Reconstruction Of Extensor Mechanism Research Articles

Outcomes of rotating versus pure hinge knee arthroplasty in the setting of one-stage exchange for periprosthetic joint infection.

Rotating or pure hinge knee prostheses are often used in case of periprosthetic joint infection (PJI). Five-year survival data of rotating hinge implants ranging from 52 to 90%, whereas pure hinge data are sparse. This study describes the results of both hinge knee prostheses after one-stage septic exchange. One hundred sixty-seven one-stage septic exchanges of a primary unconstrained total knee arthroplasty (TKA) to a cemented hinge prosthesis (117 rotating and 50 pure hinge TKAs) performed between 2008 and 2017 were retrospectively reviewed. Exclusion criteria were stem extensions or augments used in primary TKA, history of extensor mechanism reconstruction, and a follow-up less than twoyears after surgery. Rates of reinfection, mechanical failures, and all-cause revision-free survival data were documented. At fiveyears, the all-cause revision-free survival was 77% (95% CI 69 to 82). Thirty-one patients (19%) had further revision for aseptic reasons. In the rotating hinge group, the mechanical failure rate was more than twice as high as in the pure hinge group (13% vs 6%), significantly influenced by higher body weight. At a mean follow-up of 6.7years, 21 (13%) patients had a reinfection and underwent a further surgery. Reinfection rates did not differ between the two groups. The use of hinge TKA in the revision of PJI shows favourable fiveyear infection-free and all-cause revision-free survival rates of 91% and 77%, respectively. Our study showed poorer results of the rotating hinge design. These results may help surgeons to choose proper implants in case of septic knee revision.

Soft Tissue Reconstruction of the Knee Extensor Mechanism with Free Flaps: A 7-Year Institutional Experience

Soft Tissue Reconstruction of the Knee Extensor Mechanism with Free Flaps: A 7-Year Institutional Experience

Extensor Mechanism Reconstruction Using Achilles Tendon Allograft With Suture Tape Augmentation

The management of chronic extensor mechanism injuries represents a significant challenge for orthopaedic surgeons, with numerous options for graft choice and fixation construct, but no clear consensus on which technique achieves optimal outcomes. Although there is little published data regarding outcomes of different fixation methods, small case series have demonstrated modest success using Achilles tendon bone block allografts and transverse patellar screw fixation. In this technical note, we describe a surgical technique for the treatment of a chronic inferior pole patella fracture, with extensor mechanism reconstruction using an Achilles tendon allograft with suture tape augmentation. Our technique describes the use of vertical cannulated screws in the patella for passing tape augmentation sutures, increased construct security by suturing of the Achilles graft directly to the quadriceps tendon, and the use of a post screw in the proximal tibia for suture tape augmentation.

CORR Insights®: Allograft or Synthetic Mesh Extensor Mechanism Reconstruction After TKA Carries a High Risk of Infection, Revision, and Extensor Lag.

CORR Insights®: Allograft or Synthetic Mesh Extensor Mechanism Reconstruction After TKA Carries a High Risk of Infection, Revision, and Extensor Lag.

Limited Durability of Extensor Mechanism Reconstruction Following Total Knee Arthroplasty: Mesh and Allograft Show Equivalent Outcomes at Five-Year Follow-Up

BackgroundExtensor mechanism disruption is a challenging complication following total knee arthroplasty. The purpose of this study was to compare outcomes between patients who received mesh versus allograft extensor mechanism reconstruction. MethodsAll patients who underwent extensor mechanism reconstruction at a single institution were screened. Demographic and surgical variables were recorded, including technique (ie, synthetic mesh versus allograft reconstruction). Patients were assessed for preoperative and postoperative extensor lag, revision, and duration of follow-up. Analyses, including Kaplan-Meier survivorships, were performed to compare mesh to allograft reconstruction. In total, 50 extensor mechanism reconstructions (30 mesh and 20 allograft) were conducted between January 1st, 2001, and December 31st, 2022. ResultsThere were no differences between the cohorts with respect to revision (26.7 [8 of 30] versus 35.0% [7 of 20], P = .680) or failure defined as above knee amputation or fusion (6.7 [2 of 30] versus 5.0% [1 of 20], P = .808). There were also no differences in time to reoperation (average 27 months [range, 6.7 to 58.8] versus 29 months [range, 1.2 to 84.9], P = .910) or in postoperative extensor lag among patients who did not undergo a reoperation (13 [0 to 50] versus 11° [0 to 30], P = .921). The estimated 5-year Kaplan-Meier survival with extensor mechanism revision as the endpoint was similar between the 2 groups (52.1, 95% confidence interval [CI] = 25.4 to 73.3 versus 55.0%, 95% CI = 23.0 to 78.4%, P = .990). ConclusionsThe purpose of this study was to present the findings of a large cohort of patients who required extensor mechanism reconstruction. Regardless of the reconstruction type, the 5-year outcomes of patients requiring extensor mechanism reconstruction are suboptimal.

