Enxerto homólogo de mecanismo extensor em artroplastia total do joelho

Abstract

Objective To analyze the experience with allograft transplantation of the extensor mechanism in total knee arthroplasty and compare results with the international experience. Methods We retrospectively evaluated three cases of extensor mechanism allograft after total knee arthroplasty performed in our hospital with the aid of one of the few tissue banks in Brazil and attempt to establish whether our experiences were similar to others reported in the world literature regarding patient indication, techniques, and outcomes. Results Two cases went well with the adopted procedure, and one case showed bad results and progressed to amputation. As shown in the literature, the adequate tension of the graft, appropriate tibial fixation and especially the adequate patient selection are the better predictors of good outcomes. Previous chronic infection can be an unfavorable predictor. Conclusion This surgical procedure has precise indication, albeit uncommon, either because of the rarity of the problem or because of the low availability of allografts, due to the scarcity of tissue banks in Brazil. Level of Evidence IV, Case Series.

Fresh-frozen Complete Extensor Mechanism Allograft versus Autograft Reconstruction in Rabbits

“…Bone-patellar tendon-bone allograft 14 15 16 17 and Achilles tendon bone block allograft 6 18 19 20 21 22 23 have provided satisfactory results for patients with an adequate patella and patellar component. Fresh-frozen complete extensor mechanism (CEM) allograft consisting of the quadriceps tendon, patella, patellar tendon and anterior tibial tubercle is suitable for patients with insufficient or no patella, or other complicated lesions 4 6 24 25 26 27 28 29 30 31 .…”

“…Despite the early promising results, extensor lag subsequently occurred in some patients 25 . The technique was modified by tightly tensioning the allograft in full extension 28 , and the clinical results improved 4 6 29 30 . However, high failure rate of reconstruction using fresh-frozen CEM allograft has also been reported 27 31 .…”

Revizyon diz artroplastisinde ekstansör mekanizma sorunları

“…[18] Tendon rüptürüne patellar parçalanmanın eşlik etmesi ve onarılamayacak kadar kötü kemik varlığı ya da herhangi bir nedenle tüm bu yöntemlerin uygulanamadığı durumlarda, Helito ve arkadaşları ile Brown ve arkadaşlarının önerdiği şekilde, ekstansör mekanizma allogrefti kullanılabilir. [19][20][21] Bahsedilen tedavi seçenekleri, patellar tendon rüptürlerinde tam restorasyonu genellikle sağlayamamaktadır. Bu noktada en iyi tedavinin, bu durumun önlenmesi olduğu unutulmamalıdır.…”