{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:43:52Z","timestamp":1793328232818,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Extensor mechanism (EM) ruptures after total knee arthroplasty (TKA) are rare but lead to substantial functional impairment and morbidity. Treatment remains challenging due to the diversity of surgical techniques and the limited number of comparative studies. The European Knee Associates (EKA) group conducted a systematic review to evaluate available treatments for EM rupture following primary TKA, assess outcomes such as extensor lag, patient\u2010reported outcome measures (PROMs) and walking status, and to identify prevailing trends and complication rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was registered in PROSPERO (CRD42022341591) and conducted according to Preferred Reporting Items for Systematic Review and Meta\u2010Analysis and Cochrane guidelines. PubMed\/Medline and Scopus databases were searched for clinical studies published between 2014 and 2024 reporting outcomes after EM repair in TKA patients. Inclusion criteria encompassed retrospective and prospective studies in English or German. Studies on EM ruptures due to infection, revision TKA, or patellectomy were excluded. Data extraction included demographics, time\u2010to\u2010reconstruction, repair type, extensor lag, PROMs and walking status. Due to heterogeneity, a meta\u2010analysis was not feasible, and results were descriptively reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 32 studies comprising 893 EM rupture cases were included. The mean patient age was 66.8 years (standard deviation [SD]\u2009\u00b1\u20097.4), with a mean body mass index of 34.5 (SD\u2009\u00b1\u20096.2). Patellar tendon ruptures (39%) were the most frequent. Nine different surgical techniques were identified, including allografts, synthetic meshes, autografts and direct repairs. The overall complication rate was 16%, with autografts having the highest complication rate (38%). All repair techniques led to improvements in extensor lag and post\u2010operative Knee Society Scores exceeding the minimal clinically important difference thresholds. However, walking status and PROMs were inconsistently reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EM failure after TKA remains a complex complication with variable outcomes depending on treatment strategy. Standardization of surgical techniques and outcome measures, along with multicenter collaborations, is crucial to improve future patient care as the number of TKA procedures continues to rise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, systematic review of Level III studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70015","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T09:07:03Z","timestamp":1756458423000},"page":"586-595","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Various surgical techniques result in different outcomes for full extensor mechanism ruptures following total knee replacement: A systematic review by the European Knee Associates (ESSKA\u2010EKA)"],"prefix":"10.1002","volume":"34","author":[{"given":"Bruno","family":"Violante","sequence":"first","affiliation":[{"name":"Director Orthopaedic Department Fatebenefratelli Isola Tiberina \u2013 Gemelli Isola Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8259-8488","authenticated-orcid":false,"given":"Riccardo","family":"Compagnoni","sequence":"additional","affiliation":[{"name":"1\u00b0 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Milan Italy"},{"name":"Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health Universita\u0300 degli Studi di Milano Milan Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Kroell","sequence":"additional","affiliation":[{"name":"Orthopaedic Clinic Lucerne (OKL AG) St. Anna Hospital Lucerne Luzern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Engl","sequence":"additional","affiliation":[{"name":"Department of Surgery, Traumatology and Orthopedic Surgery Hospital of Sterzing (SABES\u2010ASDAA) Vipiteno\u2010Sterzing Italy"},{"name":"Teaching Hospital of the Paracelsus Medizinischen Privatuniversit\u00e4t Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octav","family":"Russu","sequence":"additional","affiliation":[{"name":"Orthopaedic and Traumatology department University of Medicine, Pharmacy, Sciences and Technology George Emil Palade Targu Mures Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Mihai","family":"Avram","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology Department Ponderas Academic Hospital Bucharest Romania"},{"name":"Central Military Emergency Hospital Dr. Carol Davila Bucharest Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarper","family":"Gursu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology University of Health Sciences, M. S. (Metin Sabanc\u0131) Baltalimani Bone and Joint Diseases Research Hospital Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvire","family":"Servien","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Chirurgie Orthop\u00e9dique et de M\u00e9decine du Sport, FIFA Medical Center of Excellence H\u00f4pital de la Croix\u2010Rousse, Centre Hospitalier Universitaire de Lyon Lyon France"},{"name":"LIBM \u2013 EA 7424, Interuniversity Laboratory of Biology of Mobility Universit\u00e9 Claude Bernard Lyon 1 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4886-4233","authenticated-orcid":false,"given":"Francesco","family":"Puglia","sequence":"additional","affiliation":[{"name":"U.O.C. Ortopedia e Traumatologia Pediatrica, ASST Gaetano Pini\/CTO Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro Simone","family":"Randelli","sequence":"additional","affiliation":[{"name":"1\u00b0 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini\u2010CTO Milan Italy"},{"name":"Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health Universita\u0300 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reha","family":"Tandogan","sequence":"additional","affiliation":[{"name":"Cankaya Orthopedics Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Hirschmann","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology Kantonsspital Baselland Liestal Switzerland"},{"name":"Department of Clinical Research, Research Group Michael T. 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