Allograft or Synthetic Mesh Extensor Mechanism Reconstruction After TKA Carries a High Risk of Infection, Revision, and Extensor Lag.

Extensor mechanism disruption is a devastating complication after TKA. Extensor mechanism reconstruction can be performed using an allograft or synthetic mesh. Recent studies have disagreed about the durability of these reconstructions. Evaluating a larger series of reconstructions that use current popular techniques and principles provides information to guide patient and surgeon expectations while bringing to light the potential fate of patients who experience an infection postoperatively. (1) What was the 5-year survival free of repeat revision surgery or persistent extensor lag of more than 30° after allograft or synthetic mesh reconstruction of extensor mechanism disruptions after TKA, and did this differ between techniques? (2) What was the 5-year survival free of infection after allograft or mesh reconstruction, and what proportion of those patients experienced a secondary severe complication (arthrodesis or amputation)? Between April 2008 and December 2020, 123 patients underwent extensor mechanism reconstruction after TKA at one center. Of those, 37% (45) were lost to follow-up before 2 years, had not been seen in the past 5 years, did not reach a study endpoint (repeat revision or extensor lag > 30°) before that time, or underwent primary repair and thus could not be analyzed, leaving 63% (78) for analysis here. During the study period, we considered extensor mechanism surgery when acute or chronic disruption of the patellar or quadriceps tendon was present or there was a fracture of the patella resulting in extensor lag. The decision to use either mesh or an allograft largely depended on surgeon experience and familiarity with either technique. We collected patient demographics, operative details (location of disruption and presence of a hinged prosthesis), subsequent periprosthetic joint infection (PJI), and postoperative SF-12 and Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, scores. We used Kaplan-Meier survivorship analysis, with endpoints of extensor lag more than 30° or revision of the reconstruction and PJI. The mean follow-up duration was 5.3 ± 3.2 years. Survivorship free from revision or recurrent extensor lag was 54% (95% CI 44% to 66%) at 5 years. There was no difference between those undergoing reconstruction with allografts and those with mesh in terms of survivorship free from those endpoints at that timepoint (52% [95% CI 40% to 68%] versus 57% [95 CI% 41 to 78%]; p = 0.99). Survivorship free from PJI was 81% (95% CI 73% to 90%) at 2 years. There was no difference between those with allografts and those with mesh in terms of survivorship free from PJI at that timepoint (79% [95% CI 69% to 92%] versus 83% [95% CI 71% to 98%]; p = 0.75). Of the 17 patients who experienced PJI, four ultimately underwent arthrodesis and three more underwent transfemoral amputation. Allograft and synthetic mesh reconstructions commonly left patients with persistent limb dysfunction, while several patients had PJI and some underwent salvage procedures. Although improvements have been made with regard to treating extensor mechanism disruptions, patients and surgeons should be well aware of the potential adverse outcomes when determining management and use these findings to conduct risk-benefit analyses. There is a need for future studies to identify protocols that improve the durability of reconstructions and to determine whether interventions such as prolonged prophylactic antibiotic therapy have a role in minimizing the risk of PJI. Level III, therapeutic study.

The Utility of Flap Coverage for Limb Salvage in Patients With Severe Prosthetic Joint Infections of the Knee Requiring Implant Exchange.

