Wilken F, Harrasser N, Pohlig F, Laux F M, von Eisenhart-Rothe R
Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, München.
Z Orthop Unfall. 2015 Apr;153(2):209-11. doi: 10.1055/s-0035-1545804. Epub 2015 Apr 14.
Injuries to the extensor apparatus of the knee are a rare but in case of their occurrence a serious injury. In the following discussion, the focus is on treatment of chronic patellar tendon tears. The aim of surgical treatment is the recovery of the active extension and full weight-bearing ability of the leg. The video presentation shows the operative treatment of a patient with a chronic extensor mechanism deficiency of the knee after multiple revision of a total knee arthroplasty due to periprosthetic infection and three-times occurrence of a patella tendon tear. A frame-shaped reinforcement between patella and tibial tuberosity by FiberTape® combined with a medial gastrocnemius flap was performed. This type of surgery is indicated in cases of large defects of the patellar tendon that cannot be treated with end-to-end suture or simple augmentation with autologous tendons (e.g. semitendinosus). In addition to augmentation of the tendon defect, cutaneous soft tissue defects around the knee and proximal lower leg can be covered. In general, the best treatment option is chosen according to size of the defect, the quality of the tendon tissue and possible previous surgery on the knee joint. There are no reports of large series of chronic patella tendon tears, but only isolated cases using a variety of techniques. In addition with low level of evidence, there is currently no established gold standard in the surgical treatment of insufficiencies of the extensor apparatus of the knee.
膝关节伸肌装置损伤虽罕见，但一旦发生则是严重损伤。在以下讨论中，重点是慢性髌腱撕裂的治疗。手术治疗的目的是恢复腿部的主动伸展和完全负重能力。视频展示了一名因假体周围感染多次翻修全膝关节置换术后出现膝关节伸肌机制缺陷且髌腱撕裂三次的患者的手术治疗过程。通过FiberTape®在髌骨和胫骨结节之间进行框架状加强，并结合内侧腓肠肌瓣。这种手术适用于髌腱大缺损的情况，而这些缺损无法通过端端缝合或自体肌腱（如半腱肌）简单加强来治疗。除了加强肌腱缺损外，还可以覆盖膝关节周围和小腿近端的皮肤软组织缺损。一般来说，根据缺损大小、肌腱组织质量以及膝关节可能的既往手术情况选择最佳治疗方案。目前尚无大量慢性髌腱撕裂的报道，仅有使用各种技术的个别病例。此外，由于证据水平较低，目前膝关节伸肌装置功能不全的手术治疗尚无既定的金标准。
