Emerson R H, Head W C, Malinin T I
Presbyterian Hospital of Dallas, Southwestern Medical School, Texas.
Clin Orthop Relat Res. 1990 Nov(260):154-61.
Although patellar tendon rupture after total knee arthroplasty (TKA) is a rare complication, the consistently poor outcome of conventional tendon repair has convinced some to abandon such reconstruction in favor of a prospective protocol using an allograft distal extensor mechanism. The graft consists of a quadriceps tendon, a patella with a cemented prosthesis, a patellar tendon, and a tibial tubercle. Since December 1985, 13 knees in 12 patients were reconstructed using this method. Ten knees were followed for six to 51 months; five of these knees were followed for more than 24 months. Knee extension power and improved function were ultimately attained in all cases, although minimal extensor lags were present in three cases. Preoperative motion returned in all but one knee. Healing of the allograft to the host tissue was attained primarily at all of the tibial junctions. Two graft complications occurred, both in the first three months after surgery: one quadriceps junction treated by resuture failed at the one-month mark, and the other graft had to be revised for extensor weakness from rupture of the graft at the patella-patellar tendon junction, which was attributed to surgical damage to the tendon. After completion of healing to the host and rehabilitation of the knee joint, no grafts in the series failed during the course of normal daily activities. One patient fractured the allograft patella in a severe fall. The long-term durability of this construct needs to be studied further.
尽管全膝关节置换术（TKA）后髌腱断裂是一种罕见的并发症，但传统肌腱修复的效果一直不佳，这使得一些人放弃这种重建方法，转而采用使用同种异体远端伸肌机制的前瞻性方案。移植物包括股四头肌肌腱、带有骨水泥假体的髌骨、髌腱和胫骨结节。自1985年12月以来，12例患者的13个膝关节采用这种方法进行了重建。10个膝关节随访了6至51个月；其中5个膝关节随访了超过24个月。所有病例最终均获得了膝关节伸展力量和功能改善，尽管3例存在轻微伸肌滞后。除1个膝关节外，其余所有膝关节均恢复了术前活动度。同种异体移植物与宿主组织的愈合主要在所有胫骨连接处实现。发生了2例移植物并发症，均在术后前3个月内：1例股四头肌连接处经再次缝合处理，在1个月时失败；另1例移植物因髌骨-髌腱连接处移植物断裂导致伸肌无力而不得不进行翻修，这归因于手术对肌腱的损伤。在移植物与宿主愈合完成以及膝关节康复后，该系列中没有移植物在正常日常活动过程中失败。1例患者在严重跌倒时导致同种异体髌骨骨折。这种结构的长期耐久性需要进一步研究。
