[Reconstruction of the extensor tendons in revision total knee arthroplasty and tumor surgery].
Reconstruction of the extensor mechanism in extended revision after total knee replacement and tumor surgery remains a clinically relevant problem. Due to large tibial bone defects with resection of the extensor insertion area, the specific problem of patella ligament refixation frequently arises. Several biological approaches and augmentation techniques have been published. Most of these are associated with a high rate of revision surgery because of failed replacement of the extensor mechanism and unsatisfactory functional outcome. Surgical reconstruction of these tendon defects is complicated by the difficulty of completely neutralizing tensional force across the repair. To overcome this problem, methods have been developed to reinforce the reconstruction with overlapping flaps; in addition, artificial materials are being increasingly used for tension neutralization. These artificial strips need special fixation mechanisms on the tibial component and specific technical modifications of the prosthesis. The present study gives an overview of reconstruction modalities of the extensor mechanism and provides an improved technology for better reconstruction by using artificial strips combined with specific modifications of the tibial component.
Gerdesmeyer
L
L
Klinik für Orthopädie und Unfallchirurgie, Technische Universität, München. Gerdesmeyer@aol.com
Gollwitzer
H
H
Diehl
P
P
Burgkart
R
R
Steinhauser
E
E
D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D009369:Neoplasms / Q000150:complications / Q000601:surgery*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000009:adverse effects; D013708:Tendon Injuries / Q000209:etiology* / Q000601:surgery*