Longo Luis Henrique, Vanzin Marcos Paulo T, Bauer Luis Antonio R, Popovicz Nunes Carolline, Rezende Lucas, Miyamoto Letícia H, Nakahashi Seiji G
Orthopaedics and Traumatology, Universidade Federal do Paraná, Hospital do Trabalhador, Curitiba, BRA.
Cureus. 2024 Sep 6;16(9):e68801. doi: 10.7759/cureus.68801. eCollection 2024 Sep.
The rupture of the extensor mechanism following total knee arthroplasty (TKA) is a rare and severe complication that poses a significant challenge in knee surgery. The rupture can occur in the patellar or quadriceps tendons or due to patellar fractures, leading to substantial functional deficits. Risk factors include multiple prior surgeries, systemic conditions, as well as iatrogenic injuries. Reconstruction techniques range from autografts, allografts, and synthetic materials to local flaps, but none have shown exceptional results. This case report describes extensor mechanism reconstruction using a peroneus longus tendon graft in a patient. A 74-year-old active female patient was referred from a rural area to a knee surgery referral hospital with a history of progressive osteoarthritis in the left knee and underwent TKA. At her first post-surgical follow-up, she was diagnosed with an extensor mechanism rupture and referred to our institution, being admitted six weeks postoperatively. On initial assessment, she presented difficulty in fully extending the knee and patellar elevation. Extensor mechanism reconstruction was indicated, using an autograft from the peroneus longus tendon due to limited access to tissue banks and synthetic materials. The graft was fixed using anchors and an interference screw, resulting in stable patellar tracking. Postoperatively, the patient followed a rehabilitation protocol with the use of a brace and gradual weight-bearing and mobility. One year after surgery, she demonstrated an unassisted gait without a limp, with restored extensor mechanism competence and a range of motion of 0-120 degrees. Several techniques have been described for patellar tendon reconstruction following TKA, but the results remain unsatisfactory. Most techniques involve the use of allografts, which, although moderately effective, can lead to residual deficits and the need for ambulatory aids. Synthetic materials have gained popularity but face challenges such as cost and tissue reactions. The use of autografts, like the peroneus longus tendon, has shown promise due to its robustness and adaptability. This report highlights a successful case of extensor mechanism reconstruction using the peroneus longus tendon. The peroneus longus tendon graft offers a viable alternative for extensor mechanism reconstruction after TKA: minimizes costs, reduces risks of tissue rejection and cross-infection, and facilitates early rehabilitation.
全膝关节置换术（TKA）后伸肌机制断裂是一种罕见且严重的并发症，给膝关节手术带来了重大挑战。这种断裂可发生在髌腱或股四头肌肌腱，也可能由髌骨骨折引起，导致严重的功能缺陷。风险因素包括多次既往手术、全身状况以及医源性损伤。重建技术包括自体移植、异体移植、合成材料以及局部皮瓣，但均未取得特别理想的效果。本病例报告描述了一名患者使用腓骨长肌腱移植进行伸肌机制重建的情况。一名74岁的活跃女性患者从农村地区被转诊至一家膝关节手术转诊医院，有左膝进行性骨关节炎病史，接受了全膝关节置换术。在术后首次随访时，她被诊断为伸肌机制断裂，并被转诊至我们机构，于术后六周入院。初步评估时，她表现出膝关节完全伸直困难和髌骨抬高受限。由于获取组织库和合成材料的途径有限，遂使用腓骨长肌腱自体移植进行伸肌机制重建。移植物使用锚钉和干涉螺钉固定，使髌骨轨迹稳定。术后，患者遵循康复方案，使用支具并逐渐进行负重和活动。术后一年，她表现出无需辅助的步态，无跛行，伸肌机制功能恢复，活动范围为0至120度。已有多种技术用于全膝关节置换术后髌腱重建，但结果仍不尽人意。大多数技术使用异体移植，虽然有一定效果，但可能导致残留缺陷并需要使用助行器。合成材料越来越受欢迎，但面临成本和组织反应等挑战。使用自体移植，如腓骨长肌腱，因其坚固性和适应性而显示出前景。本报告突出了一例使用腓骨长肌腱成功进行伸肌机制重建的病例。腓骨长肌腱移植为全膝关节置换术后伸肌机制重建提供了一种可行的替代方案：可降低成本、减少组织排斥和交叉感染风险，并便于早期康复。
