Abstract

Introduction: Patellar tendon rupture following Total Knee Arthroplasty (TKA) is a rare but devastating complication that compromises the extensor mechanism and poses substantial challenges for both surgical reconstruction and postoperative rehabilitation. Optimal postoperative management remains controversial, particularly in balancing graft protection with early functional recovery.
Case summary: We report the case of a 57-year-old male with obesity who sustained a traumatic patellar tendon rupture six weeks after primary TKA. Surgical management consisted of a complex repair using V-Y quadricepsplasty, suture and suture-anchor fixation, and augmentation with posterior tibial tendon allograft and BioBrace®. Postoperatively, the patient deviated from the standard immobilization protocol and transitioned early to a customized dynamic patellofemoral extension-assist brace. Despite early full weight bearing and return to work against medical advice, the patient demonstrated progressive improvements in range of motion, functional performance and patient-reported outcome measures without repair failure or rerupture.
Conclusion: This case demonstrates that, in select patients, a customized dynamic extension-assist brace may facilitate functional recovery after complex patellar tendon repair following TKA without compromising repair integrity. Dynamic bracing may provide a viable adjunct to traditional postoperative protocols by permitting controlled loading, improving gait confidence and supporting earlier return to activities of daily living and work. Further study is warranted to define patient selection criteria and optimal rehabilitation strategies.

Keywords:Patellar tendon rupture; Total knee arthroplasty; Extensor mechanism reconstruction; V-Y quadricepsplasty; Patellofemoral unloader brace; BioBrace®