This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 Adult Knee Reconstruction Test 7: Outcomes of Total Knee Arthroplasty
CME 4: October, November, December 2004
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Burnett, R. S. J.
Right arrow Articles by Rosenberg, A. G.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Burnett, R. S. J.
Right arrow Articles by Rosenberg, A. G.
Related Collections
Right arrow Adult Knee
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American). 2004;86:2694-2699
© 2004 The Journal of Bone and Joint Surgery, Inc.

Extensor Mechanism Allograft Reconstruction After Total Knee Arthroplasty

A COMPARISON OF TWO TECHNIQUES

R. Stephen J. Burnett, MD, FRCS(C)1, Richard A. Berger, MD2, Wayne G. Paprosky, MD2, Craig J. Della Valle, MD2, Joshua J. Jacobs, MD2 and Aaron G. Rosenberg, MD2

1 Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110
2 Department of Orthopedic Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612

Investigation performed at the Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Zimmer) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Disruption of the extensor mechanism is an uncommon but catastrophic complication of total knee arthroplasty. We evaluated two techniques of reconstructing a disrupted extensor mechanism with use of an extensor mechanism allograft following total knee arthroplasty.

Methods: Twenty consecutive reconstructions with use of an extensor mechanism allograft consisting of the tibial tubercle, patellar tendon, patella, and quadriceps tendon were performed. The first seven reconstructions (Group I) were done with the allograft minimally tensioned. The thirteen subsequent procedures (Group II) were performed with the allograft tightly tensioned in full extension. All surviving allografts were evaluated clinically and radiographically after a minimum duration of follow-up of twenty-four months.

Results: All of the reconstructions in Group I were clinical failures, with an average postoperative extensor lag of 59° (range, 40° to 80°) and an average postoperative Hospital for Special Surgery knee score of 52 points. All thirteen reconstructions in Group II were clinical successes, with an average postoperative extensor lag of 4.3° (range, 0° to 15°) (p < 0.0001) and an average Hospital for Special Surgery score of 88 points. Postoperative flexion did not differ significantly between Group I (average, 108°) and Group II (average, 104°) (p = 0.549).

Conclusions: The results of reconstruction with an extensor mechanism allograft after total knee arthroplasty depend on the initial tensioning of the allograft. Loosely tensioned allografts result in a persistent extension lag and clinical failure. Allografts that are tightly tensioned in full extension can restore active knee extension and result in clinical success. On the basis of the number of knees that we studied, there was no significant loss of flexion. Use of an extensor mechanism graft for the treatment of a failure of the extensor mechanism will be successful only if the graft is initially tensioned tightly in full extension.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
N. P. Sheth, D. I. Pedowitz, and J. H. Lonner
Periprosthetic Patellar Fractures
J. Bone Joint Surg. Am., October 1, 2007; 89(10): 2285 - 2296.
[Full Text] [PDF]

Home page
 JBJSHome page
R. S. J. Burnett, R. A. Berger, C. J. Della Valle, S. M. Sporer, J. J. Jacobs, W. G. Paprosky, and A. G. Rosenberg
Extensor Mechanism Allograft Reconstruction After Total Knee Arthroplasty
J. Bone Joint Surg. Am., September 1, 2005; 87(1_suppl_2): 175 - 194.
[Abstract] [Full Text] [PDF]