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Treating extensor mechanism disruption after total knee arthroplasty.

Robert L Barrack1, Tom Stanley, R Allen Butler

  • 1Department of Orthopaedic Surgery, Tulane University Health Sciences Center, New Orleans, LA 70012, USA. rbarrack@tulane..edu

Clinical Orthopaedics and Related Research
|December 4, 2003
PubMed
Summary

Allograft reconstruction effectively restored knee extensor function in 14 patients with chronic disruption after total knee arthroplasty (TKA). Most patients regained community ambulation, showing significant functional improvement and satisfaction with the surgical outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Reconstructive Surgery

Background:

  • Chronic extensor mechanism disruption after total knee arthroplasty (TKA) presents a significant challenge, often leading to extensor lag and impaired mobility.
  • Previous reconstructions have varied success rates, necessitating exploration of effective allograft techniques.

Purpose of the Study:

  • To evaluate the efficacy of allograft reconstruction for chronic extensor mechanism disruption following TKA.
  • To assess functional outcomes and patient satisfaction after allograft repair.

Main Methods:

  • A series of 14 patients with chronic extensor mechanism disruption post-TKA underwent allograft reconstruction.
  • Two distinct allograft techniques were employed: Achilles tendon with calcaneal bone block or quadriceps tendon-patella-patellar tendon-tibial tubercle composite graft.

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  • Follow-up averaged 42 months, assessing ambulation status, extensor lag, and patient-reported outcomes.

    • Main Results:

    • All 14 patients achieved community ambulation, with 7 requiring no assistive devices.
    • Postoperative extensor lag varied, with 10 patients having less than 10 degrees.
    • One patient experienced rerupture with a 45-degree lag; others showed significant improvement.

    Conclusions:

    • Allograft reconstruction is a viable option for managing chronic extensor mechanism disruption after TKA.
    • The procedure significantly improves functional status and patient satisfaction, restoring ambulation capabilities.
    • Allograft techniques, including Achilles tendon and composite grafts, demonstrate positive outcomes in this patient cohort.