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Table 1 Characteristics of the studied included

From: Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

Nr. of reference No. of patients Gender Mean age Mechanism of rupture Time before surgery Type of lesion/rerupture Associated injury/comorbidities Type of surgery Complications
[25] Bilateral quadriceps tendon rupture in a seasoned marathon runner with patellar spurs. (2011) Assiotis et al. 1 M 63 Tripped on a step and fell down, landing on both knees 42 days Bilateral QT ruptures None Three separate Krakow-type sutures +three separate drilled tunnels in the patella and secured over the distal pole None
[29] The hemisoleus rotational flap provides a novel superior autograft reconstructive option for the treatment of chronic extensor mechanism disruption. (2016) Auregan et al. 1 F 80 6 weeks after TKA during active extension of the knee against resistance 210 days QT rerupture None Medial gastrocnemius-soleus-calcaneus rotational flap None
[32] Allograft reconstruction of a chronic quadriceps tendon rupture with use of a novel technique. (2014) Forslund et al. 1 M 47 Primary tear: descending from a cinderblock; Re-tear: during physical therapy 1°: 210 days 2°: 365 days Full thickness after QT rerupture Hypertension 1°: quadriceps tendon V-Y advancement 2°: Achilles tendon-bone block allograft None
[40] Simultaneous chronic rupture of quadriceps tendon and contra-lateral patellar tendon in a patient affected by tertiary hyperparatiroidism. (2008) Grecomoro et al. 1 M 48 Giving way of the left knee during walking and a secondary fall 40 days Full thickness of the distal insertion of QT Chronic renal failure, tertiary hyperparathyroidism Codivilla’s Y/V technique None
[41] Neglected rupture of the quadriceps tendon in a patient with chronic renal failure (case report and review of the literature). (2014) Hassani et al. 1 M 32 Common fall 60 days Full thickness of the QT at the osteo-tendinous junction with retraction of 3 cm + calcifications Chronic renal failure, with hemodialysis dependence for 5 years Codivilla’s Y/V technique None
[22] Bilateral extensor mechanism allograft reconstruction for chronic spontaneous rupture: a case report and review of the literature. (2019) Lamberti et al. 1 F 51 Acute failure of the left knee while getting up from a chair 480 days Full-thickness lesion on the left QT End-stage renal failure + full-thickness lesion on the right patellar tendon A full extensor mechanism allograft None
[36] Surgical treatment of neglected traumatic quadriceps tendon rupture with knee ankylosis. (2016) Lee et al. 1 M 15 Motorcycle accident 270 days Chronic QT rupture + a patellar superior pole avulsion fracture of the left knee + nonunion of the left proximal tibia fracture Open fracture of the left femur shaft + an intra-articular fracture of the proximal tibia QT reconstruction using tibialis anterior allograft and additional screw fixation None
[17] Reconstruction of a chronic quadriceps tendon tear in a body builder. (2006) Leopardi et al. 1 M 28 Car accident 210 days Full-thickness tear of the quadriceps tendon proximal to the superior pole of the patella Anabolic steroid use QT reconstruction using gracilis and semitendinosus autograft None
[42] Neglected ipsilateral simultaneous ruptures of patellar and quadriceps tendon (2015) Karahasanoglu et al. 1 M 40 Fall from a standing height 730 days Chronic full-thickness and QT retraction Ipsilateral patellar tendon rupture Peroneus longus autograft None
[43] Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure. (2007) Kazimoglu et al. 1 F 37 Two consecutive falls 60 days Bilateral QT ruptures Chronic renal failure, with hemodialysis for 2 years Tycron transpatellar suture anchors None
[28] Autologous hamstring tendon used for revision of quadiceps tendon tears. (2013) McCormick et al. 1 M 38 Primary tear: playing basketball
Re-tear: fall from standing height
1°: immediatly 2°: 300 days after the rerupture Complete QT rerupture None Bilateral hamstring autograft through a QT weave and a transosseous patellar repair None
[44] Chronic Quadriceps Tendon Rupture After Total Knee Arthroplasty Augmented With Synthetic Mesh. (2017) Ormaza et al. 3 2 M 1 F 67,5 One patient experienced trauma 1 year after TKA revision surgery; one patient 6 months after TKA revision surgery; one patient 2 years after TKA revision surgery 148 days Full thickness One of them had a hystory of hemochromatosis End-to-end sutures No. 5 Ethibond and reinforcement with MUTARS synthetic mesh None
