Introduction: Revision total knee arthroplasty (TKA) in the setting of extensor mechanism failure presents a significant surgical challenge. Extensor mechanism allograft reconstruction is a suitable option for chronic, irreparable ruptures, especially in patients with a history of prior TKA and failed repairs. This video abstract demonstrates the operative steps, key technical considerations, and postoperative management for a complex case requiring revision TKA with concurrent extensor mechanism allograft reconstruction.

Case Presentation: A 67-year-old male with a history of atrial fibrillation on apixaban, COPD, and obstructive sleep apnea presented with bilateral knee pain refractory to conservative treatment. Past surgical history included bilateral TKAs performed in 2013 and a left extensor mechanism repair. Following the initial surgeries, the patient sustained multiple injuries including right quadriceps tendon rupture, left patellar tendon rupture, and right patella fracture. Despite extensor mechanism repair, he experienced persistent pain and functional limitations over the subsequent decade. Radiographs and MRI revealed valgus alignment of the left leg, patella alta, sclerotic patella with prior anchor sutures, and lucency around the left femoral component. Infection work-up was negative. The decision was made to proceed with revision left TKA and extensor mechanism allograft reconstruction.

Surgical Technique

Discussion and Literature Review