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Extensor Mechanism Disruption Remains a Challenging Problem.

Joshua T Anderson1, Cody B McLeod1, Lucas A Anderson2

  • 1Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

The Journal of Arthroplasty
|March 31, 2023
PubMed
Summary
This summary is machine-generated.

Extensor mechanism reconstruction after total knee arthroplasty shows modest success rates. High complication and reoperation rates persist, indicating extensor mechanism disruption remains a significant challenge.

Keywords:
KOOS JRallograftextensor mechanism disruptionextensor mechanism reconstructionmeshtotal knee arthroplasty complications

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Reconstructive Surgery

Background:

  • Extensor mechanism disruption (EMD) following total knee arthroplasty (TKA) is a severe complication.
  • Current treatments involve allograft or synthetic reconstruction, but success rates and patient outcomes are poorly understood.

Purpose of the Study:

  • To evaluate the functional success and survivorship of extensor mechanism reconstruction (EMR) following TKA.
  • To identify factors influencing the success of EMR and assess patient-reported outcomes.

Main Methods:

  • A retrospective review of patients undergoing mesh or whole-extensor allograft reconstruction for EMD after TKA between 2011 and 2019.
  • Minimum 2-year follow-up was required, with functional failure defined by extensor lag, amputation, fusion, or revision EMR.
  • Survivorship was analyzed using Kaplan-Meier curves, and logistic regression identified success factors.

Main Results:

  • Fifty-six EMRs (49 patients) showed a 50.0% functional success rate at a mean follow-up of 3.2 years.
  • In situ survivorship at 36 months was 75.0%, with 50.0% of failed reconstructions retained.
  • Mean extensor lag and Knee Injury and Osteoarthritis Outcome Score, Joint Replacement scores differed significantly between successes and failures (P=.01).
  • All-cause reoperation rate was 42.9%, including revision EMR (14.3%) and amputation/fusion (10.7%).

Conclusions:

  • Mesh or allograft EMR after TKA demonstrates only modest functional success.
  • High complication and reoperation rates were observed irrespective of the reconstruction technique.
  • EMD following TKA continues to be a problematic orthopedic complication.