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Findings The radiographs show a medial unicompartment arthroplasty with conversion to a TKA which on imaging in the PACU is without complication. Subsequent radiographs one month later show prominent anterior soft tissue swelling and a joint effusion which is perhaps slightly greater than expected given the recent surgery. MRI demonstrates a disruption along the medial aspect of the quadriceps tendon in a somewhat oblique pattern with associated marked soft tissue edema and hematoma of the soft tissue. The area of disruption extends to the medial retinacular tissue. Inferior to the patella, the medial capsular tissue is intact.
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Diagnosis: Arthrotomy Dehiscence This case highlights that particularly relatively early on in the postoperative period, the area of the medial parapatellar arthrotomy (most common technique utilized) is a vulnerable site to injury. Dehiscence of the arthrotomy most frequently is precipitated by a fall, and as seen in this case, the dehiscence is an oblique fashion like a zipper coming undone. This is in distinction to a quadriceps tear which in the coronal plane is more typically transverse in orientation with a disruption of the quadriceps near or at the patella attachment. Both injuries present with anterior swelling and a compromised extensor mechanism. However, the surgery to repair the injury is clearly markedly different and frequently the prognosis is markedly different. In this case, meticulous repair of the arthrotomy was performed relatively quickly, two weeks later, to optimize patient outcome.
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References Tandogan RN, Terzi E, Gomez-Barrena E, Violante B, Kayaalp A. Extensor mechanism ruptures. EFORT Open Rev. 2022 May 31;7(6):384-395. doi: 10.1530/EOR-22-0021. PMID: 35638613; PMCID: PMC9257728.
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