Abstract
A modified technique for the reconstruction of the extensor mechanism after revision total knee arthroplasty, is described. A medial gastrocnemius flap, in combination with in situ use of semitendinosus tendon autograft through intraosseous patellar tunnel, was used. The patient was followed for 2 years after the final reconstruction. After the procedure, the patient who previously had been dependent on a walker was able to walk without a cane. The above mentioned technique provided good functional outcome in our case.
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Aracil J, Salom M, Aroca JE, Torro V, Lopez-Quiles D (1999) Extensor mechanism reconstruction with Leeds–Keio ligament in total knee arthroplasty. J Arthroplasty 14:204–208
Barrack RL, Stanley T, Allen Butler R (2003) Treating extensor mechanism disruption after total knee arthroplasty. Clin Orthop Relat Res 416:98–104
Burnett SJ, Berger RA, Paprosky WG, Della Valle CJ, Jacobs JJ, Rosenberg AG (2004) External mechanism allograft reconstruction after total knee arthroplasty. A comparison of two techniques. J Bone Joint Surg Am 86:2694–2699
Burnett SJ, Berger RA, Della Valle CJ, Sporer SM, Jacobs JJ, Paprosky WG, Rosenberg AG (2005) Extensor mechanism allograft reconstruction after total knee arthroplasty. J Bone Joint Surg Am 87(Suppl 1:Part 2):175–194
Busfield BT, Huffman GR, Nahai F, Hoffman W, Ries MD (2004) Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patient with and without total knee arthroplasty. Clin Orthop Relat Res 428:190–197
Cadambi A, Engh GA (1992) Use of a semitendinosus tendon autogenous graft for rupture of the patella ligament after total knee arthroplasty. A report of seven cases. J Bone Joint Surg Am 74:974–979
Crossett LS, Sinha RK, Sechriest VF, Rubash HE (2002) Reconstruction of a ruptured patellar tendon with achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am 84:1354–1361
Dobbs RE, Hanssen AD, Lewallen DG, Pagnano MW (2005) Quadriceps tendon rupture after total knee arthroplasty. J Bone Joint Surg Am 97:37–45
Emerson RH Jr, Head WC, Malinin TI (1990) Reconstruction of patellar tendon rupture after total knee arthroplasty with and extensor mechanism allograft. Clin Orthop Relat Res 260:154–161
Emerson RH Jr, Head WC, Malinin TI (1994) Extensor mechanism reconstruction with an allograft after total knee arthroplasty. Clin Orthop Relat Res 303:79–85
Falconiero RP, Pallis MP (1996) Chronic rupture of a patellar tendon: a technique for reconstruction with Achilles allograft. Arthroscopy 12:623–626
Fernandez-Baillo N, Garay EG, Ordonez JM (1993) Rupture of the quadriceps tendon after total knee arthroplasty. A case report. J Arthroplasty 8:331–334
Fujikawa K, Ohtani T, Matsumoto H, Seedhom BB (1994) Reconstruction of the extensor apparatus of the knee with the Leeds–Keio ligament. J Bone Joint Surg Br 76:200–203
Gerwin M, Rothaus KO, Windsor RE, Brause BD, Insall JN (1993) Gastrocnemius muscle flap coverage of exposed or infected knee prostheses. Clin Orthop Relat Res 286:64–70
Jaureguito JW, Dubios CM, Smith SR, Gottlieb LJ, Finn HA (1997) Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am 79:866–873
Leopold SS, Greidanus N, Paprosky WG, Berger RA, Rosenberg AG (1999) High rate of failure of allograft reconstruction of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am 81:1574–1579
Malawer MM, McHale KA (1989) Limb-sparing surgery for high-grade malignant tumors of the proximal tibia. Surgical technique and a method of extensor mechanism reconstruction. Clin Orthop Relat Res 239:231–248
Malawer MM, Price WM (1984) Gastrocnemius transposition flap in conjunction with limb-sparing surgery for primary bone sarcomas around the knee. Plast Reconstr Surg 73:741–750
Nazarian DG, Booth RE Jr (1999) Extensor mechanism allografts in total knee arthroplasty. Clin Orthop Relat Res 367:123–129
Parker DA, Dunbar MJ, Rorabeck CH (2003) Extensor mechanism failure associated with total knee arthroplasty: prevention and management. J Am Acad Orthop Surg 11:238–247
Rand JA, Morrey BF, Bryan RS (1989) Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res 244:233–238
Rasul AT Jr, Fischer DA (1993) Primary repair of quadriceps tendon rupture. Results of treatment. Clin Orthop Relat Res 289:205– 207
Sanders R, O’Neill T (1981) The gastrocnemius myocutaneous flap used as a cover for the exposed knee prosthesis. J Bone Joint Surg Br 63:383–386
Scapinelli R (1967) Blood supply to the human patellae. J Bone Joint Surg Br 49:563–570
Schoderbek RJ Jr, Brown TE, Mulhall KJ, Mounasamy V, Iorio R, Krackow KA, Macaulay W, Saleh KJ (2006) Extensor mechanism disruption after total knee arthroplasty. Clin Orthop Relat Res 446:176–185
Siwek CW, Rao JP (1981) Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am 63:932–937
Zanotti RM, Freiberg AA, Matthews LS (1995) Use of patellar allograft to reconstruct a patellar tendon-deficient knee after total joint arthroplasty. J Arthroplasty 10:271–274
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Roidis, N., Varitimidis, S., Poultsides, L. et al. A “biologic technique” for the treatment of a disruption of the extensor mechanism after revision total knee arthroplasty: a case report. Knee Surg Sports Traumatol Arthr 16, 661–665 (2008). https://doi.org/10.1007/s00167-008-0533-y
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DOI: https://doi.org/10.1007/s00167-008-0533-y