Travmatologiâ i Ortopediâ Rossii (Jul 2017)

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

  • T. A. Kulyaba,
  • N. N. Kornilov,
  • P. M. Mikhailova,
  • G. Yu. Bovkis

DOI
https://doi.org/10.21823/2311-2905-2017-23-2-27-38
Journal volume & issue
Vol. 23, no. 2
pp. 27 – 38

Abstract

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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.

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