Complete Allograft Reconstruction After Extensor Mechanism Failure

Extensor mechanism failure after total knee arthroplasty is an infrequent but devastating complication. Several techniques for reconstruction have been proposed. Satisfactory results have been reported using whole extensor allograft implantation. However, this surgery can be technically demanding, may require specialized tissue, and often demands attention to critical technical parts of the procedure. Preoperative considerations should include an assessment of patient potential for rehabilitation compliance, eradication of infection, and ensuring that a sufficient soft-tissue envelope will be available for a safe and successful closure. Critical surgical techniques relate to the incision and approach, preparation of the graft, distal and proximal graft fixation, all in the context of proper prosthetic component implantation. Finally, appropriate postoperative rehabilitation protocols must be adhered to protect the graft and encourage healing, while providing optimal conditions for restoration of extensor mechanism strength and knee range of motion. A review of the reported results to date suggests that the application of the principles of whole allograft reconstruction for extensor mechanism failure after total knee arthroplasty can lead to satisfactory outcomes with improved function and mild extensor lags in most patients.