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Surgical management of TKA extensor mechanism rupture

Published in N°275 - June/July 2018
Article viewed 217 times

Surgical management of TKA extensor mechanism rupture

By Nicolaas C. Budhiparama (1), Sébastien Parratte, Michel Bonin, Sébastien Lustig in category TECHNIQUE
1) Nicolaas Institute of Constructive Orthopedic Research and Education Foundation, Jakarta, Indonesia

Extensor mechanism rupture is rare (<1% of patients) but is one of the most devastating complications after TKA procedures. It occurs more commonly occurs after surgery in chronic conditions (degenerated tissues conditions). Although less frequent, acute injury may occurs, usually during intraoperative exposure in stiff knees or during postoperative period (falling on a hyper flexed knee).

Introduction

Extensor mechanism rupture is rare (<1% of patients) but is one of the most devastating complications after TKA procedures [1]. It occurs more commonly occurs after surgery in chronic conditions (degenerated tissues conditions). Although less frequent, acute injury may occurs, usually during intraoperative exposure in stiff knees or during postoperative period (falling on a hyper flexed knee). Extensor mechanism injuries may be classified as supra patellar, patella and infra patellar, but the most challenging to treat is the infra patellar. Rupture of distal tendon and avulsion of the tibial tuberosity are also the most common forms of extensor mechanism injury.

Management of extensor mechanism injury range from conservative management to repair and/or reconstruction or arthrodesis. Conservative treatments with brace or cast immobilization are only reserved in patients who are contraindicated to undergo surgery since the outcome may result in impairment and morbidity. Surgery is mainly indicated especially in active person. In the literature, indications of surgical treatments varied between authors. For us, extensor lag more than 20° is a cut off point for surgical management.

Up till today, many techniques have been described, however, the prognosis usually...

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