Lim C T, Amanatullah Derek F, Huddleston James I, Harris Alex H S, Hwang Katherine L, Maloney William J, Goodman Stuart B
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California; Department of Orthopaedic Surgery, National University Hospital, Singapore.
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
J Arthroplasty. 2017 Oct;32(10):3134-3140. doi: 10.1016/j.arth.2017.05.005. Epub 2017 May 11.
Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a debilitating complication that results in extension lag, limited range of motion, difficulty in walking, frequent falls, and chronic pain. This study presents the clinical and radiographic results of reconstruction after extensor mechanism disruption in TKA patients.
Consecutive patients with allograft reconstruction of extensor mechanism after TKA were identified retrospectively from an academic tertiary center for revision TKA.
Sixteen patients with a mean age of 61 ± 14 years at extensor mechanism reconstruction with a minimum of 2-year follow-up were included. The mean follow-up was 3.3 ± 2.2 years. Knee Society score (KSS), before and at final follow-up extension lag, range of motion, and radiographic change in patellar height were reviewed. There were statistically significant improvements between preoperative and final follow-up KSS (P < .001; KSS for pain, preoperative 40 ± 14 points to final follow-up 67 ± 15 points [P < .001]; KSS for function, preoperative 26 ± 21 points to final follow-up 48 ± 25 points [P < .001]). The extension lag was also reduced from 35° ± 16° preoperatively to 14° ± 18° (P < .001) at final follow-up. There was an average proximal patellar migration of 8 ± 10 mm. Five (31%) cases had an extensor lag of >30° or revision surgery for repeat extensor mechanism reconstruction, infection, or arthrodesis.
Our 10-year experience using allografts during extensor mechanism reconstruction demonstrates reasonable outcomes, but failures are to be anticipated in approximately one-third of patients.
全膝关节置换术（TKA）后伸肌机制破坏是一种使人衰弱的并发症，会导致伸展滞后、活动范围受限、行走困难、频繁跌倒和慢性疼痛。本研究展示了TKA患者伸肌机制破坏后重建的临床和影像学结果。
从一家学术性三级中心接受TKA翻修手术的患者中，回顾性确定连续进行TKA后伸肌机制同种异体移植重建的患者。
纳入16例伸肌机制重建时平均年龄为61±14岁且至少随访2年的患者。平均随访时间为3.3±2.2年。回顾了膝关节协会评分（KSS）、术前和末次随访时的伸展滞后、活动范围以及髌骨高度的影像学变化。术前和末次随访时的KSS有统计学意义的改善（P<.001；疼痛的KSS，术前40±14分至末次随访67±15分[P<.001]；功能的KSS，术前26±21分至末次随访48±25分[P<.001]）。伸展滞后也从术前的35°±16°减少到末次随访时的14°±18°（P<.001）。髌骨平均近端移位8±10mm。5例（31%）出现>30°的伸肌滞后或因伸肌机制重复重建、感染或关节融合而进行翻修手术。
我们在伸肌机制重建中使用同种异体移植物的10年经验显示了合理的结果，但预计约三分之一的患者会失败。
