TREATMENT OF INSUFFICIENT JOINT EXTENSOR MECHANISM IN PRIMARY AND REVISION KNEE REPLACEMENT

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Abstract

Insufficiency  of the  knee  joint  extensor  mechanism  is the  absolute  contraindication for total  knee  arthroplasty. Therefore, it is necessary to restore the extensor  mechanism before arthroplasty or to change the treatment approach.

Purpose of the study  – to evaluate  the  outcomes  of surgical  reconstruction of the  knee joint  extensor  mechanism during primary or revision knee arthroplasty.

Materials and methods. 25 reconstructions of extensor  mechanisms  (24 patients) were performed  in the period from 2006 to 2015. Five procedures out of 25 were performed in primary TKA and 20 in revision TKA. Indications for extensor mechanism  reconstruction were as follows: patellar  tendon  rupture in 15 cases (60,0%),  fracture  of patella  in 5 cases (20,0%), quadriceps tendon  rupture in 3 cases (12,0%) and other indications in 2 cases (8,0%). One of the following four techniques was used to restore  the extensor  mechanism: “Frame / Loop” allograft of patellar  tendon  in 6 cases (24,0%); bone – patellar  tendon  – bone allograft in 9 cases (36,0%); quadriceps tendon  – patella-patellar tendon  – bone allografts in 7 cases (28,0%); weber’s internal fixation of patella in 3 cases (12,0%).

Results.  All patients were  evaluated based  on  clinical  examination,  KSS  and  WOMAC  scores  (18  patients), and standard x-rays (13 patients). The mean follow-up  period  in the  present  study  was 44 months  postoperatively. Reconstruction of the knee joint extensor  mechanism  resulted  in a significant  reduction of pain in 38.8% of patients, the knee stability was restored  in 83,3% of patients and the active  knee extension  improved  significantly  in the vast majority  of patients.

Conclusion. Despite  the  objective  improvement of the  knee  joint  function  after  the  reconstructions of extensor mechanism,  the  KSS and WOMAC evaluation scores remained  low which  should  be taken  into  consideration during preoperative planning.

About the authors

T. A. Kulyaba

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Taras A. Kulyaba – Dr. Sci. (Med) Head of Knee Pathology Department.

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

N. N. Kornilov

Vreden Russian Research Institute of Traumatology and Orthopedics; Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Nikolai N. Kornilov – Dr. Sci. (Med) Professor  of  Chair of Traumatology and Orthopaedics, Vreden RRITO; Associate Professor  of  Department of Traumatology and Orthopaedics N-WSMU.

8, ul. Akad. Baykova, St. Petersburg, 195427; 41, Kirochnaya ul., St. Petersburg, 191015

Russian Federation

P. M. Mikhailova

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: mihaylova_pm@mail.ru

Polina  M.  Mikhailova   –  Researcher.

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

G. Yu. Bovkis

Vreden Russian Research Institute of Traumatology and Orthopedics.

