Synthetic mesh vs. allograft extensor mechanism reconstruction in total knee arthroplasty — A systematic review of the literature and meta-analysis

Shau, David N.; Patton, Ryan; Patel, Suhag; Ward, Laura C; Guild, George N.

doi:10.1016/j.knee.2017.12.004

Cited by 38 publications

(28 citation statements)

References 20 publications

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“…Of note, a systematic review by Shau et al. [15] comparing synthetic mesh and allograft extensor mechanism reconstruction (not exclusively quadriceps tendon rupture) found both groups to have a failure rate of approximately 25%.…”

Section: Discussionmentioning

confidence: 99%

Retrieval analysis of a failed synthetic mesh extensor mechanism reconstruction after total knee arthroplasty

2018

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Extensor mechanism disruption after total knee arthroplasty is a relatively rare but potentially devastating complication. One technique to address this problem involves reconstruction with synthetic mesh. Although there are reports of successful clinical outcomes using this technique, we are not aware of any histological analyses of removed mesh grafts. This case report of a failed mesh reconstruction includes a retrieval analysis demonstrating robust host soft-tissue incorporation into the mesh graft and supports the rationale for continued use of this off-label technique. This case report also highlights the need for careful operative technique when performing these procedures to increase the chance of a successful outcome.

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Section: Discussionmentioning

confidence: 99%

Retrieval analysis of a failed synthetic mesh extensor mechanism reconstruction after total knee arthroplasty

2018

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“…When patellar tendon disruption is diagnosed intra-operatively, primary repair with suture anchors and transosseous sutures should be performed before cementing the final implants. This repair may be augmented with autogenous hamstring tendons and wire/cable/strengthened tape constructs ( 54 ). There are no clear guidelines on the use of postoperative braces, limitation of motion and weight-bearing after intra-operative repair, and the decision should be individualized according to the quality of soft tissues and stability of repair.…”

Section: Patellar Tendon Disruptions In Knee Arthroplastymentioning

confidence: 99%

Extensor mechanism ruptures

et al. 2022

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Native patellar tendon injuries are seen in younger patients compared to quadriceps tendon ruptures. Up to a third of the patients may have local (antecedent tendinopathy and cortisone injections) or systemic risk factors (obesity, diabetes, hyperparathyroidism, chronic renal failure, fluoroquinolone or statin use) of injury, these are more frequent in bilateral disruptions. Complete extensor mechanism disruptions should be repaired surgically. Although isolated primary repair has been reported to have good outcomes in younger patients with acute tears and good tendon quality, augmentation of the repair with autograft, allograft or synthetic material should be considered in patients with poor tendon quality, chronic tears or tendon defects. High rates of return to work/sports have been reported in native patellar and quadriceps tendon tears, with re-rupture rates <5%. Extensor mechanism disruptions in patients with a total knee arthroplasty are challenging due to older age, systemic co-morbidities and poor local conditions, resulting in inferior outcomes compared to native extensor mechanism injuries. Some form of augmentation with autograft, allograft or synthetics is advisable in all cases. Salvage procedures such as whole extensor mechanism allografts provide acceptable outcomes in multiply operated knees with extensive bone and soft tissue deficits.

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Section: Discussionmentioning

confidence: 99%

“…In recent years, there has also been an increased usage of synthetic meshes over traditional allografts due to cheaper costs, easier availability, and decreased risks of host immune reactions or disease transmission [16]. Meta-analysis such as that by Deren et al shows comparable outcomes between synthetic mesh repairs and allograft repairs in postoperative complications, need for revision reconstruction, and functional outcomes as measured by the knee society score [15].…”

Section: Surgical Options In Extensor Mechanism Reconstructionmentioning

confidence: 99%

A Modified Surgical Technique of Patellar Tendon Reconstruction in Total Knee Arthroplasty Using Achilles Tendon Allograft

2022

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Patellar tendon disruption is one of the most dreaded complications after total knee arthroplasty (TKA) impacting joint function and implant longevity. Management of this condition remains controversial, and no one treatment has provided consistent clinical success. Here we propose a modified technique from the standard Achilles allograft procedure to reconstruct a ruptured patellar tendon after TKA. A fresh-frozen Achilles tendon allograft with attached calcaneal bone graft was used. Our technique offers the advantage of a more stable graft fixation by relying on both quadriceps tendon and transosseous patellar fixation and bone-to-bone allograft fixation to the tibial tuberosity. The patient regained full extension and discontinued walking aids postoperatively. Careful attention to graft preparation, tensioning, stable graft fixation, and postoperative rehabilitation led to encouraging results in this complex problem.

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Synthetic mesh vs. allograft extensor mechanism reconstruction in total knee arthroplasty — A systematic review of the literature and meta-analysis

Cited by 38 publications

References 20 publications

Retrieval analysis of a failed synthetic mesh extensor mechanism reconstruction after total knee arthroplasty

Retrieval analysis of a failed synthetic mesh extensor mechanism reconstruction after total knee arthroplasty

Extensor mechanism ruptures

A Modified Surgical Technique of Patellar Tendon Reconstruction in Total Knee Arthroplasty Using Achilles Tendon Allograft

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