Dr ABHISHEK YADAV (orthopaedic surgeon)

Extensor mechanism disruption following total knee replacement (TKR) is a rare but potentially disabling complication. In this case, intraoperative exploration revealed a complete avulsion of the inferior periosteal sleeve from the inferior pole of the patella with disruption of the patellar tendon attachment. The patellar component remained well fixed without evidence of loosening, while the femoral and tibial components were stable. Hematoma and soft tissue disruption were present, with no signs of infection. Radiographs demonstrated altered patellar height with a small inferior pole avulsion fragment, while MRI confirmed complete periosteal sleeve avulsion and extensor mechanism disruption. Following meticulous debridement, the periosteal sleeve was anatomically reduced. A Krackow locking suture repair was performed through the patellar tendon and periosteal sleeve using high-strength non-absorbable sutures, followed by transosseous fixation through the patella. The repair restored patellar height, extensor mechanism continuity, and stable patellar tracking throughout knee motion. Retinacular repair further reinforced the construct. Postoperative radiographs confirmed satisfactory anatomical restoration with maintained implant alignment. The patient was managed with protected immobilization followed by a structured rehabilitation program. Early follow-up demonstrated restoration of active knee extension, improved quadriceps function, maintained patellar position. Jul 2, 2026