Patients who experienced catastrophic disruption of the extensor mechanism after primary and revision total knee arthroplasty had excellent functional outcomes and good survivorship when Marlex mesh was used in reconstruction with a step-wise surgical approach, according to results published in The Journal of Bone and Joint Surgery.
Matthew P. Abdel
“Extensor mechanism reconstruction with Marlex mesh is a viable option for an otherwise catastrophic situation with significant improvements in extensor lag, and substantial improvements in functional outcomes. Moreover, there was a relatively low complication rate for an otherwise difficult situation,” Matthew P. Abdel, MD, co-author of the study and an associate professor of orthopedic surgery at Mayo Clinic College of Medicine, told Healio.com/Orthopedics.
Between 2000 and 2015, 77 patients underwent reconstruction for an extensor mechanism disruption after TKA with the use of Marlex mesh (C.R. Bard). Abdel and colleagues noted 23% of patients underwent treatment with primary TKA components in place and 77% of patients underwent treatment during or after revision TKA.
At the time of latest follow-up, results showed 65 mesh reconstructions were in place. Researchers found failure that required mesh revision occurred in 12 patients, of which five were for patellar tendon rupture, five were for quadriceps tendon rupture and two were for symptomatic lengthening. In addition, four patients were treated nonoperatively for mesh failure with bracing. Researchers noted significant improvement in Knee Society Score results following the reconstruction, as well as improvement in extensor lag by a mean of 26°. Results also showed a 2-year survivorship free of mesh revision of 86% for patients with no prior reconstruction and of 95% for patients with previous reconstructions of the extensor mechanism that did not involve Marlex mesh.
“This is a complex cohort. Over one in four patients had a previous extensor mechanism reconstruction at an outside institution,” Abdel, who is a consultant in the department of orthopedic surgery and associate professor of orthopedic surgery at Mayo Clinic, said. “That high survivorship includes a difficult cohort of patients, most undergone a revision TKA at the time of the Marlex mesh reconstruction.” – by Casey Tingle
Disclosure: Abdel reports he is a paid consultant for Stryker.