Prosthetic joint infection (PJI) is a challenging complication of knee arthroplasty, which can require amputation in severe cases. This study analyzes the utility of flap reconstruction in PJIs requiring hardware removal and extensive soft tissue debridement. This was a retrospective analysis of patients who were treated according to a multistage extremity salvage protocol between 2018 and 2022. The protocol involved at least 3 planned surgeries including (1) hardware removal with antibiotic spacer placement and soft tissue debridement, (2) spacer exchange with flap coverage, and (3) hardware reimplantation with simultaneous or delayed extensor mechanism reconstruction. All patients had large periprosthetic tissue defects that would necessitate an amputation if not reconstructed. Primary outcomes were extremity salvage and successful defect coverage. Fifty-two patients (25 female) underwent 62 reconstructions (52 primary, 10 salvage). Flap techniques included pedicled muscular (n = 32), fasciocutaneous (n = 4), combined muscular and fasciocutaneous (n = 2), and free flaps (n = 24). Overall rate of successful defect coverage was 95% (98% in primary and 80% in salvage reconstructions). At a median follow-up of 11 months, 41 patients completed the treatment protocol with a 68% (n = 28) extremity salvage rate (reimplantation arthroplasty, n = 15; permanent knee fusion, n = 13). On the multivariate model including demographic factors, defect size, and flap type, no single factor independently predicted limb salvage. Alongside intensive orthopedic surgical treatment, flap coverage may aid in extremity salvage in severe knee PJIs by reestablishing healthy soft tissue coverage and allowing reimplantation arthroplasty. We recommend a multispecialty approach including plastic surgeons for this challenging condition.

A flap graft technique for the reconstruction of extensor mechanism of the knee in a case of peri-articular synovial sarcoma managed by limb salvage

Synovial sarcoma is a malignant soft tissue tumour arising from the primitive mesenchymal cells which has a delayed progression has a slow progression and often mis-diagnosed. A fifty-two years old female presented with complaint of swelling, pain and inability to move her left knee for three years duration. Presented with recurrence for which Wide excision of the tumour, with reconstruction of knee using custom mega-prosthesis and extensor mechanism reconstruction was done. Patient had a good functional outcome and no recurrence.

Extensor Mechanism Disruption Remains a Challenging Problem

BackgroundExtensor mechanism disruption (EMD) following total knee arthroplasty (TKA) is a devastating problem commonly treated with allograft or synthetic reconstruction. Understanding of reconstruction success rates and patient recorded outcomes is lacking. MethodsPatients who have an EMD after TKA undergoing mesh or whole-extensor allograft reconstruction between 2011 and 2019, with minimum 2-year follow-up were reviewed at two tertiary care centers. Functional failure was defined as extensor lag >30 degrees, amputation, or fusion, as well as revision extensor mechanism reconstruction (EMR). Survivorship was assessed using Kaplan–Meier curves, and factors for success were determined with logistic regressions. ResultsOf fifty-six EMRs (49 patients), 50.0% (28/56) were functionally successful at 3.2 years of mean follow-up (range, 0.2 to 7.4). In situ survivorship of the reconstructions at 36 months was 75.0% (42 of 58). There were 50.0% (14 of 28) of functionally failed EMRs that retained their reconstruction at last follow-up. Mean extensor lag among successes and failures was 5.4 and 71.0° (P = .01), respectively. Mean Knee Injury and Osteoarthritis Outcome Score, Joint Replacement scores were 67.1 and 48.8 among successes and failures (P = .01). There were 64.0% (16 of 25) of successes and 1 of 19 failures that obtained a Knee Injury and Osteoarthritis Outcome Score, Joint Replacement score above the minimum patient-acceptable symptom state for TKA. Survivorship and success rates were similar between reconstruction methods (P = .86; P = .76). All-cause mortality was 8.2% (4 of 49), each with EMR failure prior to death. All-cause reoperation rate was 42.9% (24 of 56), with a 14.3% (8 of 56) rate of revision EMR and 10.7% (6 of 56) rate of above-knee-amputation or modular fusion. ConclusionsThis multicenter investigation of mesh or allograft EMR demonstrated modest functional success at 3.2 years. Complication and reoperation rates were high, regardless of EMR technique. Therefore, EMD after TKA remains problematic.

