Retrieval analysis of a failed synthetic mesh extensor mechanism reconstruction after total knee arthroplasty

Abstract

Extensor mechanism disruption after total knee arthroplasty is a relatively rare but potentially devastating complication. One technique to address this problem involves reconstruction with synthetic mesh. Although there are reports of successful clinical outcomes using this technique, we are not aware of any histological analyses of removed mesh grafts. This case report of a failed mesh reconstruction includes a retrieval analysis demonstrating robust host soft-tissue incorporation into the mesh graft and supports the rationale for continued use of this off-label technique. This case report also highlights the need for careful operative technique when performing these procedures to increase the chance of a successful outcome.

Marlex Mesh Reconstruction of the Extensor Mechanism

“…Expectedly, there were increased rates of mesh revision with longer-term follow-up; however, these results represent a substantial improvement in terms of construct durability when compared with previously described reconstructive techniques 2,11 . Overall, these results support the index hypotheses posed by Browne and Hanssen 6 that the ingrowth of mature, fibrous host tissue into the mesh 23 , as well as increased tensile strength relative to allograft tissue, may afford greater longevity following extensor mechanism reconstruction.…”

Synthetic Mesh Reconstruction of Chronic, Native Quadriceps Tendon Disruptions following Failed Primary Repair

“…A TKA retrieval study demonstrated similar histological findings [29]. The use of mesh in this technique is technically uncomplicated and affordable, and polypropylene mesh has favorable biomechanical properties [13,29]. As such, there is growing interest in its use in the traditionally tenuous reconstruction of relatively devitalized post-TKA extensor mechanism ruptures [10,21,30,31].…”

“…Monofilament mesh is well-studied in general surgical hernia repairs 26 and functions by inciting a robust inflammatory fibrotic reaction that promotes host/graft integration [27,28]. A TKA retrieval study demonstrated similar histological findings [29]. The use of mesh in this technique is technically uncomplicated and affordable, and polypropylene mesh has favorable biomechanical properties [13,29].…”