

Quadriceps and patellar tendon ruptures are significant injuries that require surgical repair to restore the extensor mechanism function of the knee. Postoperative complications following quadriceps or patellar tendon repair can be common and extremely disabling, but the data on early postoperative complications following these surgeries have not been well studied. This study aims to quantify and compare the incidence of 90-day postoperative complications after primary repair of quadriceps and patellar tendon ruptures using a large global multicenter database.

Methods

A retrospective study was performed using the TriNetX (Cambridge, MA), a global research network that includes research data from more than 70 healthcare organizations across 4 countries. Patients who underwent primary repair of quadriceps tendon (CPT code 27385) or patellar tendon (CPT code 27380) ruptures in the past 20 years (2004 to 2024) were identified. The incidence of early postoperative complications, including infection, deep vein thrombosis (DVT), nerve injury, and need for reoperation, was queried within 90 days of surgery. Rates of postoperative complications between the two treatment groups were compared.

Results

Through the database, 7,743 patients treated with primary quadriceps tendon repair and 7,446 patients treated with primary patellar tendon repair were identified. Among the quadriceps tendon repair patients, 355 (4.6%) developed a postoperative infection, 254 (3.3%) experienced DVT, <10 (<0.1%) suffered a nerve injury, and 662 (8.5%) required reoperation within 90 days following surgery. Among the patellar tendon repair patients, 360 (4.8%) developed infection, 207 (2.8%) experienced DVT, <10 (<0.1%) suffered a nerve injury, and 707 (9.5%) required reoperation within 90 days following surgery. There was no difference in the rate of postoperative infection (p = 0.134), DVT (p = 0.072), or nerve injury (p = 0.930) between the two groups. Patients treated with primary patellar tendon repairs had a higher rate of reoperation than patients treated with quadriceps tendon repair (p = 0.042).

Conclusions

Early postoperative complication rates following primary repair of quadriceps and patellar tendon ruptures were high, with infection, DVT, and reoperation rates of approximately 4.7%, 3%, and 9%, respectively. Reoperation rates within 90 days postoperatively were higher after patellar tendon repairs compared to quadriceps tendon repairs. The increased likelihood of reoperation after patellar tendon repairs compared to quadriceps tendon repairs may be attributed to multiple factors including decreased tissue volume of the patellar ligament compared to the distal quadriceps tendon, decreased subcutaneous tissue thickness over the patellar tendon, and occurrence of mid-substance patellar tendon ruptures that may be harder to fix and more prone to failure. These findings emphasize the need for vigilant postoperative management and infection prevention strategies, as well as the potential need for augmentation repair strategies to reduce failure rates. Understanding of these short-term complication rates after quadriceps and patellar tendon repair can also aid surgeons in the preoperative counselling of patients.