Patellar Tendon Avulsion from TKR

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- Discussion:
    - avulsion of the patella tendon is a serious complication that is very
          difficult to treat;
    - when the knee is flexed intraoperatively, the tendon insertion may be
          stressed to the point of partial or complete avulsion;
    - this is particularly true in patients who have had a HTO or who are
          undergoing revision arthroplasty, becuase scar tissue makes patella
          eversion more difficlt and the patellar tendon may be shortened;
    - extensive soft tissue release from proximal tibia, V-Y quadricepsplasty,
          or elevation of patellar tendon w/ bony block can be used to prevent
          tendon avulsion and improve the exposure of the knee;
    - patellar tendon rupture is best treated with primary repair, but knee
          arthrodesis ultimately may be required;