Abstract
Loss of the quadriceps tendon, patella, and patellar tendon leaves a major anterior defect that is difficult to close and compromises knee extension strength. Gastrocnemius muscle transfer does not sufficiently cover such major defects. A new surgical procedure is described that transfers the vastus medialis or the vastus lateralis and their tibial attachments, or both muscles and their distal expansions to cover major deficiencies in the anterior knee.
Nine cadaver knee specimens were dissected to ensure that the blood and nerve supply of the muscles would remain intact in the flap transfer. Eight clinical cases were done between 2005 and 2009. Four knees had vastus medialis transfer, two knees required vastus medialis and vastus lateralis transfer, two knees required transfer of the vastus medialis and medial gastrocnemius muscles, and two knees required transfer of both the medial gastrocnemius and medial half of the soleus muscle to close the knee and to secure distal attachment of the vastus transfer.
All patients achieved closure of the knee joint without synovial leaks by 10 days post-operatively. Mean flexion contracture at last follow-up was 3° (range, 0–7°). Mean extension lag was 22° (range, 5–65°). Extension lag was less in those cases that included gastrocnemius or soleus muscle transfer. None of the flaps developed necrosis.
The vastus medialis and vastus lateralis muscles are effective as muscle transfers about the knee.
