Extensor Mechanism Reconstruction Using Marlex Mesh: Is Postoperative Casting Mandatory? |
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| Institution: | 1. Section of Orthopaedic Surgery, Department of Public Health, “Federico II” University, Naples, Italy;2. Department of Orthopaedics and Trauma, Ospedali Riuniti, Ancona, Italy;3. Department of Orthopaedics and Trauma, S. Lazzaro Hospital, Alba, Cuneo, Italy;1. Oliashirazi Institute at Marshall University, Huntington, WV;2. Cooper Bone and Joint Institute at Cooper University Hospital, Camden, NJ;3. Orthopaedic Department, Med Care Hospital, Dubai, UAE;4. Orthopaedic Department, Alzahra Hospital, Dubai, UAE;1. Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY;2. Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY;3. Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY;1. Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain;2. Faculty of Medicine, Complutense University of Madrid, Madrid, Spain;3. Avanti Institute, Madrid, Spain;1. Colorado Joint Replacement, Denver, CO;2. University of Iowa Hospitals & Clinics, Iowa City, IA;3. Department of Biomedical Engineering, University of Tennessee, Knoxville, TN;4. University of Colorado Health Sciences Center, Denver, CO |
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| Abstract: | BackgroundExtensor mechanism (EM) disruption after total knee arthroplasty is a catastrophic complication. Reconstruction using monofilament polypropylene mesh (Marlex Mesh; CR Bard, Franklin Lakes, NJ) has emerged as the preferred treatment, but reports are limited to the designing institution. This study describes a nondesigner experience and compares 2 postoperative immobilization strategies: long leg cast vs knee immobilizer.MethodsA retrospective review of consecutive EM reconstructions between 2012 and 2019 was performed. Primary repairs and allograft reconstructions were excluded, leaving 33 knees (30 patients) who underwent Marlex reconstruction. Mean time from disruption to reconstruction was 14 months, and 14 of 33 (42%) had previous repair or reconstruction attempts. The mean age was 69 years, and mean body mass index was 35 kg/m2. Postoperatively, extension was maintained using a knee immobilizer in 19 of 33 (58%) patients, whereas 14 of 33 (42%) patients were long leg casted. Kaplan-Meier analysis determined all-cause survivorship free of mesh failure.ResultsAt mean 25-month follow-up, 19 of 33 (58%) EM reconstructions were functioning. Excluding explanted infections (5 recurrent and 2 new), 19 of 26 (73%) EM reconstructions were in situ. Six-year survivorship was 69% and not influenced by immobilization type (cast: 67%, immobilizer: 71%; P = .74). Extensor lag was not associated with immobilization type, improving from a mean preoperative lag of 43° to a mean postoperative lag of 9°. Among successes, University of California at Los Angeles activity and Knee Injury and Osteoarthritis Outcome Score - Joint Replacement score improvements exceeded minimal clinically important difference (2.2-3.3 and 52.5-64.0, respectively).ConclusionMarlex mesh EM reconstruction is a durable and reliable treatment with acceptable clinical results achievable outside the designer institution. Provided sufficient duration and compliance with postoperative immobilization, similar outcomes can be obtained with either a cast immobilizer or a knee immobilizer. |
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| Keywords: | extensor mechanism patellar tendon rupture quadriceps tendon rupture revision total knee arthroplasty Marlex mesh |
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