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Abstract
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Introduction:Extensor mechanism insufficiency(EMI) in patients with history of multiple knee surgeries is a devastating complication. Treatment usually involves surgery. Studies have reported poor outcomes after direct repair, even for acute ruptures. Thus, the 2 most popular management techniques are EM reconstruction or arthrodesis. However, no technique yields superior outcomes. The aim of our study is to describe the results of EM reconstructions with complete allografts. Methods:We prospectively followed 2 patients with TKA and history of multiple surgeries ending up in prosthetic infection and EMI. All patients were treated with fresh-frozen allografts that were composed of the quadriceps tendon, the patella, the patellar tendon and the tibial tubercle. The senior author performed all surgeries according to the technique described by Bonin. However, he used screws instead of cerclage wires to secure the graft on the proximal tibia. A medial gastrocnemius flap was done in 1 case to cover the tibial tubercle due to poor skin conditions. Recorded outcomes measures included: clinical exam, x-rays, KSS and SF-12. Results:FU time was 12±4.2m. Age at surgery was 73±14.1yo. At the most recent FU:Grafts didn’t show any signs of lengthening and tibial tubercle healed properly. Patellar height was 0.9±0.1(Caton-Deschamps). Quadriceps strength was M4. Knee flexion was 107.5°±3.5. Extension lag was 10°. All patients could walk with full weight bearing using 2 crutches. Knee and function KSS values increased from 41.5±0.7 and 0 (preoperative) to 76.5±7.8 and 35.0±21.2 (at FU), respectively. PCS and MCS SF-12 increased from 17.4 and 37 (preoperative) to 38.1±7.4 and 60.3±0.9 (at FU), respectively. Conclusion:Short-term outcomes of EM reconstruction with complete allografts in patients with lower level of activity are good. All Patients recovered their full level of activity. All the grafts are still functional and the remaining extension lag did not interfere with patient daily activities. Reported KSS values are higher than those of similar patients treated in our hospital by arthrodesis (knee and function KSS values were 51±7.1 and 30±7.1, respectively). Soft tissue coverage with a medial gastrocnemius flap is an option in patients with poor soft-tissues. Although it isn’t possible to draw any conclusions from this study because of its small number of patients, the results of such procedures are encouraging and this technique deserves to be studied in more detail
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