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Long-term results of extensor mechanism reconstruction using Achilles tendon allograft after total knee arthroplasty

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Abstract

Purpose

Disruption of the extensor mechanism after total knee arthroplasty (TKA) is an infrequent but devastating complication. Presently, limited data exists regarding the optimal treatment and long-term outcomes.

Methods

Patients who underwent reconstruction of their knee extensor mechanism using Achilles tendon allograft following TKA between January 2003 and January 2012 were identified. Sixteen patients with 17 reconstructions (10 patellar tendons, 7 quadriceps tendons) were studied. All patients underwent evaluation at an average of 45.7 months. Ten of the patients were followed to an average of 65.4 months.

Results

After reconstruction, the average extensor lag was 6.6° and average knee flexion was 105.1°. Of the patients with a minimum follow-up of two years and an average follow-up of 65.4 months, the average extensor lag and knee flexion was 8.4° and 107.9°, respectively, with quadriceps strength maintained at an average of 4/5. The quadriceps tendon reconstructions had an average extensor lag and flexion of 2.9° and 103°, respectively. The patellar tendon reconstructions, excluding one re-rupture, had an average extensor lag and flexion of 9.6° and 105.1°, respectively. Four patients died during the follow-up period. All but one of the patients were below the mean for age-matched controls on the SF-36.

Conclusion

Achilles tendon allograft reconstruction is a reliable and durable treatment for patients who sustain not only patellar tendon ruptures, but also quadriceps tendon ruptures following TKA. Despite the success of this technique, the injury and procedure have a profound impact on overall function.

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Author information

Author notes

  1. Aidin Eslam Pour

    Present address: University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5328, USA

Authors and Affiliations

  1. Emory University Orthopaedic and Spine Hospital, 1455 Montreal Road, Tucker, GA, 30084, USA

    Brent T. Wise, Greg Erens, Aidin Eslam Pour, Thomas L. Bradbury & James R. Roberson

  2. Emory University School of Medicine, 49 Jesse Hill Jr Drive SE, Atlanta, 30303, USA

    Brent T. Wise

Authors
  1. Brent T. Wise
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  2. Greg Erens
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  3. Aidin Eslam Pour
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  4. Thomas L. Bradbury
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  5. James R. Roberson
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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The article is a study with human participants and has been approved by our institution’s Institutional Review Board (IRB) who assures that the study is compliant with all ethical standards. This article does not contain any studies of animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Wise, B.T., Erens, G., Pour, A.E. et al. Long-term results of extensor mechanism reconstruction using Achilles tendon allograft after total knee arthroplasty. International Orthopaedics (SICOT) 42, 2367–2373 (2018). https://doi.org/10.1007/s00264-018-3848-4

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  • DOI: https://doi.org/10.1007/s00264-018-3848-4

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