Extensor Mechanism Integrity in Knee Arthroplasty
Summary
The knee’s extensor mechanism comprises the quadriceps muscle, quadriceps tendon, patella, patellar tendon and tibial tubercle. In total knee arthroplasty (TKA), maintaining continuity of this mechanism is critical for restoring active extension, joint stability and functional gait. Disruption can arise intra-operatively from tendon injury or patellar maltracking, or postoperatively from trauma, chronic degeneration or component loosening. Presentations vary according to the anatomical site: suprapatellar ruptures of the quadriceps tendon, transpatellar fractures and infrapatellar ruptures of the patellar tendon. Such injuries, though uncommon, carry significant morbidity and may lead to extensor lag, decreased range of motion and impaired mobility. Surgical strategies range from primary repair using suture anchors or transosseous tunnels, to reconstruction with autografts, allografts or synthetic materials. Emerging prevention and rehabilitation protocols aim to optimise extensor mechanism preservation and enhance postoperative functional outcomes worldwide.
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Extensor Mechanism Integrity in Knee Arthroplasty publication trend
The graph below shows the total number of articles in extensor mechanism integrity in knee arthroplasty across all publications each year (not limited to Nature Index journals).
Technical terms
Extensor mechanism: The anatomical unit enabling knee extension, including quadriceps muscle and tendons, patella and patellar tendon.
Total knee arthroplasty (TKA): Surgical replacement of knee joint surfaces with prosthetic components.
Quadriceps tendon rupture: Disruption of the tendon inserting the quadriceps muscle into the patella, impairing knee extension.
Patellar tendon rupture: Tear of the tendon connecting patella to the tibial tubercle, leading to loss of active extension.
Suture anchor: A device implanted into bone to secure soft-tissue repairs.
Transosseous tunnel: Surgical technique creating bone tunnels through which sutures are passed to reattach tendons.
References
- Extensor Mechanism Disruption after Total Knee Arthroplasty: A Case Series and Review of Literature. Cureus (2016).
- Biomechanical Testing of Suture Anchor Versus Transosseous Tunnel Technique for Quadriceps Tendon Repair Yields Similar Outcomes: A Systematic Review. Arthroscopy Sports Medicine and Rehabilitation (2021).
- Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes. Journal of Orthopaedic Surgery and Research (2021).
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