Orthopaedic Department, Evangelismos General Hospital, Ipsilantou 45, 10676, Athens, Greece.
Eur J Orthop Surg Traumatol. 2023 May;33(4):1051-1056. doi: 10.1007/s00590-022-03251-w. Epub 2022 Mar 29.
The management of extensor mechanism lesions after total knee replacement is still associated with an unacceptably high complication rate, especially in its chronic setting. In this study, we report on 4 patients with chronic (> 3 months) patellar tendon rupture after knee arthroplasty, who were treated with a novel procedure of staged patella advancement prior to reconstruction with autografts. Initially, a unilateral frame was applied connecting the patella with the tibial shaft. The construct allowed for gradual distal advancement of the patella based on the Ilizarov principles. After achieving the desired patella height, the frame was removed, and the patellar tendon was reconstructed with hamstrings. All four patients experienced a significant improvement in extensor lag by a mean of 38.0°, while Knee society scores increased by a mean of 38.5 units. No substantial loss in active knee flexion was observed. Our findings suggest that our technique yields favorable outcomes in patients with patellar tendon disruption in the setting of a total knee arthroplasty.
全膝关节置换术后伸肌机制损伤的管理仍然存在不可接受的高并发症发生率，尤其是在慢性期。在本研究中，我们报告了 4 例膝关节置换术后慢性（>3 个月）髌腱断裂患者，他们采用了一种新的分期髌腱前进步骤，然后用自体移植物进行重建。最初，应用单侧框架将髌骨与胫骨连接起来。该结构允许根据伊利扎罗夫原理逐渐向远端推进髌骨。达到理想的髌骨高度后，拆除框架，用半腱肌重建髌腱。所有 4 例患者的伸膝滞后均显著改善，平均改善 38.0°，而膝关节学会评分平均增加 38.5 分。主动膝关节屈曲无明显丢失。我们的研究结果表明，我们的技术在全膝关节置换术后髌腱断裂的患者中产生了良好的效果。
