Which role for synthetic ligaments in the reconstruction of patellar tendon chronic rupture after TKA? Mid-term outcomes using LARS ligament.

Main Article Content

Michele Giuntoli https://orcid.org/0000-0001-7752-7706
Enrico Bonicoli
Nicola Piolanti
Edoardo Ipponi
Antonella Vigorito
Stefano Marchetti
Michelangelo Scaglione

Keywords

LARS ligament; patellar tendon rupture; synthetic ligament; extensor mechanism; TKA; reconstruction.

Abstract

Background and aim of the work: Patellar tendon rupture is a rare complication after Total Knee Arthroplasty (TKA) which often requires surgical treatment. Patients with chronic lesions or tendon degenerations showed good results when treated using autografts or allografts, but these techniques showed poor outcomes at long-term follow-up (FU). Moreover, allografts have high costs and limited availability, not to mention the increased risk of immune reactions and infections. Recently, the use of synthetic ligaments for patellar tendon reconstruction has taken hold with encouraging results. We report our experience in the treatment of patellar tendon ruptures after TKA using the Ligament Advanced Reinforcement System-LARS®.


Methods: Clinical evaluation was performed using the Knee Society Score and recording extensor lag. Instrumental evaluation was performed using ultrasound imaging to assess patellar tendon thickness and using conventional x-rays to assess prosthesis’ mobilization signs and patella’s height.


Results: At the final FU, 6 knees were included in our study. Patient’s mean age was 66.7. Patellar tendon reconstruction occurred after a mean time of 4 months from the previous surgery. The mean FU was 44,2 months. The mean Knee Score was 63.3 and the mean Function Score was 35. In 4 knees the extensor lag was < 10° while in 2 knees it was > 20°. The mean ISI was 1.16, while the average increment in tendon thickness was 127.12%.


Conclusions: In our opinion, synthetic ligaments can be successfully employed for the reconstruction of patellar tendon breakage after TKA and rTKA in selected patients, in order to quickly return them to their activity of daily living.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 8 | PDF Downloads 1

