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Z Orthop Unfall 2013; 151(5): 475-479
DOI: 10.1055/s-0033-1350777
Arbeitsgemeinschaft Endoprothetik
Georg Thieme Verlag KG Stuttgart · New York

Behandlung der Strecksehnenruptur bei liegender Knietotalendoprothese[*]

Treatment of Extensor Mechanism Rupture after Total Knee Arthroplasty
R. Bieger
Klinik für Orthopädie, Universtätsklinikum Ulm
,
T. Kappe
Klinik für Orthopädie, Universtätsklinikum Ulm
,
D. Wernerus
Klinik für Orthopädie, Universtätsklinikum Ulm
,
H. Reichel
Klinik für Orthopädie, Universtätsklinikum Ulm
› Author Affiliations
Further Information

Publication History

Publication Date:
15 October 2013 (online)

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Zusammenfassung

Rupturen des Strecksehnenapparats gehören zu den schwerwiegendsten Komplikationen der primären und der Knierevisionsendoprothetik. Aufgrund der relativ geringen Inzidenz von 0,17–2,5 % ist das Evidenzniveau der zur Verfügung stehenden Behandlungsstrategien gering. Insgesamt sind die Ergebnisse nach periprothetischen Rupturen des Streckapparats schlechter als nach Sehnenrupturen des nativen Kniegelenks. Bei der Behandlung der selteneren Quadrizepssehnenruptur sind akute von chronischen sowie komplette von inkompletten Rupturen zu unterscheiden. Die konservative Therapie hat ihren Stellenwert bei inkompletten Rupturen mit einem aktiven Streckdefizit kleiner als 20°. Komplette Quadrizepssehnenrupturen und Rupturen der Patellarsehne werden überwiegend operativ behandelt. Je nach Ausmaß des Defekts können direkte Nahttechniken, Sehnentransfers, Muskellappenaugmentationen, Allografts oder synthetische Ersatzmaterialien Anwendung finden. Die Spätergebnisse sind häufig mit einem persistierenden Funktionsdefizit behaftet. Oberste Priorität hat daher die Prävention einer Streckapparatschädigung bei der Knieprothesenimplantation.

Abstract

Disruption of the extensor mechanism is one of the most devastating complications in knee arthroplasty with a reported incidence between 0.17 and 2.5 %. Due to a high rate of subsequent complications and poor clinical results, every effort should be made to avoid extensor mechanism disruption. In cases of disruption however, the orthopaedic surgeons must be aware of non-operative and surgical treatment options and their indications, timing, outcome and limitations. Non-operative treatment is feasible in cases of incomplete disruption of the quadriceps tendon with an extension deficit of less than 20°. Complete disruption of the quadriceps tendon or rupture of the patellar tendon should be treated operatively. Therapeutic strategies include direct repair of the tendon in acute disruption without retraction. Retraction as well as soft tissue damage necessitates augmentation of the tendon. Frequently used endogenous augments are the semitendinosus tendon as well as the gastrocnemius muscle. Exogenous options are allografts of the Achilles tendon or structured extensor mechanism grafts and synthetic augments to support endogenous tendon repair. The clinical results after extensor mechanism failure following total knee arthroplasty are less favourable compared to ruptures in native knee joints. The most common complications are postoperative stretching and the maintenance of an active extensor lag.

Schlüsselwörter

Knie - Endoprothetik - Revision - Streckapparat

Key words

knee - arthroplasty - revision - extensor mechanism

* Nach einem Vortrag vom Sektionstag der Arbeitsgemeinschaft für Endoprothetik DKOU 2012.


 

