Munzinger Extensor mechanism repair in total knee ... · Extensor mechanism repair in total knee...
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GELENKZENTRUM ZÜRICH Extensor mechanism repair in total knee arthroplasty Muscoloskeletal Conference Bern Dr. Urs Munzinger
Transcript of Munzinger Extensor mechanism repair in total knee ... · Extensor mechanism repair in total knee...
GELENKZENTRUM ZÜRICH
Extensor mechanism repair in total knee arthroplasty
Muscoloskeletal Conference Bern
Dr. Urs Munzinger
GELENKZENTRUM ZÜRICHProblems
GELENKZENTRUM ZÜRICHWhich pathology?
GELENKZENTRUM ZÜRICHLiterature Rosenberg JBJS 2012
• patellar or quadriceps tendon rupture• patella fracture • tubercle avulsion
occuring intra-operatively or post-operatively can be difficult to manage and is associated with a significant rate of failure and associated complication
GELENKZENTRUM ZÜRICHLiterature II Burnett JBJS 2004
GELENKZENTRUM ZÜRICHLiterature II Burnett JBJS 2004
• n=20• Check components – Rotational alignement!!! • Rule out infection!
• Tight tensioning in full extension leads to good clinical results• Mean extension lag 4°• No loss of flexion
GELENKZENTRUM ZÜRICHZones of pathology
GELENKZENTRUM ZÜRICHAcute Rupture refix. & augmentation
GELENKZENTRUM ZÜRICHQT-recon with pedicled Fascia lata I
+ Extensive release of the quadriceps
GELENKZENTRUM ZÜRICHQT-recon Facia lata II
GELENKZENTRUM ZÜRICHQT-recon Fascia lata III
1.5 a FUVAS 0Ø Quadriceps:Right / left52.5 cm vs 50cm
GELENKZENTRUM ZÜRICHPT-recon pedicled Achilles’ tendon
Vascularized Achilles’tendon as part of a medial gastrocnemius flap
Jaureguito JW, et al. J Bone Joint Surg 1997
First choice or only in case of failure with direct suture or tendon augmentation?
GELENKZENTRUM ZÜRICHRecon II vasc. M. gastrocnemius
Jaureguito JW, J Bone Joint Surg 1997
GELENKZENTRUM ZÜRICHRecon II vasc. M. gastrocnemius
GELENKZENTRUM ZÜRICHRecon II vasc. M. gastrocnemius
GELENKZENTRUM ZÜRICHPatellar tendon rupture
With contraction
GELENKZENTRUM ZÜRICHRecon of patellar tendon rupture
Reconstructing the anatomical length of the tendon requires orthopaedic skill!
GELENKZENTRUM ZÜRICHRecon. QT-rupture
Prognostic factors
• Delay since rupture
• Number of previous surgery (scarred tissue)
• Quadriceps atrophy and retraction +++
GELENKZENTRUM ZÜRICHPatella recon with illiac crest autograft
5 Cases
GELENKZENTRUM ZÜRICHTechnique illiac crest “sandwich”
GELENKZENTRUM ZÜRICHRadiological result illiac crest
GELENKZENTRUM ZÜRICHClinical results illiac crest
Mean preop / postop LCS Score (100 max) 48 to 92
Mean postop patella score (30 max) 27
All had excellent or good results 7 and 2
Follow up 21y
GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft I
GELENKZENTRUM ZÜRICHAugmentation LARS Band
Polyester Ligament 40x5cm
GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft II
GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
GELENKZENTRUM ZÜRICHRupture ext. apparatus & TKA
Risk factor: patellar resurfacingrheumatoid arthritis
Classical treatments:• Suture• Tendon augmentation• Allograft
Associated with high rate of re-rupture
Lynch AF, J Arthroplasty 1987, 2:135-140Leopold SS, J Bone Joint Surg 1999, 81A:1574-1579
GELENKZENTRUM ZÜRICHTreatment algorithm
Acute QT/PT ruptureAcute QT/PT rupture Chronic insufficencyChronic insufficency
Repair andbio. augmentation
Repair andbio. augmentation
Muscular‐tendinous flapMuscular‐
tendinous flap
Ext.mech. allograftExt.mech. allograft
Lynch AF, J Arthroplasty 1987, 2:135-140Leopold SS, J Bone Joint Surg 1999, 81A:1574-1579Rosenberg AG, J Bone Joint Surg 2012;94-B, Supple A:116–19
Cave:High rate of re-ruptureCave:High rate of re-rupture
Cave: Save –Tight tensioning is crucial!
Cave: Save –Tight tensioning is crucial!
+ Patella pathology+ Patella pathology
