title: Survivorship of Extensor Mechanism Allograft Reconstruction After Total Knee Arthroplasty.
abstract: Extensor mechanism disruption remains a devastating complication after total knee arthroplasty. The purpose of this study is to describe the outcomes of extensor mechanism allograft (EMA) reconstruction in a large single-center case series.
  
  
  
  Consecutive patients with a previous total knee arthroplasty undergoing extensor mechanism reconstruction using a fresh-frozen EMA tensioned in full extension were identified retrospectively from single-center institutional database (N = 25 patients, 26 knees; mean follow-up 68 months [range 22-113 months]). The primary outcome was initial allograft failure, defined as removal of the allograft or extensor lag >30 degrees at most recent follow-up.
  
  
  
  Sixty-nine percent (18/26) of knees had retained their initial allograft reconstruction at their latest follow-up despite reoperation rates of 58% (15/26). A younger age was significantly associated with failure of the initial allograft reconstruction. Knee Society Scores increased from 101 (38 standard deviation [SD]) to 116 (40 SD) at most recent follow-up for the group as a whole (P = .4). Patients undergoing a reoperation for any cause had lower Knee Society Scores (101 [SD 38] vs 138 [SD 32], respectively; P = .04) at most recent follow-up.
  
  
  
  EMA reconstruction shows adequate overall intermediate-term survival; however, reoperation rates were high and associated with worse functional outcomes.
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Ricciardi
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Oi
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: Myra
authors.initials: M
authors.lastname: Trivellas
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, New York.
authors.forename: Yuo-Yu
authors.initials: YY
authors.lastname: Lee
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: A G
authors.initials: AG
authors.lastname: Della Valle
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Westrich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: extensor mechanism allograft; patellar tendon rupture; periprosthetic patellar fracture; quadriceps tendon rupture; revision total knee arthroplasty