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Complications and re-operations after extensor mechanism repair surgery in a large cross-sectional cohort: females and tobacco-users at highest risk for adverse outcomes

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

A Correction to this article was published on 15 August 2022

This article has been updated

Abstract

Purpose

There is little information on patients most at risk for poor outcomes following surgical repair of extensor mechanism tendon injuries. The purpose of this study is to provide an epidemiological overview of patients undergoing patellar or quadriceps tendon repair and to assess the incidence of postoperative complications, readmissions, and revision repairs among this population.

Methods

Retrospective data were obtained using the PearlDiver database for patellar tendon repair and quadriceps tendon repair patients between 2010 and 2020. Baseline demographics, incidences of 90-day readmissions and postoperative complications, and reoperation rates were collected for each group. Multivariate logistic regression was performed to assess the predictive power of each demographic variable on the incidence of postoperative complications and reoperations.

Results

In total, 1543 patients underwent patellar tendon repair and 601 underwent quadriceps tendon repair. Complications within 90-days were observed in 33.7% of patients with patellar tendon repair and 39.2% of patients with quadriceps tendon repair. Reoperation rates were 4.2% and 4.8% for patellar tendon repair and quadriceps tendon repair, respectively. Females in both patellar tendon repair and quadriceps tendon repair groups were at significantly higher risk for post-operative complications (patellar tendon repair OR 3.0, 95% CI 2.4–3.7; quadriceps tendon repair OR 2.9, 95% CI 1.9–4.6; p < 0.001 for both). Older age (p < 0.001), female gender (p < 0.001), CCI (p < 0.001), tobacco use (p < 0.001), and obesity (p < 0.01) were all predictors of experiencing at least one complication following patellar tendon repair. For quadriceps tendon repair, female gender (p < 0.001) and CCI (p < 0.001) were the strongest predictors of experiencing at least one complication, while older age, tobacco use, and obesity (p < 0.05 for all) were also significant independent predictors.

Conclusion

Patellar tendon repair patients are younger on average than quadriceps tendon repair patients. Although females are less likely to sustain extensor mechanism ruptures compared to males, females are significantly more likely to have at least one complication after quadriceps or patellar tendon repair. These findings may be used by surgeons, patients, and payors to understand who is most at risk for adverse outcomes following extensor mechanism repair surgery, resulting in earlier intervention and counseling to reduce the likelihood of a poor outcome following extensor mechanism repair surgery.

Level of evidence

Level III.

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Change history

Abbreviations

PTR:

Patellar tendon repair

QTR:

Quadriceps tendon repair

CCI:

Charlson comorbidity index

ICD-10:

International classification of diseases, tenth revision

ICD-9:

International classification of diseases, ninth revision

CPT:

Current procedural terminology

OR:

Odds ratio

95% CI:

95% Confidence interval

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Authors and Affiliations

  1. Mayo Clinic Alix School of Medicine, 226 2nd St SW, Rochester, MN, 55905, USA

    Jacob F. Oeding

  2. Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA

    Rami Alrabaa, Stephanie E. Wong, Alan L. Zhang, Brian Feeley, C. Benjamin Ma & Drew A. Lansdown

Authors
  1. Jacob F. Oeding
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  2. Rami Alrabaa
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  3. Stephanie E. Wong
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  4. Alan L. Zhang
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  5. Brian Feeley
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  6. C. Benjamin Ma
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  7. Drew A. Lansdown
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Contributions

JFO: study design, data acquisition, data analysis, data interpretation, manuscript drafting, and critical revision. RA: data interpretation, manuscript drafting, and critical revision. SEW: data interpretation, manuscript drafting, and critical revision. AZ: data interpretation, manuscript drafting, and critical revision. BF: data interpretation, manuscript drafting, and critical revision. CBM: data interpretation, manuscript drafting, and critical revision. DAL: study design, data interpretation, manuscript drafting, and critical revision.

Corresponding author

Correspondence to Jacob F. Oeding.

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Conflict of interest

JFO: none. RA: none. SW: none. AZ: consulting fees: Stryker and Depuy Mitek. BF: none. CBM: grants from Aesculap, NIH, and Moximed; Consulting fees from Conmed and Stryker; Participation in NIH Stability II Trial; Participation on AOSSM and ASES Research Committees. DAL: grants from AOSSM, AANA, and Arthritis Foundation; Consulting fees from Vericel, Inc. and Allosource; Payment for educational event/lecture: Evolution Surgical/Arthrex; Patents: patent pending on cannula/suture anchor device; Participation on AOSSM and AANA Research Committees and a Knee Topic Co-Chair for ORS.

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The original online version of this article was revised: The middle initial "L" for the co-author is updated as Alan L. Zhang in the author list.

Appendix

Appendix

See Tables 6 and 7.

Table 6 Codes utilized to define quadriceps rupture
Full size table
Table 7 Codes utilized to define postoperative complications and reoperations
Full size table

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Oeding, J.F., Alrabaa, R., Wong, S.E. et al. Complications and re-operations after extensor mechanism repair surgery in a large cross-sectional cohort: females and tobacco-users at highest risk for adverse outcomes. Knee Surg Sports Traumatol Arthrosc 31, 455–463 (2023). https://doi.org/10.1007/s00167-022-07061-9

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