Extensor Mechanism Allograft for the Treatment of Extensor Mechanism Disruption After Total Knee Arthroplasty

Extensor mechanism failure after a total knee arthroplasty can be a devastating complication that is difficult to manage. Although primary repair of the extensor mechanism may be attempted acutely, similar management of a chronic disruption is associated with a substantial rate of failure and associated complications. Several options for secondary reconstruction exist, but a full extensor mechanism allograft that is tightly tensioned in full extension followed by immobilization for 6 weeks has been associated with the most consistent results. With this technique, the extensor allograft can be completely covered with host tissue, facilitating healing and restoration of active knee extension. The reconstruction requires attention to secure distal fixation and maximal extensor tension to achieve optimal outcomes.