Synthetic Graft Compared With Allograft Reconstruction for Extensor Mechanism Disruption in Total Knee Arthroplasty: A Multicenter Cohort Study

Abstract

Background: Extensor mechanism disruption after total knee arthroplasty is a serious complication leading to notable patient morbidity. The purpose of this study is to compare the outcomes of extensor mechanism allograft with synthetic graft reconstruction. Methods: We retrospectively identified all patients who underwent extensor mechanism reconstruction using either allograft or synthetic graft from two high-volume academic arthroplasty institutions between 2006 and 2017. We collected extensor lag, need for ambulatory aids, and patient-reported outcome measures, as well as the incidence of postoperative complications and revision surgeries. We evaluated cost differences, considering both material cost and the need for revision surgery. Results: We identified 27 cases. A significantly greater postoperative extensor lag was found in the allograft group (P = 0.05). Graft failure after synthetic reconstruction was zero, with an overall revision surgery rate of 15%. Graft failure was 21%, and the revision surgery rate was 43% after allograft reconstruction. The allograft cost was significantly higher compared with the synthetic graft cost (P = 0.001). The mean total cost was 4,733.08 CAD for the synthetic group and 24,050.40 CAD for the allograft group (P = 0.17). Discussion: Synthetic reconstruction for extensor mechanism disruption shows benefit in postoperative extensor lag, graft failure, revision surgery, and cost when compared with allograft. Level of Evidence: Level III

Extensor Mechanism Transplantation After Knee Prosthesis: 70-Month Follow-Up

“…However, worse knee extension capacity was reported by Wood et al with an average deficit of 26 degrees. 18 We believed that such functional limitation can be attributed, at least partially, to the fact that the authors used Achilles tendon grafts in 43% of these patients and, mainly, to the fact that 86% of the grafts were irradiated. The graft irradiation can compromise the structural integration, as admitted by the authors and, thus, we understand that there may be impairment in the functional result and alteration of the graft incorporation capacity, in addition to the possibility of progressive loss of graft tension and consequent stretching with time.…”

“…The graft irradiation can compromise the structural integration, as admitted by the authors and, thus, we understand that there may be impairment in the functional result and alteration of the graft incorporation capacity, in addition to the possibility of progressive loss of graft tension and consequent stretching with time. 18 , 19 …”

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

“…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 ].…”

KNEE extension lag

“…Comprehensive reviews have shown that CPM has a modest, temporary, and functional effect on flexion ROM, but no evidence that treatment has any lasting effects on active or functional knee extension ROM, pain, edema, or quadriceps strength. Wood TJ, et al (2019). Addressed about patients who have had hydrotherapy in the six months following a total knee replacement (TKR) has reported significant reductions in pain, stiffness, and functional impairment.…”