Skip to main content
SpringerLink
Log in

17 Extensor Mechanism Deficiency in Total Knee Replacement

  • Chapter
The Unhappy Total Knee Replacement

  • 2754 Accesses

Abstract

The patella is the biggest sesamoid bone of the human body and translates the force generated by the quadriceps muscle to the lower leg. Full active knee extension is essential for walking and all daily activities. Thus, good extension strength is essential for a successful total knee replacement (TKR). Loss of knee extension, if a TKR is in place, often results in catastrophic outcomes. Therefore, prevention of violation to the extensor mechanism during TKR implantation is of high importance. Displaced patellar fractures or partial extensor tendon ruptures, but preserved extensor function, should be treated nonsurgically. Surgical repair always bears the risk of advanced extensor mechanism failure due to the limited healing capacity.

In total loss of knee extension due to complete Rupture of the quadriceps or patellar tendon or dislocated patellar fracture most of the time surgery is required.If surgical reconstruction is necessary, augmentation with autografts, allografts, xenografts, or synthetic material is recommended to increase solid scarring and to prevent failure. Reconstruction of chronic failure of the extensor mechanism is still regarded as salvage procedure to avoid knee arthrodesis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sinha R, Crossett LS, Rubash HE. Extensor mechanism rupture. In: Insall J, Scott WN, editors. Surgery of the knee. Philadelphia: Churchill Livingstone; 2001. p. 1863–73.

    Google Scholar 

  2. Sinha R, Rubash HE. Extensor mechanism rupture. In: Callaghan J, Rosenberg AG, Rubash HE, Simonian PT, editors. The adult knee. Philadelphia: Lippincott, Williams & Wilkins; 2003. p. 1351–8.

    Google Scholar 

  3. Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty. J Arthroplasty. 1987;2:135–40.

    Article  CAS  PubMed  Google Scholar 

  4. Fansa H, Meric C. Reconstruction of quadriceps femoris muscle function with muscle transfer. Handchir Mikrochir Plast Chir. 2010;42(4):233–8.

    CAS  PubMed  Google Scholar 

  5. Shahcheraghi GH, Javid M, Zeighami B. Hamstring tendon transfer for quadriceps femoris paralysis. J Pediatr Orthop. 1996;16(6):765–8.

    Article  CAS  PubMed  Google Scholar 

  6. Dobbs RE, Hanssen AD, Lewallen DG, Pagano MW. Quadriceps tendon rupture after total knee arthroplasty. Prevalence, complications, and outcome. J Bone Joint Surg. 2005;87:37–45.

    Article  PubMed  Google Scholar 

  7. Fernandez-Baillo N, Garay EG, Ordonez JM. Rupture of the quadriceps tendon after total knee arthroplasty. A case report. J Arthroplasty. 1993;8:331–3.

    Article  CAS  PubMed  Google Scholar 

  8. Healy WL, Wasilewski SA, Takei R, Oberlander M. Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors. J Arthroplasty. 1995;10:197–201.

    Article  CAS  PubMed  Google Scholar 

  9. Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am. 1981;63:932–7.

    CAS  PubMed  Google Scholar 

  10. Trepte CT, Kirgis A. Spontaneous ruptures of the extensor system of the knee following joint replacement in patients with rheumatoid arthritis. Z Orthop Ihre Grenzgeb. 1988;126:519–25.

    Article  CAS  PubMed  Google Scholar 

  11. Scuderi C. Ruptures of the quadriceps tendon; study of twenty tendon ruptures. Am J Surg. 1958;40:128–35.

    Google Scholar 

  12. Keating EM, Haas G, Meding JB. Patella fracture after total knee replacements. Clin Orthop. 2003;416:93–7.

    Article  PubMed  Google Scholar 

  13. Malo M, Vince KG. The unstable patella after total knee arthroplasty: etiology, prevention and management. J Am Acad Orthop Surg. 2003;11:364–71.

    PubMed  Google Scholar 

  14. Spitzer A, Vince K. Patellar considerations in total knee arthroplasty. In: Scuderi GR, editor. The patella. New York: Springer; 1995. p. 309–31.

    Chapter  Google Scholar 

  15. Vince KG, McPherson EJ. The patella in total knee arthroplasty. Orthop Clin North Am. 1992;23:675–96.

    CAS  PubMed  Google Scholar 

  16. Ogata K, Shively RA, Shoenecker PL, Chang SL. Effects of standard surgical procedures on the patellar blood flow in monkeys. Clin Orthop. 1987;215:254–9.

