Reconstruction of Complete Knee Extensor Mechanism Loss with Gastrocnemius Flaps

Abstract

We assessed the outcome after reconstruction of traumatic, complete, infected, extensor mechanism loss attributable to high-velocity open knee injuries in eight consecutive patients (all males) who presented to us between

Medial Gastrocnemius Flap for Reconstruction of the Extensor Mechanism of the Knee Following High-Energy Trauma. A minimum 5 year follow-up

“…Jepegnanam et al reported their series of eight cases reconstructed using either the medial or both gastrocnemii following complete traumatic extensor mechanism loss [16]. In contrast to other previously reported studies, these injuries were associated with significant fractures of the distal femur, patella or proximal tibia.…”

“…In those settings the adjacent soft tissue envelope is usually intact and healthy, the skeleton stable, and the host physiology often normal. However, extensor mechanism reconstruction after loss resulting from trauma is uncommon as mentioned earlier [3,16,17,23].…”

“…In a case report Raschke, et al described the use of autologous ipsilateral gracilis and semitendinosus tendons, looping them through the quadriceps remnants [25]. However, other authors reported modifications by utilizing either a portion of the Achilles tendon or the thick aponeurosis from the deeper aspect of the gastrocnemius to reconstruct the entire extensor mechanism [3,16,23,27]. The strength of this technique is due to the fact that the same tissue is being used in the reconstruction to fill two roles.…”

“…Extensive traumatic injuries at the knee with involvement of the extensor apparatus are a challenging problem [16,17]. The soft tissues overlying the knee are relatively thin and highenergy trauma in this region often leads to open fractures or dislocations, with a significant risk of developing infection [7,17].…”

“…Reconstruction of the extensor mechanism using the medial gastrocnemius muscle has been previously described for combined tissue loss during revision knee arthroplasty or tumour surgery [5,15,20,26,27], but few prior reports describe its use as a post-traumatic reconstructive option [3,7,16,23].…”