Extensor Mechanism Disruption After TKA: Allograft, Mesh Reconstructions, or Something Else?

A tough problem, with no great answers.

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Smart Practice: Neither allograft nor mesh reconstructions of extensor mechanism disruption after TKA worked well; either take your chances with one of those (and accept that they’ll probably fall short) or try something else, like a gastrocnemius flap.

What’s the Claim?

A large case series of patients having extensor mechanism disruptions after TKA treated with either allograft or mesh found dismayingly poor results despite using contemporary fixation techniques, tensioning the graft or mesh in full extension, and immobilizing the knee in extension for a suitably long period, namely:

  • Survivorship free from revision or recurrent >30° lag at five years was only 54% (95% CI 44% to 66%)
  • Survivorship free from PJI at two years was 81% (95% CI 73% to 90%); there was no difference between allograft and mesh in terms of revision, lag, or PJI
  • Seven of the 17 patients in this series who had PJI had either a fusion (four) or a transferal amputation (three)

How’s It Stack Up?