Bateman Dexter K, Preston Jared S, Kayiaros Stephen, Tria Alfred J
Orthopedics. 2019 Jul 1;42(4):e385-e390. doi: 10.3928/01477447-20190403-02. Epub 2019 Apr 9.
Extensor mechanism (EM) insufficiency after knee arthroplasty is a rare but devastating complication resulting in severe disability. To date, primary repair and allograft reconstructive options have produced suboptimal results. A synthetic mesh allograft reconstruction technique has recently been introduced with promising outcomes. A retrospective chart review was performed to identify all patients who experienced EM failure after total or unicompartmental knee arthroplasty and subsequently underwent synthetic mesh EM reconstruction using a previously described technique. Patient demographics, pre- and postoperative knee range of motion and residual extensor lag, pre- and postoperative pain and functional outcome scores, and complications were extracted during the chart review. Twelve patients met inclusion criteria: 3 with patellar tendon and 9 with quadriceps tendon defects. At mean follow-up of 27.0 months, all patients were ambulatory, with a mean residual extensor lag of 12.9° (range, 0°-30°). Mean visual analog scale pain score decreased significantly after EM reconstruction: 4.6±2.3 (range, 1-8) preoperatively vs 1.8±2.4 (range, 0-7) postoperatively (P=.01). The mean Knee Society knee score improved from 41.5±11.1 (range, 21-57) preoperatively to 79.5±13.8 (range, 54-90) postoperatively (P<.0001). The mean Knee Society function score improved from 14.6±12.3 (range, 0-40) preoperatively to 64.2±27.1 (range, 5-95) postoperatively (P<.0001). One clinical failure occurred as a result of prosthetic joint infection. Synthetic mesh EM reconstruction effectively restores knee function for a variety of EM deficiencies following knee arthroplasty. [Orthopedics. 2019; 42(4):e385-e390.].
膝关节置换术后伸肌机制（EM）功能不全是一种罕见但极具破坏性的并发症，会导致严重残疾。迄今为止，一期修复和同种异体移植重建方案的效果都不尽人意。最近引入了一种合成网片同种异体移植重建技术，取得了令人期待的结果。我们进行了一项回顾性图表审查，以确定所有在全膝关节置换术或单髁膝关节置换术后出现EM功能障碍并随后使用先前描述的技术进行合成网片EM重建的患者。在图表审查过程中，提取了患者的人口统计学数据、术前和术后膝关节活动范围及残留伸肌滞后、术前和术后疼痛及功能结果评分以及并发症情况。12名患者符合纳入标准：3例为髌腱缺损，9例为股四头肌肌腱缺损。平均随访27.0个月时，所有患者均能行走，平均残留伸肌滞后为12.9°（范围为0°至30°）。EM重建后，视觉模拟量表疼痛评分显著降低：术前为4.6±2.3（范围为1至8），术后为1.8±2.4（范围为0至7）（P = 0.01）。膝关节协会膝关节平均评分从术前的41.5±11.1（范围为21至57）提高到术后的79.5±13.8（范围为54至90）（P < 0.0001）。膝关节协会功能平均评分从术前的14.6±12.3（范围为0至40）提高到术后的64.2±27.1（范围为5至95）（P < 0.0001）。1例临床失败是由人工关节感染导致的。合成网片EM重建可有效恢复膝关节置换术后各种EM缺陷患者的膝关节功能。[《骨科》。2019年；42(4):e385 - e390。]
