Verma Gopalkrishna G, Sultan Jawad, Nyunt Kan, Ismail Mobeen
Trauma and Orthopaedics, Manchester University NHS Foundation Trust, Manchester, GBR.
Trauma and Orthopaedics, Manchester Univeristy NHS Foundation Trust, Manchester, GBR.
Cureus. 2025 Apr 20;17(4):e82633. doi: 10.7759/cureus.82633. eCollection 2025 Apr.
Ruptures of the knee extensor apparatus in elderly individuals or following total knee replacement present a significant functional limitation and surgical challenge. The Leeds-Keio ligament, a synthetic graft, has been historically used for reconstruction but has seen declining popularity with advancements in biological grafts. This study revisits the application of the Leeds-Keio ligament in managing chronic and complex extensor mechanism ruptures. It is a retrospective review of five patients (mean age 73.6 years) who underwent surgical reconstruction of the ruptured patella or quadriceps tendons with the Leeds-Keio ligament between 2022 and 2025. The surgical technique involved a figure-of-eight configuration to bridge or augment the repair. The postoperative protocol included initial immobilisation followed by a progressive rehabilitation program. All patients achieved satisfactory functional recovery with independent mobilisation at the latest follow-up, with some exhibiting mild residual extension lag. The diverse presentations included one case with a chronic 10 cm gap quadriceps tendon rupture that required quadriceps V-Y plasty and bridging with Leeds-Keio ligament. Three cases with patella tendon ruptures after total knee arthroplasty (TKA) had patella tendon reconstruction with the Leeds-Keio ligament, and notably, two TKA dislocations required revision to a hinged knee prosthesis for stability. Another case involved a re-ruptured primary patella tendon repair four weeks post surgery that needed reconstruction with a Leeds-Keio ligament. No major complications, such as deep infection or graft failure, were observed in this small series. The Leeds-Keio ligament may be a viable option for reconstructing complex chronic patella and quadriceps tendon ruptures in elderly patients, including revision scenarios and those with concomitant TKA complications, providing satisfactory early functional outcomes. Careful patient selection and individualised treatment strategies are essential to optimise outcomes.
老年个体或全膝关节置换术后出现的膝伸肌装置断裂会导致严重的功能受限，并带来手术挑战。利兹-庆应韧带是一种合成移植物，过去一直用于重建，但随着生物移植物的发展，其受欢迎程度有所下降。本研究重新审视了利兹-庆应韧带在处理慢性和复杂伸肌机制断裂中的应用。这是一项对五名患者（平均年龄73.6岁）的回顾性研究，这些患者在2022年至2025年间接受了使用利兹-庆应韧带对破裂的髌腱或股四头肌肌腱进行手术重建。手术技术采用8字形构型来桥接或加强修复。术后方案包括初期固定，随后是逐步的康复计划。所有患者在最近一次随访时均实现了满意的功能恢复，能够独立活动，部分患者表现出轻度的残留伸展滞后。不同的病例包括一例慢性股四头肌肌腱10厘米间隙断裂，需要进行股四头肌V-Y成形术并用利兹-庆应韧带桥接。三例全膝关节置换术（TKA）后髌腱断裂的患者采用利兹-庆应韧带进行髌腱重建，值得注意的是，两例TKA脱位需要翻修为铰链式膝关节假体以确保稳定性。另一例涉及术后四周原发性髌腱修复再断裂，需要用利兹-庆应韧带进行重建。在这个小系列研究中未观察到重大并发症，如深部感染或移植物失败。利兹-庆应韧带可能是老年患者重建复杂慢性髌腱和股四头肌肌腱断裂的可行选择，包括翻修情况以及伴有TKA并发症的患者，可提供满意的早期功能结果。仔细的患者选择和个体化治疗策略对于优化结果至关重要。
