Tibial tubercle osteotomy (TTO) facilitates surgical exposure and protects the extensor mechanism during revision total knee arthroplasty (rTKA). The purpose of this study was to determine the rates of bony union, complications, and reoperations following TTO during rTKA, to assess the functional outcomes of rTKA with TTO at two years’ minimum follow-up, and to identify the risk factors of failure. Between January 2010 and September 2020, 695 rTKAs were performed and data were entered into a prospective database. Inclusion criteria were rTKAs with concomitant TTO, without extensor mechanism allograft, and a minimum of two years’ follow-up. A total of 135 rTKAs were included, with a mean age of 65 years (SD 9.0) and a mean BMI of 29.8 kg/m2 (SD 5.7). The most frequent indications for revision were infection (50%; 68/135), aseptic loosening (25%; 34/135), and stiffness (13%; 18/135). Patients had standardized follow-up at six weeks, three months, six months, and annually thereafter. Complications and revisions were evaluated at the last follow-up. Functional outcomes were assessed using the Knee Society Score (KSS) and range of motion.Aims
Methods
Disruption of the extensor mechanism in total
knee arthroplasty may occur by tubercle avulsion, patellar or quadriceps
tendon rupture, or patella fracture, and whether occurring intra-operatively
or post-operatively can be difficult to manage and is associated
with a significant rate of failure and associated complications.
This surgery is frequently performed in compromised tissues, and
repairs must frequently be protected with cerclage wiring and/or
augmentation with local tendon (semi-tendinosis, gracilis) which
may also be used to treat soft-tissue loss in the face of chronic
disruption. Quadriceps rupture may be treated with conservative
therapy if the patient retains active extension. Component loosening
or loss of active extension of 20° or greater are clear indications
for surgical treatment of patellar fracture. Acute patellar tendon
disruption may be treated by primary repair. Chronic extensor failure
is often complicated by tissue loss and retraction can be treated
with medial gastrocnemius flaps, achilles tendon allografts, and
complete extensor mechanism allografts. Attention to fixing the
graft in full extension is mandatory to prevent severe extensor
lag as the graft stretches out over time.
We compared extrusion of the allograft after
medial and lateral meniscal allograft transplantation and examined
the correlation between the extent of extrusion and the clinical
outcome. A total of 73 lateral and 26 medial meniscus allografts
were evaluated by MRI at a mean of 32 months (24 to 59) in 99 patients
(67 men, 32 women) with a mean age of 35 years (21 to 52). The absolute
values and the proportional widths of extruded menisci as a percentage were
measured in coronal images that showed maximum extrusion. Functional
assessments were performed using Lysholm scores. The mean extrusion
was 4.7 mm (1.8 to 7.7) for lateral menisci and 2.9 mm (1.2 to 6.5)
for medial menisci (p <
0.001), and the mean percentage extrusions
were 52.0% (23.8% to 81.8%) and 31.2% (11.6% to 63.4%), respectively
(p <
0.001). Mean Lysholm scores increased significantly from
49.0 (10 to 83) pre-operatively to 86.6 (33 to 99) at final follow-up
for lateral menisci (p = 0.001) and from 50.9 (15 to 88) to 88.3
(32 to 100) for medial menisci (p <
0.001). The final mean Lysholm
scores were similar in the two groups (p = 0.312). Furthermore,
Lysholm scores were not found to be correlated with degree of extrusion
(p = 0.242). Thus, transplanted lateral menisci extrude more significantly
than transplanted medial menisci. However, the clinical outcome
after meniscal transplantation was not found to be adversely affected
by extrusion of the allograft.
We describe 119 meniscal allograft transplantations performed concurrently with articular cartilage repair in 115 patients with severe articular cartilage damage. In all, 53 (46.1%) of the patients were over the age of 50 at the time of surgery. The mean follow-up was for 5.8 years (2 months to 12.3 years), with 25 procedures (20.1%) failing at a mean of 4.6 years (2 months to 10.4 years). Of these, 18 progressed to knee replacement at a mean of 5.1 years (1.3 to 10.4). The Kaplan-Meier estimated mean survival time for the whole series was 9.9 years ( The survival of the transplant was not affected by gender, the severity of cartilage damage, axial alignment, the degree of narrowing of the joint space or medial
We compared the results ten years after an inverted V-shaped high tibial osteotomy with those of a historical series of conventional closing-wedge osteotomies. The closing-wedge series consisted of 56 knees in 51 patients with a mean follow-up of 11 years (10 to 15). The inverted V-shaped osteotomy was evaluated in 48 knees in 43 patients at a mean follow-up of 14 years (10 to 19). All the patients were scored using the Japanese Orthopaedic Association rating scale for osteoarthritis of the knee and radiological assessment. The pre-operative grade of osteoarthritis was similar in both groups. Post-operatively, the knee function score was graded as satisfactory in 63% (35) of the closing-wedge group but in 89% (43) of the inverted V-shaped osteotomy group. Post-operative radiological examination showed that delayed union and loss of correction occurred more often after a closing-wedge osteotomy than after an inverted V-shaped procedure. Our study suggests that the inverted V-shaped osteotomy may offer more dependable long-term results than traditional closing-wedge osteotomy.