Carlson Strother Courtney R, LaPrade Matthew D, Keyt Lucas K, Wilbur Ryan R, Krych Aaron J, Stuart Michael J
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Orthop J Sports Med. 2021 Oct 18;9(10):23259671211046625. doi: 10.1177/23259671211046625. eCollection 2021 Oct.
The loss of extensor mechanism continuity that occurs with patellar and quadriceps tendon rupture has devastating consequences on patient function.
To describe a treatment strategy for extensor mechanism disruption and evaluate the outcomes of 3 techniques: primary repair, repair with semitendinosus tendon autograft augmentation, and reconstruction with Achilles tendon allograft.
Case series; Level of evidence, 4.
The authors reviewed surgeries for extensor mechanism disruption performed by a single surgeon between 1999 and 2019. Patient characteristics, imaging studies, surgical techniques, and outcomes were recorded. Primary ruptures with robust tissue quality were repaired primarily, and first-time ruptures with significant tendinosis or moderate tissue loss were repaired using quadrupled semitendinosus tendon autograft augmentation. Patients with failed previous extensor mechanism repair or reconstruction and poor tissue quality underwent reconstruction with Achilles tendon allograft. The primary outcome was extensor mechanism integrity at a minimum 1-year follow-up, with extensor mechanism lag defined as >5° loss of terminal, active knee extension. Secondary outcomes included postoperative knee range of motion, International Knee Documentation Committee (IKDC) and Tegner activity scores, and the radiographic Caton-Deschamps Index.
Included were 22 patellar tendon and 21 quadriceps tendon surgeries (patients: 82.5% male; mean age, 48.1 years; body mass index, 31). Seventeen (39.5%) cases underwent primary tendon repair, 13 (30.2%) had repair using semitendinosus tendon autograft augmentation, and 13 (30.2%) underwent reconstruction using an Achilles tendon allograft. Seventeen (39.5%) cases had at least 1 prior failed extensor mechanism surgery performed at an outside facility. At the last follow-up, 4 (9.3%) cases had an extensor mechanism lag, no cases required additional extensor mechanism surgery, and all cases were able to achieve >90° of knee flexion. Postoperative IKDC scores were significantly improved with all methods of extensor mechanism surgery, and postoperative Tegner activity scores were significantly improved in patients who underwent primary repair and Achilles tendon allograft reconstruction ( < .05 for all).
Primary repair alone, repair using quadrupled semitendinosus tendon autograft augmentation, and reconstruction using Achilles tendon allograft were all effective methods to restore extensor mechanism and knee function with the proper indications. Persistent knee extensor lag was more common in chronic extensor mechanism injuries after failed surgery, although patients still reported significantly improved postoperative functional outcomes.
髌腱和股四头肌肌腱断裂导致的伸肌机制连续性丧失会对患者功能产生严重后果。
描述一种伸肌机制破坏的治疗策略，并评估三种技术的结果：一期修复、半腱肌肌腱自体移植增强修复和跟腱异体移植重建。
病例系列；证据等级，4级。
作者回顾了1999年至2019年间由一名外科医生进行的伸肌机制破坏手术。记录患者特征、影像学检查、手术技术和结果。组织质量良好的初次断裂进行一期修复，存在明显肌腱病或中度组织缺损的初次断裂采用四倍半腱肌肌腱自体移植增强修复。既往伸肌机制修复或重建失败且组织质量差的患者采用跟腱异体移植进行重建。主要结局是至少随访1年时伸肌机制的完整性，伸肌机制滞后定义为终末主动膝关节伸展丧失>5°。次要结局包括术后膝关节活动范围、国际膝关节文献委员会（IKDC）和泰格纳活动评分，以及影像学卡顿-德尚指数。
纳入22例髌腱手术和21例股四头肌肌腱手术（患者：82.5%为男性；平均年龄48.1岁；体重指数31）。17例（39.5%）病例进行了一期肌腱修复，13例（30.2%）采用半腱肌肌腱自体移植增强修复，1十三例（30.2%）采用跟腱异体移植进行重建。17例（39.5%）病例至少有1次既往在外部机构进行的伸肌机制手术失败。在最后随访时，4例（9.3%）病例存在伸肌机制滞后，无病例需要额外的伸肌机制手术，所有病例均能达到膝关节屈曲>90°。所有伸肌机制手术方法术后IKDC评分均显著改善，接受一期修复和跟腱异体移植重建的患者术后泰格纳活动评分显著改善（所有P<0.05）。
单独一期修复、四倍半腱肌肌腱自体移植增强修复和跟腱异体移植重建都是在有适当适应证时恢复伸肌机制和膝关节功能的有效方法。尽管患者术后功能结局仍有显著改善，但持续性膝关节伸肌滞后在手术失败后的慢性伸肌机制损伤中更为常见。