[35] Knee osteoarthritis with chronic quadriceps tendon rupture treated with total knee arthroplasty and extensor mechanism allograft reconstruction: a case report. (2018) Piatek et al. 1 M 51 Traumatic fall 90 days Chronic full-thickness and QT retraction Tricompartmental knee osteoarthritis TKA + complete knee extensor mechanism allograft None
[45] Delayed reconstruction of a quadriceps tendon. (2008) Pocock et al. 1 F 80 Common fall 2920 days Chronic full-thickness and QT retraction Hypertension Four FiberWire1 (Arthrex Ltd, Sheffield, England) sutures None
[30] Chronic rupture of the extensor apparatus of the knee joint. (2005) Poonnoose et al. 1 M 50 Common fall 4380 days Chronic full-thickness and QT retraction Comminuted patellar fracture treated with patellectomy Controlateral ileo-tibial band autograft None
[19] Quadriceps tendon repair using hamstring, prolene mesh and autologous conditioned plasma augmentation. A novel technique \for repair of chronic quadriceps tendon rupture. (2015) Rehman et al. 1 M 61 Rerupture after primary repair 300 days Chronic full thickness Hypertension + glaucoma QT reconstruction using semitendinosus and gracilis autograft + prolene mesh reinforcement + PRP injection None
[46] Chronic quadriceps rupture: treatment with lengthening and early mobilization without cerclage augmentation and a report of three cases. (2008) Rizio et al. 3 1 M 2 F 46,75 One patient fell down a flight of stairs; One patient injured his knee while jumping in church during prayers; One patient fell while stepping off a curb 240 days Chronic full thickness Hypertension, Hypercolesterolaemia, Obesity + obesity + hip and chronic back pain V-Y lengthening and direct repair through drill holes in the patella without augmentation None
[18] Repair of ruptured quadriceps tendon with Leeds-Keio ligament following revision knee surgery. (2008) Rust et al. 1 F 86 Four months after TKA revision surgery 120 days Chronic full-thickness + 10-cm QT retraction None Leeds-Keio graft inserted in an 8 shape and sutured to the periosteum None
[23] Modified V-Y turndown flap augmentation for quadriceps tendon rupture following total knee arthroplasty: a retrospective study. (2019) Shi et al. 23 10 M 13 F 61 Fall from a standing height after TKA 21 days (range, 14 to 56 days) Complete quadriceps tendon rupture following TKA + 1rerupture Obesity, diabetes, chronic dialysis, steroid dependence (12pt) V-Y turndown flap 1 hematoma and delayed wound healing 1 fall and rerupture after 24 months
[47] A simultaneous bilateral quadriceps and patellar tendons rupture in patients with chronic kidney disease undergoing long-term hemodialysis: a case report. (2020) Tao et al. 2 M 33,5 1 fall down the stairs 1 sudden twist bilateral QT ruptures Chronic renal failure, with hemodialysis dependence for 9 and 11 years Krackow sutures None
[37] Extensor Mechanism Reconstruction with Use of Marlex Mesh. (2019) Abdel et al. 27 10 M 17 F 67 Rupture after TKA 219 days Complete QT rupture Obesity, diabetes, coronary artery diease, hypertension, OA, rheumatoid arthritis, Parkinson, cancer (leukemia, breast cancer, bladder cancer) Marlex Mesh augmentation 5 QT re-ruptures that required mesh revision
[38] Polypropylene mesh augmentation for complete quadriceps rupture after total knee arthroplasty. (2016) Nodzo et al. 7 2 M 5 F 58,7 Rupture after TKA 90 days Complete QT rupture Diabetes, rheumathoid arhtritis, chronic pulmunary disease with steroid use, HCV, drug abuse, smoke, chronic renal failure Polypropylene mesh augmentation 2 QT reruptures and 2 QT rerupture with infections
[33] Reconstruction of disrupted extensor mechanism after total knee arthroplasty. (2017) Lim et al. 3 2 M 1 F 59 Rupture after TKA 205 days Chronic full thickness GERD, Pulmunary embolism, diabetes, hypothyroid, asthma, hypertension, stroke, smoke Achilles tendon allograft 1 deep infection and graft failure
[34] Long-term results of extensor mechanism reconstruction using Achilles tendon allograft after total knee arthroplasty. (2018) Wise et al. 6 3 M 3 F 68 Rupture after TKa Complete QT rupture [5] + 1 bilateral rupture Hypertension [3], GERD, obesity [3], hypothyroidism, asthma, chronic kidney disease, OA, diabetes [3] Achilles tendon allograft  
[48] Quadriceps tendon rupture after total knee arthroplasty. Prevalence, complications, and outcomes. (2005) Dobbs et al. 7 1 M 6 F 72 3 patients fall, 1 patients while kneeling, 2 patients while walking, 1 patient while rising from a chair 40 days QT rupture after TKA, 1 rerupture Obesity [1], steroid abuse [1], DM [1] Suture 4 reruptures and 1 chronic recurvatum