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

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 31; no. 2; pp. 455 - 463
• Main Authors: Oeding, Jacob F., Alrabaa, Rami, Wong, Stephanie E., Zhang, Alan L., Feeley, Brian, Ma, C. Benjamin, Lansdown, Drew A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2023; Springer Nature B.V
• Subjects: Complications; Cross-Sectional Studies; Demographic variables; Demographics; Demography; Epidemiology; Female; Females; Gender; Humans; Knee; Male; Medicine; Medicine & Public Health; Obesity; Orthopedics; Patellar Ligament - surgery; Postoperative; Postoperative Complications - epidemiology; Quadriceps muscle; Reoperation; Retrospective Studies; Risk; Sports Medicine; Surgery; Tendons; Tobacco; Tobacco Use; Extensor mechanism; Patellar tendon repair; Complications; Outcomes; Reoperations; Quadriceps tendon repair
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-022-07061-9

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.