Synthetic Mesh Vs. Allograft Extensor Mechanism Reconstruction in Total Knee Arthroplasty - A Systematic Review of the Literature and Meta-analysis

Background: Extensor mechanism disruption after total knee arthroplasty (TKA) is a devastating complication. Reconstruction with allograft and synthetic mesh has been described. However, these reports have typically been small case series, and controversy exists with regard to which reconstruction technique is optimal.

Methods: The authors performed a systematic review using PUBMED, MEDLINE, EMBASE, BIOSIS, Clinicaltrials.gov, and Cochrane Database of Systematic Reviews identifying 14 articles meeting inclusion criteria and producing 204 knees for comparison. Studies with repairs performed under full knee extension were included. Case reports and non-English studies were excluded. Available demographics and clinical outcome data were collected from each study. Appropriate statistical analysis was performed to compare the variables.

Results: Baseline demographics and patient complexity were similar between the two cohorts. Reconstruction success rates (76% allograft vs. 74% mesh), average time to diagnosis/treatment, Knee Society Scores (KSS), knee range of motion/extensor lag, and complication rates yielded no statistical difference. Synthetic mesh was used more frequently with concomitant revision of components.

Discussion: This systematic review shows equivalent success of allograft and synthetic mesh with approximately 25% failure rate in both groups. Periprosthetic joint infection remains a common and significant complication and reason for failure in both groups. Overall, synthetic mesh showed equivalent extensor mechanism reconstruction success as allograft but with much lower cost, near universal availability, lack of disease transmission, and potential for diminishing graft stretch-out. Future research in larger case series or comparative study is needed to help aid in management of this largely unsolved problem in total knee reconstruction.