Knee Osteoarthritis with over 32 Years of Chronic Quadriceps Tendon Rupture Treated with Total Knee Arthroplasty and Extensor Mechanism Autograft Reconstruction: A Case Report

Background: Management of chronic quadriceps tendon rupture presents considerable technical difficulty because of extensive fibrosis and tendon retraction.The coexistence of ipsilateral knee osteoarthritis (OA) further complicates surgical planning and rehabilitation.While this dual pathology is uncommon, there is limited literature describing strategies to address both conditions in a single operative setting.When the extensor mechanism is insufficient, implant survival and postoperative knee range of motion (ROM) are negatively affected.The anatomy has to be understood primarily, and then the correct treatment for the patient.Management is particularly challenging when the extensor mechanism has been deficient for many years.Case presentation: A 65-year-old male with a 32-year history of chronic quadriceps tendon rupture presented with complete loss of knee extension (actively) and tricompartmental OA of the ipsilateral knee.He is a known case of hypertension (HTN) and already taking medications for the same.Clinical evaluation subsequently demonstrated a prominent palpable defect in the left suprapatellar region, accompanied by marked weakness of active knee extension.The patient went under simultaneous total knee arthroplasty (TKA) combined with extensor mechanism reconstruction using an autograft.In a single sitting.The procedure involved removal of the degenerated tendon tissue, implantation of a cemented posterior stabilized total knee arthroplasty (PS TKA) prosthesis, and fixation of the quadriceps tendon by using the semitendinosus, gracilis, and peroneus longus graft.Postoperatively, the patient followed the structural rehabilitation program with prolonged immobilisation followed by a gradual ROM exercises (static at post-op day 1 and dynamic at 3 weeks).Postoperatively patient was clinically examined and checked for knee stability, functional recovery, and ROM.Postoperative course and outcomes: Knee ROM exercises were started on postoperative day one.Partial weight-bearing was allowed initially and gradually progressed to full weight-bearing.At 6 weeks, he was able to ambulate independently, achieving an active knee ROM of 20-100, with active extension limited to 20 and full passive extension.Quadriceps strength was graded as IV/V.The patient continued to demonstrate progressive improvement, maintaining functional gains at the final follow-up at 6 months. Conclusion:In long-standing quadriceps tendon rupture with advanced knee OA, combined TKA and extensor mechanism allograft reconstruction can restore functional extension, improve life quality, and adherence to rehabilitation is critical for success.Lack of active knee extension is already a contraindication for TKA, but we did this procedure successfully to attain knee ROM stability and functional recovery by performing primary TKA along with an autograft for quadriceps tendon rupture.