Surgical Technique: Muscle Transfer Restores Extensor Function After Failed Patella-Patellar Tendon Allograft

Whiteside, Leo A.

doi:10.1007/s11999-013-3101-9

Cited by 8 publications

(10 citation statements)

References 18 publications

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“…Fourteen studies were excluded based on eligibility criteria. The remaining 22 studies 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 met all of the inclusion criteria and were included in our systematic review. The articles consisted of case series ( n = 14, 63.6%) 14 15 16 17 19 20 21 24 25 29 31 32 or case reports ( n = 8, 36.4%).…”

Section: Resultsmentioning

confidence: 99%

“…17 20 21 30 Eight studies allowed immediate weight-bearing status postoperatively, with six of them also starting isometric quadriceps exercises at the same time. 13 14 21 23 26 30 34 Although rehabilitation protocols varied greatly among the studies, most gradually increased the intensity of exercise as tolerated by the patient. This progression often began with passive flexion and extension, eventually advancing to intensive active quadriceps strength training.…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen studies 13,14,17,[19][20][21][22][23][24][25][27][28][29][30]33,34 presented ambulation data for a total of 125 patients, revealing that 109 patients (87.2%) were able to ambulate without any external support. Among those requiring additional assistance, patients utilized canes (n ¼ 9), leg braces (n ¼ 5), or walkers (n ¼ 2).…”

Section: Functional Outcomesmentioning

confidence: 99%

“…In cases involving gastrocnemius muscle flaps, the mean postoperative flexion averaged 98.08 degrees, with an extension lag of 8.52 degrees [14][15][16][17][18][19][20][21][22][24][25][26][27][28][29][30][31]33 (►Table 3). For studies employing quadriceps muscle transposition, the mean postoperative flexion was 109.5 degrees, accompanied by an extension lag ranging from 0 to 65 degrees 13,23,34 (►Table 4). In a study by Whiteside utilizing both the quadriceps muscle and gastrocnemius muscle flaps, the mean postoperative flexion contracture was stable at 2 degrees (range 0-6 degrees) with an improvement in extensor lag from 47 degrees (range (35-62) preoperatively to 12 degrees (range 5-15) postoperatively 34 (►Table 5).…”

Section: Functional Outcomesmentioning

confidence: 99%

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A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism

Lee,

Fisher,

McNamara

et al. 2024

J Reconstr Microsurg

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Background Rupture of the extensor mechanism of the knee has severe functional morbidity, and repair can be complicated by infection, allograft degeneration, and recurrent rupture. Techniques of autologous tissue repair utilizing pedicled flaps such as the gastrocnemius offer vascularized methods of reconstruction, with potentially diminished complication rates. The goal of this study was to evaluate the functional outcomes and complications associated with pedicled flap repair of the knee extensor mechanism. Methods A systematic review was conducted following PRISMA guidelines. Publications that focused on local myocutaneous flaps as a means for reconstruction were included. Causes for knee extensor mechanism deficit, flap characteristics, ambulation rate, changes in range of motion pre- and post-operation, and postoperative complications were analyzed. Technique reports including primary suture repairs, synthetic mesh, and allograft use were excluded. Results An initial 119 studies were identified, with final review of 22 observational studies encompassing 128 cases of pedicled flap reconstructions. The gastrocnemius (88.2%, n=113), quadriceps (6.3%, n=8), and a combination of the vastus and gastrocnemius flaps (5.5%, n=7), were the most frequently utilized flaps. Functional outcomes were favorable with 87.2% of patients achieving ambulation without external support. Variability in range of motion outcomes across different flap may be secondary to the patient characteristics as well as extent of initial injury. Conclusions Autologous pedicle flap reconstruction of the knee extensor mechanism emerges as a viable option for cases characterized by extensive defects and insufficient soft tissue coverage, which are not amenable to direct suture repairs or allografts. Postoperative assessments revealed that the majority of patients experienced improved ambulation status, with no instances of deterioration noted among the patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Functional Outcomesmentioning

confidence: 99%

Section: Functional Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism

Lee,

Fisher,

McNamara

et al. 2024

J Reconstr Microsurg

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show abstract

“…Re-revizyon olgularında nadir görülse de, majör ekstansör mekanizma kaybı [17,18] (KT + Patella + PT + kapsül + cilt defekti) önemli bir problemdir. Cilt ve kapsül defekti olduğu için, total ekstansör mekanizma allogreftleri kullanılamaz.…”

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