Allograft Extensor Mechanism Reconstruction in Salvage Revision Knee Arthroplasty: Surgical Technique.

Although extensor mechanism failure remains a catastrophic complication of knee arthroplasty, there are a number of contemporary techniques with reasonable outcomes that restore function. Chronic failures require advanced reconstruction techniques. Similar complication rates have been reported for the use of autografts, allografts, or mesh reconstructions. Here, we describe our surgical technique in allograft extensor mechanism reconstruction for chronic failures in salvage revision knee arthroplasty using a complete extensor mechanism allograft with a modified proximal fixation and case demonstrations.

Satisfactory outcomes of patellar tendon reconstruction using achilles’ tendon allograft with bone block after infected total knee arthroplasty

PurposeExtensor mechanism disruption is an uncommon and devastating complication after total knee arthroplasty. It negatively affects patients’ quality of life and leads to significant functional limitations and the inability to stand and walk. The purpose of the present study was to evaluate the outcomes of the extensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty. It was hypothesized that it is a safe procedure and that patients will present good clinical and functional results.MethodsTen patients treated for infra-patellar extensor mechanism disruption after infected total knee arthroplasty were prospectively followed for two years. The mean age of patients was 70.8 (range 55–85), with a median BMI of 28.72 ± 2.2 kg/m2. All patients underwent reconstruction using a fresh frozen Achilles tendon allograft. Preoperative and postoperative evaluation included knee-related clinical and functional assessment based on objective and subjective scores, including the knee flexion, the extension lag, the Knee Society Score (KSS) clinical and functional, and the visual analog scale (VAS) for pain at 12 and 24 months. Radiological evaluation was also performed using the Caton-Deschamps index. Reported complications were also recorded.ResultsClinical and functional outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as follows: Knee flexion was improved from 66° ± 4.8 to 99.7° ± 3.9, and the extension lag was decreased from 28.3° ± 4.4 to 9° ± 2.7. The mean KSS clinical and functional were also improved from 22.6 ± 7.9 to 73.4 ± 3.9 and from 10 ± 13.8 to 55 ± 13.8, respectively. The VAS for pain was decreased from 8.1 ± 1.2 to 1.9 ± 1.2. The Caton-Deschamps index demonstrated a tendency to patella Alta. Two treatment failures were recorded, one patellar dislocation and one re-rupture revised to arthrodesis.ConclusionsExtensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty is an efficient and safe procedure for infra-patellar disruption. The present study’s findings demonstrate that most of the patients (80%) presented significant clinical and functional improvement at two-year follow-up.

Extensor mechanism reconstruction with allograft following total knee arthroplasty: a systematic review and meta-analysis of achilles tendon versus extensor mechanism allografts for isolated chronic patellar tendon ruptures.

Extensor mechanism rupture is a severe complication with an incidence of 0.1-2.5% after total knee arthroplasty (TKA). Achilles tendon allograft (ATA) and extensor mechanism allograft (EMA) in TKA surgery have yielded mixed clinical results. Our systematic review aims to identify the proportion of failure in extensor mechanism reconstruction after TKA using allograft and evaluate clinical and functional outcomes and the most common complications. Furthermore, we performed a meta-analysis among studies dealing with isolated patellar tendon ruptures to assess the failure rate, surgical complications, and clinical findings (extensor lag and knee range of motion) of extensor mechanism reconstruction using either ATA or EMA grafts. A systematic review of the literature was performed following the PRISMA guidelines, including the studies dealing with the use of EMA and ATA for extensor mechanism rupture following TKA. Coleman Methodology Score and the MINORS score were used to assess the quality of the studies. A meta-analysis was performed to evaluate the failure rate, complications, and clinical findings (extensor lag and knee range of motion) of the ATA and EMA treatments in isolated patellar tendon ruptures. A total of 238 patients (245 knees), with a mean age ranging from 54 to 74years, who underwent extensor mechanism reconstruction with an allograft were identified in the 18 included studies. We analysed 166 patellar tendon ruptures, 29 quadriceps tendon ruptures, and 29 patellar fractures in the analysis. A chronic injury was described in the majority of included cases. ATA and whole EMA were used in 89 patients (92 knees) and 149 patients (153 knees), respectively. The overall failure percentage was 23%, while EMA and ATA were 23 and 24%. The most common complication was extensor lag (≥ 20°). The overall incidence of postoperative infection was 7%. Eleven of 14 included papers reported more than 100° of the mean postoperative knee flexion. The percentage of patients requiring walking aids is 55 and 34.5% in ATA and EMA, respectively. The failure outcome after extensor mechanism reconstruction in isolated patellar tendon ruptures was 27%, with no statistical difference between EMA and ATA in terms of failure rate and clinical outcomes. Extensor mechanism reconstruction with allograft represents a valid treatment option in patients with acute or chronic rupture following total knee arthroplasty. Persistent extensor lag represents the most common complication. EMA is associated with a lower frequency of patients requiring walking aids at last follow-up, although it has similar clinical and functional outcomes to ATA. In patellar tendon ruptures, ATA has a comparable success rate with EMA. Level IV, therapeutic study. PROSPERO 2019 CRD42019141574.

