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      A novel technique with Dacron vascular graft augmentation for knee extensor mechanism repairs: Technical note

      research-article
      1 , * , , 2 , 3 , 4 , 5 , 5 , 5
      SICOT-J
      EDP Sciences
      Knee, Extensor mechanism, Reconstruction, Graft

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          Abstract

          Ruptures of the extensor apparatus can have different etiologies and be complicated by underlying situations. Direct repair is not always possible, and reconstruction procedures can be insufficient, which leads to the appearance of multiple augmentation techniques to improve the strength of these constructs. Despite the proven results of these techniques, numerous procedures are described without any gold standard. We present our augmentation method for repairing the knee extensor apparatus with a vascular prosthesis that facilitates healing, does not interfere with the primary procedure, has no donor morbidity or rejection risk, and allows earlier mobilization and rehabilitation. The technique was used in different cases with multiple etiologies that needed reinforcement, with promising results.

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          Most cited references20

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          Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh.

          Patellar tendon disruption associated with total knee arthroplasty is an uncommon but potentially disastrous complication. Repair with isolated suture fixation is insufficient, and autograft and allograft tendon reconstruction techniques have variable results. The purpose of this study was to determine the results of a novel surgical technique in which readily available synthetic mesh is used for patellar tendon reconstruction. We retrospectively reviewed thirteen consecutive patients who underwent extensor mechanism reconstruction for subacute or chronic patellar tendon disruption following total knee arthroplasty at an average age of sixty years (range, thirty-seven to seventy-seven years). Five patients had already been treated unsuccessfully with an allograft extensor mechanism reconstruction and eight had a prior revision knee arthroplasty. The surgical technique included use of a knitted monofilament polypropylene graft to reconstruct the patellar tendon and to facilitate fixation of adjacent host tissue into the graft. Follow-up was available for all patients at a mean of forty-two months (range, eleven to 118 months). Three patients had evidence of failure of the graft reconstruction, all within six months. One patient with previous sepsis had recurrent infection and was treated with a knee arthrodesis. The remaining nine patients all demonstrated an extensor lag of no greater than 10° and have had no loss of extension at the time of final follow-up. Knee flexion was maintained in all patients (a mean of 103° preoperatively versus a mean of 107° postoperatively). The mean Knee Society scores for pain and function improved significantly (p < 0.01). Synthetic mesh was significantly less expensive than allograft for this reconstruction. The use of synthetic mesh to reconstruct a disrupted patellar tendon is a straightforward surgical procedure that was successful and durable in the majority of patients in our series. Compared with the use of an allograft, this technique eliminates the possibility of disease transmission and may be more cost-effective. No complications unique to the synthetic mesh were observed.
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            Extensor tendon ruptures after total knee arthroplasty.

            Extensor tendon rupture is a rare but serious complication after total knee arthroplasty (TKA) that impairs active knee extension, thereby severely affecting knee function. Surgery is usually required. Surgical options range from simple suturing to allograft reconstruction of the entire extensor mechanism and include intermediate methods such as reconstruction using neighbouring tendons or muscles, synthetic ligament implantation, and partial allograft repair. Simple suturing carries a high failure rate and should therefore be routinely combined with tissue augmentation using a neighbouring tendon or a synthetic ligament. After allograft reconstruction, outcomes are variable and long-term complications common. Salvage procedures for managing the most severe cases after allograft failure involve reconstruction using gastrocnemius or vastus flaps. Regardless of the technique used, suturing must be performed under tension, with the knee fully extended, and rehabilitation must be conducted with great caution. Weaknesses of available case-series studies include small sample sizes, heterogeneity, and inadequate follow-up duration. All treatment options are associated with substantial failure rates. The patient should be informed of this fact and plans made for a salvage option. Here, the main techniques and their outcomes are discussed, and a therapeutic strategy is suggested.
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              Extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty.

              Extensor mechanism disruption following total knee arthroplasty is a rare but devastating complication. The purpose of this study was to report our experience with extensor mechanism allograft reconstruction for chronic extensor mechanism failure.
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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2022
                15 August 2022
                : 8
                : ( publisher-idID: sicotj/2022/01 )
                : 31
                Affiliations
                [1 ] Unidade Local de Saúde do Alto Minho 4904-858 Viana do Castelo Portugal
                [2 ] Hospital Central do Funchal 9000-177 Madeira Portugal
                [3 ] Università degli Studi di Firenze, AOU Careggi 50121 Firenze Italy
                [4 ] Faculty of Medicine and Life Sciences, University of Antwerp 2610 WILRIJK Antwerp Belgium
                [5 ] Orthoca, AZ Monica 2100 Antwerp Belgium
                Author notes
                [* ]Corresponding author: almost_romulo@ 123456hotmail.com
                Author information
                http://orcid.org/0000-0002-8273-6593
                http://orcid.org/0000-0002-8117-0946
                http://orcid.org/0000-0001-5476-1225
                http://orcid.org/0000-0003-2254-9451
                Article
                sicotj210117 10.1051/sicotj/2022034
                10.1051/sicotj/2022034
                9377215
                35969122
                cb56e432-7113-4c4b-9ebd-f9eaa6ee36e9
                © The Authors, published by EDP Sciences, 2022

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 December 2021
                : 27 June 2022
                Page count
                Figures: 15, Tables: 1, Equations: 0, References: 20, Pages: 9
                Categories
                Surgical Technique
                Knee

                knee,extensor mechanism,reconstruction,graft
                knee, extensor mechanism, reconstruction, graft

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