Munzinger Extensor mechanism repair in total knee ... · Extensor mechanism repair in total knee...
Transcript of 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
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GELENKZENTRUM ZÜRICHProblems
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GELENKZENTRUM ZÜRICHWhich pathology?
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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
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GELENKZENTRUM ZÜRICHLiterature II Burnett JBJS 2004
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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
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GELENKZENTRUM ZÜRICHZones of pathology
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GELENKZENTRUM ZÜRICHAcute Rupture refix. & augmentation
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GELENKZENTRUM ZÜRICHQT-recon with pedicled Fascia lata I
+ Extensive release of the quadriceps
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GELENKZENTRUM ZÜRICHQT-recon Facia lata II
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GELENKZENTRUM ZÜRICHQT-recon Fascia lata III
1.5 a FUVAS 0Ø Quadriceps:Right / left52.5 cm vs 50cm
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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?
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GELENKZENTRUM ZÜRICHRecon II vasc. M. gastrocnemius
Jaureguito JW, J Bone Joint Surg 1997
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GELENKZENTRUM ZÜRICHRecon II vasc. M. gastrocnemius
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GELENKZENTRUM ZÜRICHRecon II vasc. M. gastrocnemius
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GELENKZENTRUM ZÜRICHPatellar tendon rupture
With contraction
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GELENKZENTRUM ZÜRICHRecon of patellar tendon rupture
Reconstructing the anatomical length of the tendon requires orthopaedic skill!
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GELENKZENTRUM ZÜRICHRecon. QT-rupture
Prognostic factors
• Delay since rupture
• Number of previous surgery (scarred tissue)
• Quadriceps atrophy and retraction +++
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GELENKZENTRUM ZÜRICHPatella recon with illiac crest autograft
5 Cases
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GELENKZENTRUM ZÜRICHTechnique illiac crest “sandwich”
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GELENKZENTRUM ZÜRICHRadiological result illiac crest
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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
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GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft I
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GELENKZENTRUM ZÜRICHAugmentation LARS Band
Polyester Ligament 40x5cm
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GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft II
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GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
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GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
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GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
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GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
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GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
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GELENKZENTRUM ZÜRICHRecon Ext. mech. allograft III
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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
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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