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Surgical Technique: Vastus Medialis and Vastus Lateralis as Flap Transfer for Knee Extensor Mechanism Deficiency

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Loss of the quadriceps tendon, patella, and patellar tendon leaves a major anterior defect that is difficult to close and compromises knee extension strength. Gastrocnemius muscle transfer does not sufficiently cover such major defects. This paper describes a new surgical technique that addresses these defects and the results of eight cases of revision TKA managed with this new technique.

Description of Technique

The new procedure transfers the vastus medialis or the vastus lateralis and their tibial attachments or both muscles and their distal expansions combined with gastrocnemius and soleus flaps to cover major deficiencies in the anterior knee. Nine cadaver knee specimens were dissected to determine the effect of the transfer on nerve and blood supply of the muscles.

Methods

Eight patients underwent the new procedure between 2005 and 2009. Four knees had vastus medialis transfer, two vastus medialis and vastus lateralis transfer, two vastus medialis and medial gastrocnemius transfer, and two medial gastrocnemius and medial ½ of the soleus muscle transfer. Minimum followup was 15 months (mean, 43 months; range, 15–74 months). Patients were evaluated for anterior knee pain, quality of knee closure, ROM, extensor lag, walking ability, use of assistive devices, and ability to climb stairs with the operated extremity.

Results

All patients achieved closure of the knee without synovial leaks by 10 days postoperatively. Mean flexion contracture at last followup was 3° (range, 0°–7°). Mean extension lag was 22° (range, 5°–65°). Extension lag was less in those knees that included gastrocnemius or soleus muscle transfer. None of the flaps developed necrosis.

Conclusions

The vastus medialis and vastus lateralis muscles provide adequate coverage for anterior soft tissue deficits of the knee.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The author thanks William Andrea, MA, CMI, for preparing the illustrations, Marcel Roy, PhD, for assistance with the cadaver dissection, and Diane Morton, MS, for editorial assistance with manuscript preparation.

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Authors and Affiliations

  1. Missouri Bone and Joint Research Foundation, Missouri Bone and Joint Center, 1000 Des Peres Road, Suite 150, St Louis, MO, 63131, USA

    Leo A. Whiteside MD

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  1. Leo A. Whiteside MD
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Correspondence to Leo A. Whiteside MD.

Additional information

The author (LAW) received funding for this study from the Missouri Bone and Joint Research Foundation (St Louis, MO, USA). The author certifies that he, or a member of his immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Whiteside, L.A. Surgical Technique: Vastus Medialis and Vastus Lateralis as Flap Transfer for Knee Extensor Mechanism Deficiency. Clin Orthop Relat Res 471, 221–230 (2013). https://doi.org/10.1007/s11999-012-2532-z

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  • DOI: https://doi.org/10.1007/s11999-012-2532-z

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