The management of extensor mechanism complications in total knee arthroplasty

AAOS exhibit selection

Denis Nam, Matthew Abdel, Michael B. Cross, Lauren E. LaMont, Keith R. Reinhardt, Benjamin A. McArthur, David J. Mayman, Arlen D. Hanssen, Thomas P. Sculco

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Complications involving the knee extensor mechanism and patellofemoral joint occur in 1% to 12% of patients following total knee arthroplasty and have major negative effects on patient outcomes and satisfaction. The surgeon must be aware of intraoperative, postoperative, and patient-related factors that can increase the rate of these problems. This review focuses on six of the most commonly encountered problems: patellar tendon disruption, quadriceps tendon rupture, patellar crepitus and soft-tissue impingement, periprosthetic patellar fracture, patellofemoral instability, and osteonecrosis of the patella. The goals of this report are to (1) review the relevant anatomy of the knee extensor mechanism, (2) present risk factors that may lead to extensor mechanism complications, (3) provide a diagnostic and treatment algorithm for each of the aforementioned problems, and (4) review the specific surgical techniques of Achilles tendon allograft reconstruction and synthetic mesh augmentation. Extensor mechanism disorders following total knee arthroplasty remain difficult to manage effectively. Although various surgical techniques have been used, the results in patients with a prior total knee arthroplasty are inferior to the results in the young adult without such a prior procedure. Surgical attempts at restoration of the knee extensor mechanism are usually warranted; however, the outcomes of treatment of these complications are often poor, and management of patient expectations is important.

Original languageEnglish (US)
JournalJournal of Bone and Joint Surgery - Series A
Volume96
Issue number6
DOIs
StatePublished - Mar 19 2014

Fingerprint

Knee Replacement Arthroplasties
Knee
Patellar Ligament
Periprosthetic Fractures
Patellofemoral Joint
Achilles Tendon
Osteonecrosis
Patella
Patient Satisfaction
Allografts
Rupture
Young Adult
Anatomy
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

The management of extensor mechanism complications in total knee arthroplasty : AAOS exhibit selection. / Nam, Denis; Abdel, Matthew; Cross, Michael B.; LaMont, Lauren E.; Reinhardt, Keith R.; McArthur, Benjamin A.; Mayman, David J.; Hanssen, Arlen D.; Sculco, Thomas P.

In: Journal of Bone and Joint Surgery - Series A, Vol. 96, No. 6, 19.03.2014.

Research output: Contribution to journalArticle

Nam, Denis ; Abdel, Matthew ; Cross, Michael B. ; LaMont, Lauren E. ; Reinhardt, Keith R. ; McArthur, Benjamin A. ; Mayman, David J. ; Hanssen, Arlen D. ; Sculco, Thomas P. / The management of extensor mechanism complications in total knee arthroplasty : AAOS exhibit selection. In: Journal of Bone and Joint Surgery - Series A. 2014 ; Vol. 96, No. 6.
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