Composite TFL flap for reconstruction of knee extension, a case report

Deficiency of the knee extensor mechanism may result from severe injury, loss of structural tissues after tumor resection or complications due to joint replacement surgery. Current treatment options for extensive defects are limited, yielding unsatisfactory functional results and high complication rates. Here, we propose for the first time the use of a free vascularized tissue transfer to reconstruct the extensor mechanism of the knee. The tensor fasciae latae free flap provides sufficient vascularized muscle and fascia as well as a large skin paddle. We present the anatomical concept and long-term outcomes in a patient. • Use of a free, vascularized TFL flap for reconstruction of the knee extensor mechanism is feasible. • A musculotendinous flap can be used to replace the distal quadriceps and patellar tendon, including a skin island if necessary. • Our patient achieved stable ambulation and ability to perform sports such as running or cycling.

Extensor mechanism reconstruction and joint preservation surgery following a tibial tuberosity fracture in giant cell tumor of bone: A case report.

Introduction and importancePathologic fractures of the tibial tuberosity secondary to giant cell tumor of bone are rare injuries. While there are several well-described methods in the literature to reattach the tibial tuberosity, these techniques rely on good quality bone. However, in the presence of diseased and weak bone, additional factors have to be considered.Case presentationA 47-year-old man with a Giant Cell Tumor of bone affecting the proximal tibia presented with a displaced avulsion fracture of the tibial tuberosity. The patient underwent surgical curettage, bone grafting and osteosynthesis with reattachment of the tibial tuberosity. Eighteen months after surgery there is no evidence of tumor recurrence, and despite mild knee pain and a limited range of movement, the patient has returned to work.Clinical discussionThe extensor mechanism was repaired by first reinforcing the tuberosity fragment with an autograft before reattaching it using a tension band FibreWire ® suture. Without access to a tumor endoprosthesis we used a joint sparing approach to treat the Giant Cell Tumor.ConclusionPatients with dual-pathology present technical challenges in repairing the extensor mechanism and treating the underlying condition. Surgeons must address competing priorities in a holistic, patient-centred approach consistent with their working environment.

Motor Response of Mirror Therapy after Reconstruction of Extensor Mechanism Caused by Glass Cut Injury

Treatment by mirror therapy (MT) restores motion in injured limbs without invasive procedures. This process is widely accepted for rehabilitating patients with phantom limb pain, stroke victims, or patients who need therapy after nerve damage. The procedure is specifically useful in restoring motion to the hand after surgical repairs to the extensor muscle and tendons. Mirror therapy rewires the brain by making the restored limb remember hand motions by observing the motions of a normal hand. The concept of a mirror image is that the movement of the uninjured arm forms the illusion of the same movement in the affected arm. Efforts to repeat hand movements elicit the same reaction in the affected hand in what is referred to as Hebbian learning. This case study evaluated MT’s effectiveness in motion restoration after a glass injury. This case study showed restoration of normal hand motions in a patient following surgery to repair a glass cut to the arm. Surgery repaired the lacerated extensor tendon and radial nerve. The muscle belly was repaired, and a graft fixed the nerve gap. Once the arm healed, the patient underwent rehabilitation in mirror therapy to restore normal function in his hand. After conducting mirror therapy, the pain was eliminated, and the patient restored normal function of moving the hand and finger extension. In addition, the therapy could be conducted at home without needing a professional. The effectiveness of mirror therapy was seen in the functional restoration of hand and finger movement. The process is also less complicated as it can be performed at home.

