Partial extensor mechanism allograft reconstruction for chronic patellar tendon disruption shows superior outcomes in native knees when compared to same technique following total arthroplasty
- 64 Downloads
Chronic patellar tendon disruption occurs mostly after total knee arthroplasty, and is a challenging complication to treat. We have previously described an original technique for reconstruction using extensor mechanism allograft. The goal of this study was to assess the results of this technique in TKA and native knees.
An observational, single centre, retrospective study was conducted. Nine patients in the TKA group and eight in the native knee group were included, all treated for chronic PT rupture. The operative technique included fresh-frozen allograft, in which the patella was fashioned into an hourglass shape and press-fit in a corresponding groove in the native patella. The primary outcome was failure of the graft defined by a residual extensor lag > 10°.
The mean age was 68 in the TKA group and 51 in the native group. The minimum follow-up was 24 months and the mean follow-up respectively 42 and 39 months. 33% of allografts failed in the TKA group where none failed in the native knee group, with a mean extension lag of 12.2° (0–30) and 1.25° (0–5), respectively. All but the three failures presented with an extension lag < 10°. Four cases of patellar bone block distal migration, less than 1 cm, were recorded in the native knee group without clinical repercussion.
The results of this original technique in the setting of chronic PT rupture were excellent for native knees at a minimum follow-up of 24 months. However, results were less satisfactory in the TKA group, due to the substantial rate of failure.
Level of Evidence III
KeywordsChronic patellar tendon disruption TKA Native knee Hourglass partial extensor mechanism allograft
Total knee arthroplasty
Extensor mechanism allograft
Anterior tibial tubercle
Knee society score
Caton Deschamps Index
Body mass index
This study received no funding.
Compliance with ethical standards
Conflicts of interest
C. Fiquet: None
N. White: None
R. Gaillard: None
E. Servien: S&N consultant; institutional support: amplitude, Corin
P. Neyret: Royalties from Tornier; institutional support: none
S. Lustig: S&N, Medacta and Lepine consultant; institutional support: amplitude, Corin
The Ethics Committee of the University Hospital of Lyon declares that the project titled “Partial Extensor Mechanism Allograft Reconstruction for chronic Patellar Tendon Disruption shows superior outcomes in Native Knees compared to same technique following Total Knee Arthroplasty (TKA)” submitted by Charles Fiquet et al., is ethically correct. Therefore, its execution is allowed.
Informed consent was obtained from all individual participants included in the study.
- 5.Wise BT, Erens G, Pour AE et al (2018) Long-term results of extensor mechanism reconstruction using Achilles tendon allograft after total knee arthroplasty. Int Orthop 86:2694–2697Google Scholar
- 6.Emerson RH, Head WC, Malinin TI (1994) Extensor mechanism reconstruction with an allograft after total knee arthroplasty. Clin Orthop Relat Res:79–85Google Scholar
- 17.Fiquet C, Schneider A, Ballis R et al (2017) Reconstructing the chronically disrupted knee extensor mechanism after total knee arthroplasty: hourglass variant of the original partial allograft technique. Orthop Traumatol Surg ResGoogle Scholar
- 24.Lamberti A, Balato G, Summa PP et al (2016) Surgical options for chronic patellar tendon rupture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc:1–7Google Scholar