Knee extensor mechanism allograft reconstruction following chronic disruption

Abstract

The management of chronic extensor mechanism disruption can be complex. One of the options is allograft reconstruction. The goal of this study was to present the surgical procedure and provide preliminary results with this technique. The allograft uses the whole extensor mechanism (anterior tibial tubercle, patellar ligament, patella, quadriceps tendon). The native patella can be completely removed if the quality of the bone is poor, otherwise a bone groovecan be created to receive the allograft. The allograft is tightly tensioned with the knee in full extension. This surgical technique was performed 5 times with a minimum follow-up of 1 year. Active extension was recovered in all cases. The mean postoperative KOOS was 55.5 the IKS function score was 68.5 and the IKS knee score was 83.

A Strategy for Repair, Augmentation, and Reconstruction of Knee Extensor Mechanism Disruption: A Retrospective Review

“…Patients were able to achieve pain relief, return to activities of daily living, and maintain knee range of motion at the final follow-up, although overall satisfaction rates were mild to moderate. 10 Similar functional outcomes were noted in a case series by Murgier et al, 19 although no patients in this series had a persistent extensor mechanism lag at the final follow-up. While excluded from this study, allograft extensor mechanism reconstruction in the setting of total knee arthroplasty poses additional challenges in management, with a reported 38% failure rate by Brown et al 3 …”

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

“…A large review that studied exclusively quadriceps tendon ruptures showed a fairly high incidence of poor results after open surgical repair. But when facing a complete and chronic rupture a quadriceps turndown, allograft reconstruction or synthetic graft is probably the best option [17][18][19][20][21][22][23][24].…”

“…The gracilis tendon can also be harvested and attached to the semi-tendinosis for additional length if needed [21]. Allograft reconstruction is an alternative option that can restore active extension of the knee [22][23][24]. The main advantage of this technique is to avoid autologous harvesting, reducing the morbidity of the surgical procedure.…”

“…A postoperative extensor lag seen during active extension is a major prognostic feature, the mean is 15° [32] but has been found to reach 59° [30]. An extensor lag can be partially prevented by tensioning the graft and by keeping the limb in full extension while securing the quadriceps [24]. Concerns with the use of allograft include tissue availability, cost, immune reaction, and disease transmission [35].…”

“…However, in some cases gastrocnemius flaps may be insufficient to close defects of the lower portion of the capsule of the knee and are never adequate for defects involving the quadriceps tendon and rectus femoris muscle [51,53]. In this case scenario, the latissimus dorsi free flap [25], vastus medialis and lateralis flap, reversed gracilis pedicle flap [37], distally based vastus lateralis flap [8], rectus abdominus free flap [13], perforator flaps [24,31], and neurofasciocutaneous flaps [38] all have the potential to close large anterior defects but are technically demanding and require a plastic surgeon assistance. So local muscle and tendon transfer is a common practice to overcome diminished knee function.…”