A case series of traumatic extensor mechanism rupture managed by extensor mechanism reconstruction using Z-plasty of Quadriceps tendon and autologus tendon graft augmentation

Extensor Mechanism Injuries of knee are rare. True incidence of traumatic Patellar tendon rupture is unknown but is third in sequence after neglected Patellar fracture and quadriceps tears. Often the diagnosis or treatment of such cases are delayed, hence the biggest challenge here is to the need to bridge the gap caused by the contracted quadriceps muscle or the patellar tendon. i.e. Patella baja in quadriceps rupture and Patella alta in patellar tendon rupture. The goal of treatment is to bring down the displaced fragment and maintain its position by lengthening the contracted tissue and restore the Extensor mechanism through a bone to bone or a tendon to bone repair. We have treated 2 cases of delayed presentation of Extensor mechanism Injuries. The first case was a 40-Y-M with patella non union and the second case a 35-Y-M was a Left tibial plateau fracture (type -2) with ruptured Patellar tendon and associated ligamentous injuries. Both the patient were managed by reconstructing the Extensor mechanism.

Reconstruction of the extensor mechanism augmented with reverse transferred iliotibial band after proximal tibia tumor resection and mega-prosthetic replacement

BackgroundThe optimal procedure for functional reconstruction of the extensor mechanism after proximal tibia mega-prosthetic replacement remains unclear. MethodsSince 2006, 14 consecutive patients with aggressive bone tumors in the proximal tibia who underwent mega-prosthetic replacement were prospectively treated with reconstruction of the extensor mechanism using an ipsilateral iliotibial band. The surgical procedure consisted of wrapping the reversed iliotibial band around the tibia component, firmly suturing it to the remaining patellar tendon and tibialis anterior fascia, and covering it with a muscle flap. At the last follow up, the function was assessed based on extensor lag, active flexion of the knee, and Musculoskeletal Tumor Society score. Patellar height was measured with the Insall–Salvati ratio (ISR) preoperatively, postoperatively, and at the last follow up. ResultsAt the last follow up, the extensor lag and active flexion in 14 patients averaged 2.5° and 86°, respectively. Musculoskeletal Tumor Society score could be obtained in nine surviving patients at the last follow up and was a mean of 20.7 points. The mean ISR preoperatively, postoperatively, and at the last follow up was 1.04, 0.75, and 0.89, respectively. The extensor lag was not associated with the ISR value at any points, while reduced active flexion significantly correlated with a low ISR at the last follow up (P = 0.015). Four patients underwent additional surgeries due to postoperative infection, but none required eventual revision or amputation. ConclusionThe extensor mechanism reconstruction with the reverse transferred iliotibial band for mega-prosthetic replacement after proximal tibia resection yielded reliable outcomes with functional benefit to stabilize active knee extension.

Pedicled fibular transfer for biologic knee extensor tendon reinsertion following proximal tibial resection in pediatric osteosarcoma: Long-term outcomes.

Proximal tibial sarcoma resections result in a reconstructive challenge, necessitating joint and extensor mechanism reconstruction. The gait and functional outcomes for children reconstructed with a combination of megaprosthesis and pedicled fibular flap for extensor mechanism reconstruction, are presented. Four patients, aged 11-18 years old, were available for comprehensive analysis. The proximal tibial osteosarcoma was resected, and the reconstructive technique involved a megaprosthesis for the knee joint, used in combination with a pedicled fibula flap as a biologic structure for reinsertion of the knee extensor mechanism. Outcomes were measured with three-dimensional gait analysis and patient questionnaires. Minor postoperative wound issues occurred in some patients, requiring debridement with skin grafting. One patient fractured their transferred fibula, requiring fixation. The follow up period ranged from 1.7 to 24 years postoperatively. The longevity and quality of reconstructions were strong, measured by both objective and patient-reported outcomes. All patients reported independent walking >500m in the Functional Mobility Scale and rated their walking as a nine or 10 (out of 10) on the Functional Assessment Questionnaire. Knee society scoring revealed overall satisfaction rate of 75-80%. No patients required gait aids. The gait profile analysis revealed effective gait patterns, with patterns deviating 5.4-7° from "typical gait." Deviations >6.5° are considered abnormal. The long-term results of combining a megaprosthesis with a pedicled fibula flap for extensor reinsertion, revealed a high level of independent function. The patients performed well, without the need for aids, and gait study evidence of minimal gait deviations.