Email: fake@neicon.ru

Gennady    Yu.   Bovkis   –  Researcher

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

References

  1. Гилев Я.Х., Пронских А.А., Милюков А.Ю., Тлеубаев Ж.А. Современные технологии лечения переломов коленного сустава. Политравма. 2007;(2):28-34.
  2. Кавалерский Г.М., Мурылев В.Ю., Рукин Я.А., Холодаев М.Ю., Елизаров П.М. Нарушение разгибательного аппарата после первичного и ревизионного эндопротезирования коленного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2014;(2):40-45.
  3. Кавалерский Г.М., Сметанин С.М. эндопротезирование коленного сустава при системных заболеваниях соединительной ткани. Врач-аспирант. 2016;77(4):9-14.
  4. Корнилов Н.Н., Куляба Т.А., Филь А.С., Муравьёва Ю.В. Данные регистра эндопротезирпования коленного сустава РНИИТО им. Р.Р. Вредена за 2011-2013 годы. Травматология и ортопедия России. 2015;1(75): 136-151.
  5. Преображенский П.М., Каземирский А.В., Гончаров М.Ю. Современные взгляды на диагностику и лечение пациентов с перипротезной инфекцией после эндопротезирования коленного сустава. Гений ортопедии. 2016;(3):94-104.
  6. Тихилов Р.М., Корнилов Н.Н., Куляба Т.А., Сараев А.В., Игнатенко В.Л. Современные тенденции в ортопедии: артропластика коленного сустава. Травматология и ортопедия России. 2012;2(64):5-15.
  7. Aracil J., Salom M., Aroca J.E., Torro V., Lopez-Quiles D. Extensor apparatus reconstruction with LeedsKeio ligament in total knee arthroplasty. J Arthroplasty. 1999;14(2):204-208.
  8. Barrack R.L., Stanley T., Butler R.A. Treating extensor mechanism disruption after total knee arthroplasty. Clin Orthop Relat Res. 2003;(416):98-104. doi: 10.1097/01.blo.0000092993.90435.69.
  9. Brown N., Murray T., Sporer S.M., Wetters N., Berger R.A. Extensor Mechanism Allograft Reconstruction for Extensor Mechanism Failure Following Total Knee Arthroplasty. J Bone Joint Surg Am. 2015;(97):279-362. doi: 10.2106/JBJS.N.00759.
  10. Browne J.A., Hanssen A.D. Reconstruction of patellar tendon disruption after total knee arthroplasty: Results of a new technique utilizing synthetic mesh. J Bone Joint Surg Am. 2011;93(12):1137-1143. doi: 10.2106/JBJS.J.01036.
  11. Burnett R.S., Berger R.A., Paprosky W.G., Della Valle C.J., Jacobs J.J., Rosenberg A.G. Extensor mechanism allograft reconstruction after total knee arthroplasty: A comparison of two techniques. J Bone Joint Surg Am. 2004;(86):2694-2699.
  12. Burnett R.S., Butler R.A., Barrack R.L. Extensor mechanism allograft reconstruction in TKA at a mean of 56 months. Clin Orthop Relat Res. 2006;(452):159-165. doi: 10.1097/01.blo.0000238818.25530.2b.
  13. Busfield B.T., Huffman G.R., Nahai F., Hoffman W., Ries M.D.: Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. Clin Orthop Relat Res. 2004;(428):190-197.
  14. Cadambi A., Engh G.A. Use of a semitendinosus tendon autogenous graft for rupture of the patellar ligament after total knee arthroplasty: A report of seven cases. J Bone Joint Surg Am. 1992;74(7):974-979.
  15. Chalidis B.E., Tsiridis E., Tragas A.A., Stavrou Z., Giannoudis P.V. Management of periprosthetic patellar fractures. A systematic review of literature. Injury. 2007;38(6):714-724.
  16. Cottino U., Abdel M.P., Hanssen A.D. Chronic extensor mechanism insufficiency in total knee arthroplasty (TKA). Curr Rev Musculoskelet Med. 2015;8(4):368-458. doi: 10.1007/s12178-015-9292-9.
  17. Crossett L.S., Sinha R.K., Sechriest V.F., Rubash H.E. Reconstruction of a ruptured patellar tendon with achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am. 2002;84(8):1354-1361.
  18. Cushner F., Agnelli G., Fitzgerald G., Warwick D. Complications and functional outcomes after total hip arthroplasty and total knee arthroplasty: results from the global Orthopaedic Registry (gLORY). Am J Orthop. (Belle Mead NJ). 2010;39(9 Suppl):22-28.
  19. Dobbs R.E., Hanssen A.D., Lewallen D.G., Pagnano M.W. Quadriceps tendon rupture after total knee arthroplasty. Prevalence, complications, and outcomes. J Bone Joint Surg Am. 2005;87(1):37-45. doi: 10.2106/JBJS.D.01910.
  20. Diaz-Ledezma C., Orozco F.R., Delasotta L.A., Lichstein P.M., Post Z.D., Ong A.C. Extensor mechanism reconstruction with achilles tendon allograft in TKA: results of an abbreviate rehabilitation protocol. J Arthroplasty. 2014;29(6):1211-1216. doi: 10.1016/j.arth.2013.12.020.
  21. Dominkus M., Sabeti M., Toma C., Abdolvahab F., Trieb K., Kotz R.I. Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop Relat Res. 2006;(453): 328-362. doi: 10.1097/01.blo.0000229368.42738.b6.
  22. Emerson R.H. Jr., Head W.C., Malinin T.I. Extensor mechanism reconstruction with an allograft after total knee arthroplasty. Clin Orthop Relat Res. 1994;(303): 79-85.
  23. Jaureguito J.W., Dubois C.M., Smith S.R., Gottlieb L.J., Finn H.A. Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am. 1997;79(6):866-873.
  24. Kollender Y., Bender B., Weinbroum A.A., Nirkin A., Meller I., Bickels J. Secondary reconstruction of the extensor mechanism using part of the quadriceps tendon, patellar retinaculum, and gore-Tex strips after proximal tibial resection. J Arthroplasty. 2004;19(3):354-60.
  25. Lynch A.F., Rorabeck C.H., Bourne R.B. Extensor mechanism complications following total knee arthroplasty. J Arthroplasty. 1987;2(2):135-140.
  26. Malhotra R., Garg B., Logani V., Bhan S. Management of extensor mechanism deficit as a consequence of patellar tendon loss in total knee arthroplasty: a new surgical technique. J Arthroplasty. 2008;23(8):1146-1197. doi: 10.1016/j.arth.2007.08.011.
  27. Meding J.B., Fish M.D., Berend M.E., Ritter M.A., Keating E.M. Predicting patellar failure after total knee arthroplasty. Clin Orthop Relat Res. 2008;466(11): 2769-2843. doi: 10.1007/s11999-008-0417-y.
  28. Nazarian D.G., Booth R.E. Jr. Extensor mechanism allografts in total knee arthroplasty. Clin Orthop Relat Res. 1999;(367):123-129.
  29. Ortiguera C.J., Berry D.J. Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am. 2002;84-A(4):532-40.
  30. Pagnano M.W. Patellar tendon and quadriceps tendon tears after total knee arthroplasty. J Knee Surg. 2003; 16(4):242-247.
  31. Pierce T.P., Jauregui J.J., Cherian J.J., Elmallah R.K., Harwin S.F.,MontM.A.IsThereanIdealPatellarThicknessFollowing Total Knee Arthroplasty? Orthopedics. 2016;39(1):e187-92. doi: 10.3928/01477447-20151222-03.
  32. Rand J.A., Morrey B.F., Bryan R.S. Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res. 1989;(244):233-238.
  33. Rust P.A., Tanna N., Spicer D.D. Repair of ruptured quadriceps tendon with Leeds-Keio ligament following revision knee surgery. Knee Surg Sports Traumatol Arthrosc. 2008;16(4):370-372. doi: 10.1007/s00167-007-0475-9.
  34. Siwek C.W., Rao J.P. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am. 1981;63(6):932-937.
  35. Stinner D.J., Orr J.D., Hsu J.R. Fluoroquinolone-associated bilateral patellar tendon rupture: a case report and review of the literature. Mil Med. 2010;175(6):457-466.

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