Management of Extensor Mechanism Deficit as a Consequence of Patellar Tendon Loss in Total Knee Arthroplasty: A New Surgical Technique

Extensor mechanism disruption is an uncommon but devastating complication of total knee arthroplasty. A new technique of extensor mechanism reconstruction for patellar tendon loss, after total knee arthroplasty, with the help of extensor mechanism composite allograft is described. Four patients with chronic extensor mechanism–deficient total knee arthroplasty were undertaken for revision surgery along with reconstruction of extensor mechanism with an innovative technique using an extensor mechanism composite allograft consisting of a patella–patellar tendon–tibial tubercle. On final follow-up, none of the patients had extensor lag but for 10° of extensor lag in 1 patient only. Providing an environment for bone-to-bone healing both proximally as well as distally and supervised postoperative rehabilitation led to encouraging results in the management of a failed extensor mechanism after total knee arthroplasty.