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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


General Principles: All repairs should be repaired in full extension. Repairs should be immobilised in full extension for 6–12 weeks. Gradual resumption of motion in a hinged brace over an additional 6–8 weeks almost always yields flexion to at least 90 degrees. Marlex Mesh has been shown to be an excellent replacement as well as an augment for deficient soft tissue.

Acute tibial tuberosity avulsion: Open repair is best accomplished with a non-absorbable heavy Krackow suture, secured distally around a screw and washer followed by 6–8 weeks of immobilization. Augmentation with a semitendinosus graft or Marlex can provide additional support.

Acute Patella Tendon Rupture: End-to-end repair is standard, but re-rupture is not uncommon, so supplemental semitendinosus reconstruction is recommended. The tendon is harvested proximally, left attached distally and passed through a transverse hole in the inferior patella. The gracilis tendon can be harvested and sutured to semitendinosus for additional length if needed.

Acute Quadriceps Tendon Rupture: These can be repaired end-to-end with a non-absorbable heavy Krackow suture. A superficial quadriceps fascial turndown or mesh may be a useful adjunct.

Patella Fracture: Treatment depends on the status of the patellar component and the loss of active extension. If the component remains well fixed and the patient has less than a 20 degree lag. A loose component and/or > 20 degree extensor lag requires ORIF +/− component revision.

Chronic Disruptions: While standard repair techniques are possible, tissue retraction usually prevents a “tension-free” repair. In most chronic disruptions allograft extensor mechanism reconstruction is preferable. If the patella remains viable and has not retracted proximally an Achilles tendon graft is appropriate while in any patellar tendon defect, mesh repair has been shown to be effective.