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Related Experiment Video

Updated: Dec 15, 2025

A Mini-Invasive Internal Fixation Technique for Studying Immobilization-Induced Knee Flexion Contracture in Rats
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Extensor Mechanism Reconstruction Using Marlex Mesh: Is Postoperative Casting Mandatory?

Leonard T Buller1, Lucian C Warth1, Evan R Deckard1

  • 1Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.

The Journal of Arthroplasty
|July 11, 2020
PubMed
Summary
This summary is machine-generated.

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Marlex mesh reconstruction effectively treats extensor mechanism disruption after knee replacement, showing durable results. Both long leg casts and knee immobilizers provide similar outcomes for postoperative immobilization.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science

Background:

  • Extensor mechanism (EM) disruption is a severe complication following total knee arthroplasty.
  • Monofilament polypropylene mesh (Marlex Mesh) reconstruction is the preferred treatment, but data outside the designing institution is limited.

Purpose of the Study:

  • To evaluate the outcomes of Marlex Mesh reconstruction for EM disruption in a non-designer setting.
  • To compare the efficacy of two postoperative immobilization methods: long leg cast versus knee immobilizer.

Main Methods:

  • A retrospective review of 33 knees (30 patients) undergoing Marlex Mesh reconstruction between 2012 and 2019.
  • Exclusion of primary repairs and allograft reconstructions.
  • Comparison of outcomes based on postoperative immobilization strategy (long leg cast vs. knee immobilizer) using Kaplan-Meier analysis.
Keywords:
Marlex meshextensor mechanismpatellar tendon rupturequadriceps tendon rupturerevision total knee arthroplasty

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Main Results:

  • At a mean 25-month follow-up, 58% of EM reconstructions were functioning; 73% were in situ excluding infections.
  • Six-year survivorship was 69%, with no significant difference between immobilization groups (cast: 67%, immobilizer: 71%).
  • Significant improvement in extensor lag (43° to 9°) and patient-reported outcomes (UCLA activity, KOOS-JR scores) exceeding minimal clinically important difference.

Conclusions:

  • Marlex Mesh reconstruction offers a durable and reliable treatment option for EM disruption, achievable outside the designing institution.
  • Both cast immobilization and knee immobilizers yield comparable clinical results when adequate duration and compliance are ensured.
  • This study validates Marlex Mesh as a viable reconstructive option with acceptable outcomes in a broader clinical setting.