  • Literatur

  • 1 Emerson jr. RH, Head WC, Malinin TI. Extensor mechanism reconstruction with an allograft after total knee arthroplasty. Clin Orthop Relat Res 1994; 303: 79-85
    PubMedGoogle Scholar
  • 2 Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty. J Arthroplasty 1987; 2: 135-140
    CrossrefPubMedGoogle Scholar
  • 3 Brooks P. Extensor mechanism ruptures. Orthopedics 2009; 32
    PubMedGoogle Scholar
  • 4 Burnett RS, Berger RA, Della Valle CJ et al. Extensor mechanism allograft reconstruction after total knee arthroplasty. J Bone Joint Surg [Am] 2005; 87 (Suppl. 01) S175-S194
    PubMedGoogle Scholar
  • 5 Malhotra R, Garg B, Logani V et al. Management of extensor mechanism deficit as a consequence of patellar tendon loss in total knee arthroplasty: a new surgical technique. J Arthroplasty 2008; 23: 1146-1151
    CrossrefPubMedGoogle Scholar
  • 6 Rand JA. Extensor mechanism complications following total knee arthroplasty. J Bone Joint Surg [Am] 2004; 86: 2061-2071
    PubMedGoogle Scholar
  • 7 Berger RA, Crossett LS, Jacobs JJ et al. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 1998; 356: 144-153
    CrossrefPubMedGoogle Scholar
  • 8 Rosenberg AG. Management of extensor mechanism rupture after TKA. J Bone Joint Surg [Br] 2012; 94 (Suppl. A) S116-S119
    PubMedGoogle Scholar
  • 9 Booth RE, Femino FP. Acute and chronic Rupture of the Quadriceps Tendon treated with direct Repair. In: Scuderi GR, Tria AJ, eds. Knee Arthroplasty Handbook. New York: Springer; 2006: 154-157
    CrossrefGoogle Scholar
  • 10 Scuderi GR, De Muth BC. Management of Patella Tendon Disruptions in total Knee Arthroplasty. In: Scuderi GR, Tria AJ, eds. Knee Arthroplasty Handbook. New York: Springer; 2006: 158-168
    CrossrefGoogle Scholar
  • 11 Dobbs RE, Hanssen AD, Lewallen DG et al. Quadriceps tendon rupture after total knee arthroplasty. Prevalence, complications, and outcomes. J Bone Joint Surg [Am] 2005; 87: 37-45
    CrossrefPubMedGoogle Scholar
  • 12 Kim TW, Kamath AF, Israelite CL. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty. J Arthroplasty 2011; 26: 817-820
    CrossrefPubMedGoogle Scholar
  • 13 Scuderi C. Ruptures of the quadriceps tendon; study of twenty tendon ruptures. Am J Surg 1958; 95: 626-634
    CrossrefPubMedGoogle Scholar
  • 14 Rand JA, Morrey BF, Bryan RS. Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res 1989; 244: 233-238
    PubMedGoogle Scholar
  • 15 Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg [Am] 1981; 63: 932-937
    PubMedGoogle Scholar
  • 16 Kelikian H, Riashi E, Gleason J. Restoration of quadriceps function in neglected tear of the patellar tendon. Surg Gynecol Obstet 1957; 104: 200-204
    PubMedGoogle Scholar
  • 17 Feldman JJ, Cohen BE, May jr. JW. The medial gastrocnemius myocutaneous flap. Plast Reconstr Surg 1978; 61: 531-539
    CrossrefPubMedGoogle Scholar
  • 18 Hierner R. [The gastrocnemius muscle flaps]. Oper Orthop Traumatol 2008; 20: 128-144
    CrossrefPubMedGoogle Scholar
  • 19 Jaureguito JW, Dubois CM, Smith SR et al. Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg [Am] 1997; 79: 866-873
    CrossrefPubMedGoogle Scholar
  • 20 Busfield BT, Huffman GR, Nahai F et al. Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. Clin Orthop Relat Res 2004; 428: 190-197
    CrossrefPubMedGoogle Scholar
  • 21 Tiengo C, Macchi V, Vigato E et al. Reversed gracilis pedicle flap for coverage of a total knee prosthesis. J Bone Joint Surg [Am] 2010; 92: 1640-1646
    CrossrefPubMedGoogle Scholar
  • 22 Whiteside LA. Surgical technique: vastus medialis and vastus lateralis as flap transfer for knee extensor mechanism deficiency. Clin Orthop Relat Res 2013; 471: 221-230
    CrossrefPubMedGoogle Scholar
  • 23 Bürde C, Sweeney P. Die Behandlung der Streckapparatinsuffizienz nach Knieprothetik durch allogene Transplantation. Orthopäde 2007; 36: 372-378
    CrossrefPubMedGoogle Scholar
  • 24 Leopold SS, Greidanus N, Paprosky WG et al. High rate of failure of allograft reconstruction of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg [Am] 1999; 81: 1574-1579
    PubMedGoogle Scholar
  • 25 Browne JA, Hanssen AD. Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh. J Bone Joint Surg [Am] 2011; 93: 1137-1143
    CrossrefPubMedGoogle Scholar
  • 26 Neuerburg C, Bieger R, Jung S et al. Bridging knee arthrodesis for limb salvage using an intramedullary cemented nail: a retrospective outcome analysis of a case series. Arch Orthop Trauma Surg 2012; 132: 1183-1189
    CrossrefPubMedGoogle Scholar