Courtney P Maxwell, Edmiston Tori A, Pflederer Caleb T, Levine Brett R, Gerlinger Tad L
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2018 Jul;33(7S):S244-S248. doi: 10.1016/j.arth.2017.11.045. Epub 2017 Dec 2.
Extensor mechanism disruption remains a challenging problem in total knee arthroplasty (TKA) with historically poor outcomes. The purpose of our study is to determine if patients undergoing acute extensor mechanism repair had different outcomes than patients undergoing allograft reconstruction.
We reviewed a series of 126 total knee arthroplasty patients requiring surgical repair or reconstruction of an extensor mechanism injury from 2005 to 2014 with a minimum of 24 months of follow-up. Demographics, comorbidities, Knee Society Scores, time from injury, and reoperations were all recorded from the medical record. A poor outcome was defined as an extensor lag >30°, postoperative Knee Society Scores <60, or a reoperation. A multivariate analysis was then performed to identify independent risk factors for a poor outcome.
Of the 126 patients, there were 58 patients who underwent direct extensor repair (46%) and 68 patients who underwent allograft reconstruction (54%) at a mean postsurgical follow-up of 81.2 months. Rates of poor outcomes were comparably high in both groups (33% vs 44%, P = .192). Patella tendon repair had the highest rate of poor outcomes compared to quadriceps repair and patella fixation (63% vs 22% vs 8%, P = .002). Independent risk factors for poor outcomes included patients with a history of infection (odds ratio 4.559, P = .002) and injury greater than 2 weeks duration (odds ratio 4.237, P = .031).
Outcomes following direct extensor mechanism are comparable to extensor mechanism allograft reconstruction; however, patients should be counseled regarding poor outcomes. Direct repair of patellar tendon injuries should likely be avoided due to prohibitively high complication rate.
伸肌机制破坏在全膝关节置换术（TKA）中仍然是一个具有挑战性的问题，历来预后较差。我们研究的目的是确定接受急性伸肌机制修复的患者与接受同种异体移植重建的患者的预后是否不同。
我们回顾了2005年至2014年期间126例需要手术修复或重建伸肌机制损伤的全膝关节置换术患者，随访时间至少24个月。从病历中记录人口统计学、合并症、膝关节协会评分、受伤时间和再次手术情况。预后不良定义为伸肌滞后>30°、术后膝关节协会评分<60或再次手术。然后进行多变量分析以确定预后不良的独立危险因素。
126例患者中，58例（46%）接受了直接伸肌修复，68例（54%）接受了同种异体移植重建，术后平均随访81.2个月。两组预后不良率均较高（33%对44%，P = 0.192）。与股四头肌修复和髌骨固定相比，髌腱修复的预后不良率最高（63%对22%对8%，P = 0.002）。预后不良的独立危险因素包括有感染史的患者（比值比4.559，P = 0.002）和受伤时间超过2周的患者（比值比4.237，P = 0.031）。
直接伸肌机制修复后的预后与伸肌机制同种异体移植重建相当；然而，应向患者告知预后不良的情况。由于并发症发生率过高，可能应避免直接修复髌腱损伤。