References

REFERENCES
1. Schoderbek Jr RJ, Brown TE, Mulhall KJ, Mounasamy V, Iorio R, Krackow KA,et al. Extensor mechanism disruption after total knee arthroplasty. Clin OrthopRelat Res 2006;446:176–85.
2. Rand JA, Morrey BF, Bryan RS. Patellar tendon rupture after total knee arthro-plasty. Clin Orthop Relat Res 1989:233–8.
3. Nam D, Abdel MP, Cross MB, LaMont LE, Reinhardt KR, McArthur BA, et al. The management of extensor mechanism complications in total knee arthroplasty. AAOS exhibit selection. J Bone Joint Surg Am 2014;96:e47.
4. Papalia R, Vasta S, D’Adamio S, Albo E, Maffulli N, Denaro V. Complicationsinvolving the extensor mechanism after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014.
5. A.G.Rosenberg: Management of extensor mechanism rupture after TKA. J Bone Joint Surg Br 2012;94-B, Supple A:116–19.
6. M. Bonnin,∗, S. Lustig, D. Huten: Extensor tendon ruptures after total knee arthroplasty. Orthopaedics & Traumatology: Surgery & Research 102 (2016) S21–S31.
7. Dobbs RE, Hanssen AD, Lewallen DG, Pagnano MW. Quadriceps tendon ruptureafter total knee arthroplasty. Prevalence, complications, and outcomes. J BoneJoint Surg Am 2005;87:37–45.
8. Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications follow-ing total knee arthroplasty. J Arthroplasty 1987;2:135–40.
9. Pagnano MW. Patellar tendon and quadriceps tendon tears after total kneearthroplasty. J Knee Surg 2003;16:242–7.
10. Cadambi A, Engh GA. Use of a semitendinosus tendon autogenous graft forrupture of the patellar ligament after total knee arthroplasty. A report of sevencases. J Bone Joint Surg Am 1992;74:974–9.
11. Alfredo Lamberti · Giovanni Balato · Pier Paolo Summa · Ashok Rajgopal · Surgical options for chronic patellar tendon rupture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-016-4370-0.
12. Brown NM, Murray T, Sporer SM, Wetters N, Berger RA, Della Valle CJ. Extensor mechanism allograft reconstruction for mechanism failure following total knee arthroplasty. J Bone Joint Surg Am 2015;97:279–83.
13. Fujikawa K, Ohtani T, Matsumoto H, Seedhom BB. Reconstruction of he extensor apparatus of the knee with the Leeds-Keio ligament. J Bone Joint Surg Br. 1994;76:200–203.
14. Aracil J, Salom M, Aroca JE, Torro V, Lopez-Quiles D. Extensor apparatus reconstruction with leeds-keio ligament in total knee arthroplasty.J Arthroplasty. 1999;14:204–208.
15. Browne JA, Hanssen AD. Reconstruction of patellar tendon disruption after totalknee arthroplasty: results of a new technique utilizing synthetic mesh. J BoneJoint Surg Am 2011;93:1137–43.
16. Dominkus M, Sabeti M, Toma C, Abdolvahab F, Trieb K, Kotz RI. Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop Relat Res. 2006;453:328–334.
17. Adrian James Talia and Phong Tran. Bilateral patellar tendon reconstruction using LARS ligaments: case report and review of the literature. Talia and Tran BMC Musculoskeletal Disorders (2016) 17:302.
18. Naim S, Gougoulias N, Griffiths D. Patellar tendon reconstruction using LARS ligament: surgical technique and case report. Strat Traum Limb Recon (2011) 6:39–41.
19. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989 Nov;(248):13-4.
20. Giles R. Scuderi, Robert B. Bourne, Philip C. Noble, James B. Benjamin, Jess H. Lonner, W. N. Scott. The New Knee Society Knee Scoring System. Clin Orthop Relat Res. 2012 Jan; 470(1): 3–19.
21. Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101:101–104.
22. Trieb K, Blahovec H, Brand G, Sabeti M, Dominkus M, Kotz R (2004): In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments. Eur Surg Res 36(3):148–151.
23. Wang C-L, Hsiao C-K, Hsu A-T, Dung C-Z, Chang C-H (2012) Biocompatibility and mechanical property of LARS artificial ligament with tissue ingrowth. J Mech Med Biol 1250012:1–13.
24. Parchi PD, Gianluca C, Dolfi L, et al. Anterior cruciate ligament reconstruction with LARS™ artificial ligament results at a mean follow-up of eight years. Int Orthop 2013;37(08):1567–1574
25. Parchi PD., Ciapini G., Paglialunga C., Giuntoli M., Picece C., Chiellini F., Lisanti M., Scaglione M. (2018). Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament-Clinical Results after a Long-Term Follow-Up. Joints, 6(2), 75-79.
26. Emerson Jr RH, Head WC, Malinin TI. Extensor mechanism reconstruction withan allograft after total knee arthroplasty. Clin Orthop Relat Res 1994:79–85.
27. Emerson Jr RH, Head WC, Malinin TI. Reconstruction of patellar tendon ruptureafter total knee arthroplasty with an extensor mechanism allograft. Clin OrthopRelat Res 1990:154–61.
28. Zanotti RM, Freiberg AA, Matthews LS. Use of patellar allograft to reconstructa patellar tendon-deficient knee after total joint arthroplasty. J Arthroplasty1995;10:271–4.
29. Leopold SS, Greidanus N, Paprosky WG, Berger RA, Rosenberg AG. High rate offailure of allograft reconstruction of the extensor mechanism after total kneearthroplasty. J Bone Joint Surg Am 1999;81:1574–9.
30. Nazarian DG, Booth Jr RE. Extensor mechanism allografts in total knee arthro-plasty. Clin Orthop Relat Res 1999:123–9.
31. Burnett RS, Berger RA, Della Valle CJ, Sporer SM, Jacobs JJ, Paprosky WG, et al.Extensor mechanism allograft reconstruction after total knee arthroplasty. JBone Joint Surg Am 2005;87(Suppl 1):175–94.
32. Burnett RS, Berger RA, Paprosky WG, Della Valle CJ, Jacobs JJ, Rosenberg AG.Extensor mechanism allograft reconstruction after total knee arthroplasty. Acomparison of two techniques. J Bone Joint Surg Am 2004;86–A:2694–9.
33. Burnett RS, Butler RA, Barrack RL. Extensor mechanism allograft reconstructionin TKA at a mean of 56 months. Clin Orthop Relat Res 2006;452:159–65.
34. Malhotra R, Garg B, Logani V, Bhan S. Management of extensor mechanismdeficit as a consequence of patellar tendon loss in total knee arthroplasty: anew surgical technique. J Arthroplasty 2008;23:1146–51.
35. Ares O, Lozano LM, Medrano-Najera C, Popescu D, Martinez-Pastor JC, Segur JM,et al. New modified Achilles tendon allograft for treatment of chronic patellartendon ruptures following total knee arthroplasty. Arch Orthop Trauma Surg 2014;134:713–7.
36. Diaz-Ledezma C, Orozco FR, Delasotta LA, Lichstein PM, Post ZD, Ong AC. Exten-sor mechanism reconstruction with achilles tendon allograft in TKA: results ofan abbreviate rehabilitation protocol. J Arthroplasty 2014;29:1211–5.
37. Calori GM, Mazza EL, Vaienti L, Mazzola S, Colombo A, Gala L, Colombo M. Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects. Injury 2016 Dec;47 Suppl 6:S77-S82.
38. Fukuta S, Kuge A, Nakamura M. Use of the Leeds-Keio prosthetic ligament for repair of patellar tendon rupture after total knee arthroplasty. Knee 2003 Jun;10(2):127-30.
39. Browne JA, Hanssen AD. Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh. J BoneJoint Surg Am 2011;93:1137–43.