Extensor Mechanism Disruption after Total Knee Arthroplasty

Schoderbek, Robert J.; Brown, Thomas E.; Mulhall, Kevin; Mounasamy, Varatharaj; Iorio, Richard; Krackow, Kenneth A.; Macaulay, William; Saleh, Khaled J.

doi:10.1097/01.blo.0000218726.06473.26

Cited by 87 publications

(47 citation statements)

References 53 publications

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“…The latter is determined by the amount of disruption ( patellar tendon, patella, or quadriceps tendon), degree of functional impairment (partial versus full tear), acute versus chronic nature of the disruption, availability of healthy tissue for either direct primary repair or augmentation, and the compliance of the patient [16]. Direct primary repair is a viable option in some cases and most often is a repair that involves patellar tendon ruptures.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Mazza

Vaienti

Mazzola

et al. 2016

Injury

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Introduction: Latest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia. In this group of patients bone and soft tissues conditions are completely different compared to patients with oncological back ground. The presence of infection and previous surgeries can lead to adhesion, scar interference, muscular and tendon impairment and skin problems that lead to reduced function and severe joint stiffness. The purpose of this study is to evaluate the results of treatment of reconstruction of patellar tendon during implantation of proximal tibia megaprosthesis for the treatment of septic post traumatic critical bone defects. Patients and methods: In this retrospective study, we evaluated 9 patients treated with proximal tibia megaprosthesis who underwent patellar tendon reconstruction. All patients presented a complete patellar tendon disruption at the time of prosthesis implantation. Procedures of reconstruction included a tendon-plasty of quadriceps and/or patellar tendons, a pie crusting of quadriceps fascia, a reinforcement of the apparatus with synthetic tendon graft substitutes (LARS) and a medial gastrocnemius muscular flap to reconstruct the extensor mechanism and obtain skin coverage when needed. The average follow up was 18 months (9-36). For each of the cases, we analysed the complications occurred regarding septic recurrence, patellar fracture, quadriceps and patellar tendon rupture and number of reinterventions. The clinical outcome was assessed by the WOMAC Score. Results: In all cases there was no infection recurrence or skin related problems. None of the patients require prosthesis revision due to loosening or device failure. No patellar fracture or quadriceps tendon failure was recorded. One patient presented a rupture of the reconstructed patellar tendon due to a trauma incident 18 months after the implantation and he required revision surgery. From a clinical point of view the average WOMAC score was 62.4 at 1 month rising to 72.6 at 3 months, 78.2 at 6 months, 76.4 at 1 year and 74.8 at 18 months. Conclusion: When proximal tibia megaprosthesis is implanted and there are soft tissue and patellar tendon deficiency, soft tissue reconstruction can be achieved by appropriate lengthening of the tendon and a gastrocnemius flap reinforced by LARS. Such an approach allows restoration of the extensor mechanism and coverage of the prosthesis in an area where skin problems are frequently very common.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Mazza

Vaienti

Mazzola

et al. 2016

Injury

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“…Identifying patients at risk for extensor mechanism disruption preoperatively and proper planning is essential. Preoperative history and physical examination are the keys to prevention [2,20,21,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Its incidence has been reported to range from 0.17 to 2.5% [2,20,21,[24][25][26]. The risk factors include patient comorbidities, prior knee procedures, surgical technique and prosthetic design.…”

Section: Introductionmentioning

confidence: 99%

A “biologic technique” for the treatment of a disruption of the extensor mechanism after revision total knee arthroplasty: a case report

Roidis

Varitimidis

Poultsides

et al. 2008

Knee Surg Sports Traumatol Arthr

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A modified technique for the reconstruction of the extensor mechanism after revision total knee arthroplasty, is described. A medial gastrocnemius flap, in combination with in situ use of semitendinosus tendon autograft through intraosseous patellar tunnel, was used. The patient was followed for 2 years after the final reconstruction. After the procedure, the patient who previously had been dependent on a walker was able to walk without a cane. The above mentioned technique provided good functional outcome in our case.

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“…It is an important structure to preserve during revision knee surgery, as disruption can lead to irreparable damage and long-term functional consequences. 7 It is important to appreciate the blood supply to the patella and the implications of procedures around the knee (both to gain access and to achieve soft tissue balancing). The vascular supply of the patella is distinct from that of the skin, and there is little communication between them.…”

Section: The Extensor Mechanismmentioning

confidence: 99%

Exposure in revision knee arthroplasty

Odutola

Fick

Khan

2015

Orthopaedics and Trauma

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Extensor Mechanism Disruption after Total Knee Arthroplasty

Abstract: Economic and decision analyses, level III (systematic review of level III studies). See Guide for Authors for a complete description of levels of evidence.

Cited by 87 publications

References 53 publications

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

A “biologic technique” for the treatment of a disruption of the extensor mechanism after revision total knee arthroplasty: a case report

Exposure in revision knee arthroplasty

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