title: Extensor mechanism reconstruction: a novel technique for bone patella allograft post partial patellectomy failure.
abstract: Extensor mechanism disruption, whether due to patella fracture or tendon rupture, generally occurs after low-energy trauma and frequently involves an indirect mechanism. When the fracture is comminuted and reconstruction is impossible, a partial or total patellectomy may be indicated. Although some authors advocate total patellectomy, partial patellectomy remains the standard treatment, especially for young and active patients. In the rare instance of a failed tendon repair after partial or total patellectomy, inadequate tissue is usually available for adequate restoration of the extensor mechanism. Extensor mechanism allograft, using the tibial tuberosity, patellar tendon, patella, and quadriceps tendon in continuity or the Achilles' tendon with calcaneal bone-block in continuity has been reported for extensor mechanism repair after total knee arthroplasty in patients who did not undergo patellectomy. We present a novel technique, using the bone patellar tendon bone allograft to reconstruct a posttraumatic defect of the extensor mechanism in a 28-year-old, active patient with a failed partial patellectomy following fracture of his patella. Union of the allograft was seen on x-ray after 4 months. After 6 months, the patient reached full range of motion and returned to his previous sporting activities.
authors.affiliation: Orthopedics division, Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Drexler
authors.forename: Nehemia
authors.initials: N
authors.lastname: Blumberg
authors.forename: Amir
authors.initials: A
authors.lastname: Haim
authors.forename: Ron
authors.initials: R
authors.lastname: Arbel
authors.forename: Guy
authors.initials: G
authors.lastname: Morag
mesh_terms: D000328:Adult; D050376:Bone-Patellar Tendon-Bone Grafting; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007103:Immobilization; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010329:Patella / Q000000981:diagnostic imaging / Q000601:surgery*; D017847:Patellar Ligament / Q000293:injuries*; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D014184:Transplantation, Homologous; D017211:Treatment Failure