English

BACKGROUND Patella is the largest sesamoid bone in the human body, which plays important role in biomechanics of the knee. It is one of the few bones without periosteal surrounding. Fracture of patella constitute almost 1 % of all skeletal injuries with high prevalence in age group of 20 - 50 years. Fracture of patella may be due to direct/indirect force. Direct force often results in displaced or comminuted fractures. Fracture caused by indirect mechanisms result from a violent contraction of quadriceps muscle with knee flexion. Most of the patella fractures are combination of direct and indirect forces. Most significant effects of fracture patella are loss of continuity of the extensor mechanism of the knee and potential incongruity of the patellofemoral articulation. Treatment option includes reconstruction of entire patella or partial patellectomy and tendon repair or total patellectomy with extensor mechanism repair. Advancement in surgical techniques treatment option being shifted from patellectomy to reconstruction, preservation, and restoration of extensor mechanism. The purpose of this study was to evaluate the functional outcome of transverse fracture of patella treated with tension band wiring. METHODS This prospective study was done among 35 patients, who sustained transverse patellar fractures and were admitted in Department of Orthopaedics, Government Medical College, Thrissur from 01 October 2019 to 01 October 2020. Functional and clinical outcome was assessed at 2 weeks, 4 weeks, 3 months, and 6 months using Goodfellow’s scoring system. RESULTS The mean age was found to be 43 years, males were predominant. In 62.86 % of study population, right side was involved. In 63 % of study population, fracture occurred due to road traffic accidents (RTA). Average union was achieved in 11 - 13 weeks. Functional outcome was excellent to good in 85.71 % of study population. CONCLUSIONS Transverse fracture of patella can be treated with modified tension band wiring without much complications and early weight bearing is possible with good functional outcome. KEYWORDS Transverse Fracture Patella, Prospective Study, Tension Band Wiring, Good Fellows Score

Functional and radiologic results of extensor mechanism reconstruction methods following proximal tibial modular endoprosthetic reconstructions: Direct versus medical textile augmented reattachment

BackgroundFollowing proximal tibial resection and modular endoprosthetic reconstruction, extensor mechanism can be reconstructed with different techniques. This study compares direct reattachment (DR) with medical textile augmented reattachment (MTAR) methods in terms of functional results and radiological results. Materials and methodsFifty-five patients (34 male, 21 female) operated between 1990 and 2015 with a minimum follow up of 24 months in a single center were evaluated retrospectively. The median age was 18 years (range: 9–64). The reconstruction was performed via MTAR (polypropylene mesh, Trevira) in 23 patients and DR in 32 patients. Incidence and degree of extension lag, degree of flexion and development of postoperative patella alta were evaluated at 3, 6 and 24 months. ResultsThe mean follow up was 78.5 months. Extension lag incidence at 24 months was 71.9% in the DR group compared with 43.5% in the MTAR group (P < 0.05).Theextensionlagratiosat 24 months in DR was 0–5° in 8.7% (n = 2), 6–10° in 21.7% (n = 5), 11–15° in 17.4% (n = 4) and > 15° in 52.2% (n = 12), respectively. Extension lag ratios at 24 months in MTAR were 0–5° in 12.5% (n = 4), 6–10° in 6.3% (n = 2), 11–15° in 6.3% (n = 2) and > 15° in 6.3% (n = 2). The mean MSTS score in DR group was 20.7 compared with 23.2 in the MTAR group (P = 0.008). ConclusionMTAR is associated with a lower incidence as well as a lower degree of extension lag. The flexion range and the incidence of patella alta are not statistically different between the groups. MSTS scores of MTAR group are significantly higher than DR group at 2-year follow up.