Neitzke Colin C, Borsinger Tracy M, Chandi Sonia K, Gausden Elizabeth B, Sculco Peter K, Chalmers Brian P
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, Virginia.
J Arthroplasty. 2025 Apr;40(4):1040-1047.e1. doi: 10.1016/j.arth.2024.10.004. Epub 2024 Oct 9.
Extensor mechanism disruption is a devastating complication following total knee arthroplasty (TKA). Despite its morbidity, there is no consensus regarding the optimal treatment strategy. We aimed to determine the survivorship, clinical outcomes, and improvement in patient-reported outcome measures after primary repair of acute extensor mechanism disruptions following primary or revision TKA.
A retrospective review identified 41 acute extensor mechanism disruptions (33 primary TKAs and eight revision TKAs) from 2015 to 2021. The study group was 56% women, the mean body mass index was 33, the mean age was 66 years, and the mean follow-up was 3 years. Extensor mechanism disruption occurred at the patellar tendon (n = 17), quadriceps tendon (n = 15), and patella (n = 9) at a mean of 10 months following TKA. Surgical management was primary repair (n = 30) or primary repair with augmentation (allograft or autograft) (n = 11). Kaplan-Meier analysis estimated survivorship.
The 2-year survivorship free from all-cause reoperation was 72 and 23% following primary and revision TKA, respectively (P = 0.013). The 2-year survivorship free from all-cause reoperation was 66% for primary repair versus 61% for primary repair with augmentation (P = 0.95). There were 17 (41%) patients who underwent reoperation, most commonly for rerupture (n = 4) in two primary repairs and two primary repairs with augmentation (P = 0.288). Revision TKA (P = 0.049) and increased time from disruption to repair (P = 0.039) were risk factors for reoperation. Neither did the mean extensor lag significantly improve nor did patients see improvement in their patient-reported outcome measures.
After primary and revision TKA, acute extensor mechanism disruption treated with primary repair with or without augmentation had very poor early survivorship free from all-cause reoperation. Patients should be counseled appropriately, and alternative surgical techniques should be considered.
伸肌机制破坏是全膝关节置换术（TKA）后一种严重的并发症。尽管其发病率较高，但关于最佳治疗策略尚无共识。我们旨在确定初次或翻修TKA后急性伸肌机制破坏初次修复后的生存率、临床结局以及患者报告结局指标的改善情况。
一项回顾性研究确定了2015年至2021年期间的41例急性伸肌机制破坏病例（33例初次TKA和8例翻修TKA）。研究组中女性占56%，平均体重指数为33，平均年龄为66岁，平均随访时间为3年。伸肌机制破坏发生在髌腱（n = 17）、股四头肌肌腱（n = 15）和髌骨（n = 9），平均发生在TKA术后10个月。手术治疗为初次修复（n = 30）或初次修复联合增强（同种异体移植物或自体移植物）（n = 11）。采用Kaplan-Meier分析估计生存率。
初次和翻修TKA后2年无全因再次手术的生存率分别为72%和23%（P = 0.013）。初次修复后2年无全因再次手术的生存率为66%，初次修复联合增强为61%（P = 0.95）。有17例（41%）患者接受了再次手术，最常见的原因是再次断裂（n = 4），分别发生在2例初次修复和2例初次修复联合增强的病例中（P = 0.288）。翻修TKA（P = 0.049）和从破坏到修复的时间增加（P = 0.039）是再次手术的危险因素。平均伸肌滞后既没有显著改善，患者报告结局指标也没有改善。
初次和翻修TKA后，采用初次修复联合或不联合增强治疗急性伸肌机制破坏，早期无全因再次手术的生存率非常低。应给予患者适当的咨询，并考虑采用其他手术技术。
