The Active Knee Extension After Extensor Mechanism Reconstruction Using Allograft is Not Influenced by "early Mobilization": a Systematic Review and Meta-analysis

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2022 Mar 10

PMID 35264223

Authors

Cristiano De Franco

Vincenzo De Matteo

Marco Lenzi

Ernesto Marano

Enrico Festa

Alessio Bernasconi

Francesco Smeraglia

Giovanni Balato

Affiliations

Soon will be listed here.

Abstract

Background: Postoperative rehabilitation after extensor mechanism reconstruction (EMR) with allograft following total knee arthroplasty (TKA) is not standardized. This meta-analysis aimed to evaluate the effectiveness of early and late knee mobilization after EMR. The range of motion (ROM) and extensor lag in both groups were also assessed as the secondary endpoint.

Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed, including studies dealing with the use of allograft for EMR following TKA. Failure was defined as the persistence of extensor lag > 20°. Coleman Methodology Score and Methodological Index for Non-Randomized Studies (MINORS) score were used to assess the quality of studies included. The failure rate was set as the primary outcome in early (4 weeks) and late (8 weeks) mobilization groups after EMR with allograft. Secondary outcomes were postoperative extensor lag and ROM.

Results: Twelve articles (129 knees) were finally selected for this meta-analysis. Late and early knee mobilization was described in five and seven studies, respectively. No difference was noted between both groups' failure rates (11/84 vs. 4/38, respectively; p = 0.69). The mean extensor lag at last follow-up was 9.1° ± 8.6 in the early mobilization group, and 6.5° ± 6.1 in the late mobilization group is not significantly different (p > 0.05). The mean postoperative knee flexion was 107.6° ± 6.5 and 104.8° ± 7 in the early and late mobilization group, respectively.

Conclusion: While immobilization after EMR in TKA is mandatory to allow tissue healing, early knee mobilization after four weeks can be recommended with no additional risk of failure and increased extensor lag compared to a late mobilization protocol.

Level Of Evidence: IV, therapeutic study. Registration PROSPERO (International Prospective Register of Systematic Reviews): CRD42019141574.

Citing Articles

Extensor mechanism reconstruction with allograft following total knee arthroplasty: a systematic review and meta-analysis of achilles tendon versus extensor mechanism allografts for isolated chronic patellar tendon ruptures.

Balato G, De Franco C, Lenzi M, De Matteo V, Baldini A, Burnett R Arch Orthop Trauma Surg. 2022; 143(7):4411-4424.

PMID: 36462060 DOI: 10.1007/s00402-022-04718-5.

Early patellar tendon rupture after total knee arthroplasty: A direct repair method.

Li T, Sun J, Du Y, Shen J, Zhang B, Zhou Y World J Clin Cases. 2022; 10(31):11349-11357.

PMID: 36387798 PMC: 9649570. DOI: 10.12998/wjcc.v10.i31.11349.

References

Crossett L, Sinha R, Sechriest V, Rubash H . Reconstruction of a ruptured patellar tendon with achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am. 2002; 84(8):1354-61. DOI: 10.2106/00004623-200208000-00010. View

Scuderi G . Avoiding Postoperative Wound Complications in Total Joint Arthroplasty. J Arthroplasty. 2018; 33(10):3109-3112. DOI: 10.1016/j.arth.2018.01.025. View

Coleman B, Khan K, Maffulli N, Cook J, Wark J . Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports. 2000; 10(1):2-11. DOI: 10.1034/j.1600-0838.2000.010001002.x. View

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J . Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73(9):712-6. DOI: 10.1046/j.1445-2197.2003.02748.x. View

Rajgopal A, Vasdev A, Dahiya V . Patellar Tendon Reconstruction in Total Knee Arthroplasty: A New Technique. J Knee Surg. 2014; 28(6):483-8. DOI: 10.1055/s-0034-1390332. View

Opplert J, Babault N . Acute Effects of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature. Sports Med. 2017; 48(2):299-325. DOI: 10.1007/s40279-017-0797-9. View

Lavagnino M, Bedi A, Walsh C, Sibilsky Enselman E, Sheibani-Rad S, Arnoczky S . Tendon Contraction After Cyclic Elongation Is an Age-Dependent Phenomenon: In Vitro and In Vivo Comparisons. Am J Sports Med. 2014; 42(6):1471-7. DOI: 10.1177/0363546514526691. View

Ares O, Lozano L, Medrano-Najera C, Popescu D, Martinez-Pastor J, Segur J . New modified Achilles tendon allograft for treatment of chronic patellar tendon ruptures following total knee arthroplasty. Arch Orthop Trauma Surg. 2014; 134(5):713-7. DOI: 10.1007/s00402-014-1951-6. View

Emerson Jr R, Head W, Malinin T . Extensor mechanism reconstruction with an allograft after total knee arthroplasty. Clin Orthop Relat Res. 1994; (303):79-85. View

10.

Busfield B, Ries M . Whole patellar allograft for total knee arthroplasty after previous patellectomy. Clin Orthop Relat Res. 2006; 450:145-9. DOI: 10.1097/01.blo.0000223980.44455.21. View

11.

Ellanti P, Moriarity A, Wainberg N, Ni Fhoghlu C, McCarthy T . Association between patella spurs and quadriceps tendon ruptures. Muscles Ligaments Tendons J. 2015; 5(2):88-91. PMC: 4496023. View

12.

Boettner F, Monsef J . Achilles tendon allograft for augmentation of the Hanssen patellar bone grafting. Knee Surg Sports Traumatol Arthrosc. 2014; 23(4):1035-8. DOI: 10.1007/s00167-014-2845-4. View

13.

Garbedian S, Sternheim A, Backstein D . Wound healing problems in total knee arthroplasty. Orthopedics. 2011; 34(9):e516-8. DOI: 10.3928/01477447-20110714-42. View

14.

Burnett R, Fornasier V, Haydon C, Wehrli B, Whitewood C, Bourne R . Retrieval of a well-functioning extensor mechanism allograft from a total knee arthroplasty. Clinical and histological findings. J Bone Joint Surg Br. 2004; 86(7):986-90. DOI: 10.1302/0301-620x.86b7.15182. View

15.

Nazarian D, Booth Jr R . Extensor mechanism allografts in total knee arthroplasty. Clin Orthop Relat Res. 1999; (367):123-9. View

16.

Serino J, Mohamadi A, Orman S, McCormick B, Hanna P, Weaver M . Comparison of adverse events and postoperative mobilization following knee extensor mechanism rupture repair: A systematic review and network meta-analysis. Injury. 2017; 48(12):2793-2799. DOI: 10.1016/j.injury.2017.10.013. View

17.

Rand J, Morrey B, Bryan R . Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res. 1989; (244):233-8. View

18.

Oliva F, Marsilio E, Migliorini F, Maffulli N . Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes. J Orthop Surg Res. 2021; 16(1):547. PMC: 8418006. DOI: 10.1186/s13018-021-02696-9. View

19.

Johnson D, Eastwood D, Bader D . Biomechanical factors in wound healing following knee arthroplasty. J Med Eng Technol. 1991; 15(1):8-14. DOI: 10.3109/03091909109015442. View

20.

Lim C, Amanatullah D, Huddleston 3rd J, Harris A, Hwang K, Maloney W . Reconstruction of Disrupted Extensor Mechanism After Total Knee Arthroplasty. J Arthroplasty. 2017; 32(10):3134-3140. DOI: 10.1016/j.arth.2017.05.005. View