    PubMed  Google Scholar 

  17. Kayler DE, Lyttle D. Surgical interruption of patellar bloody supply by total knee arthroplasty. Clin Orthop. 1988;229:221–7.

    PubMed  Google Scholar 

  18. Wulff W, Incavo SJ. The effect of patella preparation for total knee arthroplasty on patellar strain: a comparison of resurfacing versus inset implants. J Arthroplasty. 2000;15:778–82.

    Article  CAS  PubMed  Google Scholar 

  19. Goldberg VM, Figgie 3rd HE, Inglis AE, et al. Patellar fracture type and prognosis in condylar total knee arthroplasty. Clin Orthop. 1988;236:115–22.

    PubMed  Google Scholar 

  20. Abril JC, Alvarez L, Vallejo JC. Patellar tendon avulsion after total knee arthroplasty. A new technique. J Arthroplasty. 1995;10(3):275–9.

    Article  CAS  PubMed  Google Scholar 

  21. Pagenstert G. Zugangswege in der revisionsendoprothetik. In: Wirtz DC, editor. Revisionsendoprothetik des Kniegelenks. Berlin/Heidelberg: Springer; 2011. p. S.59–70.

    Chapter  Google Scholar 

  22. Barrack RL, Lyons T. Proximal tibia – extensor mechanism composite allograft for revision TKA with chronic patellar tendon rupture. Acta Orthop Scand. 2000;71(4):419–21.

    Article  CAS  PubMed  Google Scholar 

  23. Abrahamowicz M, Du Berger R, Krewski D, et al. Bias due to aggregation of individual covariates in Cox regression model. Am J Epidemiol. 2004;160:696–706.

    Article  PubMed  Google Scholar 

  24. Crosset LS, Sinha RK, Sechriest VF, Rubash HE. Reconstruction of a ruptured patellar tendon with Achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am. 2002;84:1354–61.

    Google Scholar 

  25. Emerson Jr RH, Head WC, Malinin TI. Reconstruction of patellar tendon rupture after total knee arthroplasty with an extensor allograft. Clin Orthop. 1990;260:154–61.

    PubMed  Google Scholar 

  26. Emerson Jr RH, Head WV, Malinin TI. Reconstruction of patellar tendon rupture after total knee arthroplasty. Clin Orthop. 1994;303:79–85.

    PubMed  Google Scholar 

  27. Leopold SS, Greidanus N, Paprosky WG, et al. High rate of failure of allograft reconstruction of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am. 1999;81:1574–9.

    CAS  PubMed  Google Scholar 

  28. Nazarian DG, Booth Jr RE. Extensor mechanism allografts in total knee arthroplasty. Clin Orthop. 1999;367:123–9.

    Article  PubMed  Google Scholar 

  29. Prada SA, Griffin FM, Nelson CL, Garvin KL. Allograft reconstruction for extensor mechanism rupture after total knee arthroplasty: 4.8-year follow-up. Orthopedics. 2003;26:1205–8.

    PubMed  Google Scholar 

  30. Fujikawa K, Ohtani T, Matsumoto H, Seedhom BB. Reconstruction of the extensor apparatus of the knee with the Leeds-Keio ligament. J Bone Joint Surg Br. 1994;76(2):200–3.

    CAS  PubMed  Google Scholar 

  31. Busfield BT, Huffman GR, Nahai F, et al. Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. Clin Orthop. 2004;428:190–7.

    Article  PubMed  Google Scholar 

  32. Jaureguito JW, Dubois CM, Smith SR, et al. Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am. 1997;79:866–73.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Department, University Hospital of Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland

    Geert Pagenstert MD (Asst. Prof. (PD)

  2. Department of Orthopaedic Surgery and Traumatology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Matthias D. Wimmer MD

Authors
  1. Geert Pagenstert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthias D. Wimmer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geert Pagenstert MD .

Editor information

Editors and Affiliations

  1. Dept. Orthopaedic Surgery & Traumatology, Knee Surgery Unit, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland

    Michael T. Hirschmann

  2. Dept. Orthopaedics & Traumatology, Hospital Brandenburg, Brandenburg/Havel, Germany

    Roland Becker

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Pagenstert, G., Wimmer, M.D. (2015). 17 Extensor Mechanism Deficiency in Total Knee Replacement. In: Hirschmann, M., Becker, R. (eds) The Unhappy Total Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-319-08099-4_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-08099-4_22

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-08098-7

  • Online ISBN: 978-3-319-08099-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation