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Surgical Technique: Muscle Transfer Restores Extensor Function After Failed Patella-Patellar Tendon Allograft

  • Symposium: 2013 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Extensor mechanism allograft provides an effective remedy for severe quadriceps deficiency caused by loss of the patella, patellar tendon, and quadriceps tendon in TKA. Late failure is common, however, and major quadriceps deficiency occurs after removal of the allograft material.

Description of Technique

Six human cadaver specimens were dissected to evaluate the feasibility of transferring the vastus medialis, vastus lateralis, and medial head of the gastrocnemius muscle to fill the defect caused by loss of the patella and extensor tendon mechanism after failure and removal of allograft material. Transfer of the medial and lateral vastus muscles with their distal attachments into the tibia achieved closure of the defect but did not provide robust tendon material to fill the defect in the anterior knee. The medial gastrocnemius muscle reached easily to the muscular portion of the vastus medialis and lateralis flaps and provided secure closure of the anterior knee and strong attachment of viable muscle and tendon.

Methods

Five knees (five patients) with failed patella-patellar tendon allograft between August 2008 and April 2010 were repaired using this technique.

Results

Mean extensor lag was 47° (range, 35°–62°) before surgery and improved to 12° (range, 5°–15°) 1 year after surgery.

Conclusions

These preliminary results suggest that the described muscle transfer technique may provide an approach to salvage the failed extensor mechanism allograft after TKA.

Level of Evidence

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

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Acknowledgments

I thank William C. Andrea MS, CMI, for preparation of the illustrations and Diane J. Morton MS, for assistance with the manuscript.

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Authors and Affiliations

  1. Missouri Bone and Joint Center, Missouri Bone and Joint Research Foundation, 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.

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Each author certifies that he, or a member of his immediate family, has no funding or 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.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

The author certifies that his 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: Muscle Transfer Restores Extensor Function After Failed Patella-Patellar Tendon Allograft. Clin Orthop Relat Res 472, 218–226 (2014). https://doi.org/10.1007/s11999-013-3101-9

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  • DOI: https://doi.org/10.1007/s11999-013-3101-9

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