Frailty is associated with prolonged hospitalization and inferior patient-reported outcomes after acute quadriceps tendon rupture: A multicenter cohort study.
5 affiliations
- 1Department of Orthopaedics and Traumatology, Erzurum City Hospital, Erzurum-Türkiye.
- 2Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital Ankara-Türkiye.
- 3Department of Orthopaedics and Traumatology, Baltalimanı Bone Diseases Training and Research Hospital, İstanbul-Türkiye.
- 4Department of Orthopaedics and Traumatology, Başakşehir Çam and Sakura City Hospital, İstanbul-Türkiye.
- 5Department of Orthopedics and Traumatology, İstinye University, School of Medicine, İstanbul-Türkiye.
Abstract
Background
Quadriceps tendon rupture is a functionally devastating injury frequently affecting patients with high comorbidity burden and impaired physiological reserve. Frailty represents an age-independent construct of diminished physiological resilience; its impact on hospitalization and long-term functional outcomes after quadriceps tendon rupture remains poorly defined.Methods
We retrospectively analyzed 67 adults who underwent surgical repair or reconstruction for acute quadriceps tendon rupture (≤4 weeks) at four tertiary centers between 2019 and 2023. Pre-operative frailty was quantified using the 5-item modified frailty index (mFI-5) and the 9-point clinical frailty scale (CFS). CFS was assigned retrospectively by two orthopedic surgeons using dual-reviewer consensus (κ=0.82). Primary outcomes were length of hospital stay (LOS) and functional recovery at ≥12 months (Lysholm Knee Scoring Scale); Knee Injury and Osteoarthritis Outcome Score and complications were secondary. Multivariable models were a priori restricted (six predictors for LOS, four for Lysholm; observations-per-predictor ≈11: 1 and ≈17: 1) and adjusted for age, sex, body mass index, comorbidity burden, surgical technique, and follow-up.Results
Mean age was 57.5±12.1 years; 79.1% male. Higher mFI-5 scores were associated with prolonged LOS (r=0.404, p<0.001); in adjusted models, each 1-point increase in mFI-5 predicted a 1.26-day longer stay (95% confidence interval [CI] 0.61-1.90; adjusted R2=0.337). At a mean follow-up of 25.5 months, the mean Lysholm score was 52.2±17.5. CFS was independently associated with poorer recovery (r=-0.328, p=0.007); each 1-point CFS increase corresponded to a 4.32-point decrement in Lysholm (95% CI -6.98 to -1.67; adjusted R2=0.163). A sensitivity analysis excluding reconstruction cases (n=6) yielded essentially unchanged effect sizes (mFI-5 → LOS: β=1.22; CFS → Lysholm: β=-4.18). No significant association was detected between either frailty metric and complications (rate 10.4%, 7 events); however, this analysis was underpowered and should be interpreted with caution.Conclusion
Frailty is associated with prolonged hospitalization and poorer patient-reported outcomes after surgical repair of quadriceps tendon rupture. Integration of mFI-5 and CFS into routine pre-operative evaluation may refine surgical planning, discharge coordination, and rehabilitation intensity.
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BibTeX
@article{ozdemir2026frailty,
title = {{Frailty is associated with prolonged hospitalization and inferior patient-reported outcomes after acute quadriceps tendon rupture: A multicenter cohort study.}},
author = {Ekrem Ozdemir and Nasuhi Altay and Kenan Sen and Serhat Akcaalan and Yasin Guler and Mustafa Serpi and Cem Yildirim and Hasan Ceylan and Yavuz Sahbat},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma \& emergency surgery : TJTES},
year = {2026},
month = oct,
doi = {10.14744/tjtes.2026.36602},
url = {https://europepmc.org/article/MED/42841891},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Frailty is associated with prolonged hospitalization and inferior patient-reported outcomes after acute quadriceps tendon rupture: A multicenter cohort study.
AU - Ekrem Ozdemir
AU - Nasuhi Altay
AU - Kenan Sen
AU - Serhat Akcaalan
AU - Yasin Guler
AU - Mustafa Serpi
AU - Cem Yildirim
AU - Hasan Ceylan
AU - Yavuz Sahbat
PY - 2026
DA - 2026/10/01
JO - Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES
DO - 10.14744/tjtes.2026.36602
UR - https://europepmc.org/article/MED/42841891
AB - Background Quadriceps tendon rupture is a functionally devastating injury frequently affecting patients with high comorbidity burden and impaired physiological reserve. Frailty represents an age-independent construct of diminished physiological resilience; its impact on hospitalization and long-term functional outcomes after quadriceps tendon rupture remains poorly defined.Methods We retrospectively analyzed 67 adults who underwent surgical repair or reconstruction for acute quadriceps tendon rupture (≤4 weeks) at four tertiary centers between 2019 and 2023. Pre-operative frailty was quantified using the 5-item modified frailty index (mFI-5) and the 9-point clinical frailty scale (CFS). CFS was assigned retrospectively by two orthopedic surgeons using dual-reviewer consensus (κ=0.82). Primary outcomes were length of hospital stay (LOS) and functional recovery at ≥12 months (Lysholm Knee Scoring Scale); Knee Injury and Osteoarthritis Outcome Score and complications were secondary. Multivariable models were a priori restricted (six predictors for LOS, four for Lysholm; observations-per-predictor ≈11: 1 and ≈17: 1) and adjusted for age, sex, body mass index, comorbidity burden, surgical technique, and follow-up.Results Mean age was 57.5±12.1 years; 79.1% male. Higher mFI-5 scores were associated with prolonged LOS (r=0.404, p<0.001); in adjusted models, each 1-point increase in mFI-5 predicted a 1.26-day longer stay (95% confidence interval [CI] 0.61-1.90; adjusted R2=0.337). At a mean follow-up of 25.5 months, the mean Lysholm score was 52.2±17.5. CFS was independently associated with poorer recovery (r=-0.328, p=0.007); each 1-point CFS increase corresponded to a 4.32-point decrement in Lysholm (95% CI -6.98 to -1.67; adjusted R2=0.163). A sensitivity analysis excluding reconstruction cases (n=6) yielded essentially unchanged effect sizes (mFI-5 → LOS: β=1.22; CFS → Lysholm: β=-4.18). No significant association was detected between either frailty metric and complications (rate 10.4%, 7 events); however, this analysis was underpowered and should be interpreted with caution.Conclusion Frailty is associated with prolonged hospitalization and poorer patient-reported outcomes after surgical repair of quadriceps tendon rupture. Integration of mFI-5 and CFS into routine pre-operative evaluation may refine surgical planning, discharge coordination, and rehabilitation intensity.
SN - 1306-696X
SN - 1307-7945
ER -