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Medial Gastrocnemius Transposition Flap for the Treatment of Disruption of the Extensor Mechanism after Total Knee Arthroplasty*
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Investigation performed at the Department of Surgery, The University of Chicago, Chicago
J Bone Joint Surg Am, 1997 Jun 01;79(6):866-73
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We describe a modified technique for the salvage of a total knee arthroplasty after disruption of the extensor mechanism. Between January and December 1992, seven patients had reconstruction of the extensor mechanism with use of a medial or an extended medial gastrocnemius flap. Six of the seven patients were followed for a mean of thirty-three months (range, twenty-six to forty-one months) and were evaluated both preoperatively and postoperatively with regard to the knee and functional scores of The Knee Society as well as the range of motion, extensor lag, walking status, and patellar height. The seventh patient was lost to follow-up six months postoperatively and was excluded from the analysis of the results.Preoperatively, the knee and functional scores were 16 ± 12.3 points and 12 ± 12.1 points (mean and standard deviation), respectively; the mean range of motion was 70 ± 44.0 degrees; and the mean extensor lag was 53 ± 33.4 degrees. Postoperatively, the mean knee and functional scores improved to 82 ± 12.4 points and 51 ± 23.0 points, respectively; the mean range of motion improved to 100 ± 21.8 degrees; and the mean extensor lag decreased to 24 ± 18.8 degrees. After the procedure, all patients who previously had been dependent on a walker were able to walk about the community with or without a cane, and those who had been dependent on a wheelchair were able to walk with the assistance of a walker.Patellar height was measured according to the method of Insall and Salvati for the four patients who had a patella. Preoperatively, the patellar heights were grossly abnormal; postoperatively, they more closely approached accepted normal values for three of the four patients.Reconstruction of a complicated rupture of the extensor mechanism with use of a medial gastrocnemius transposition flap after total knee arthroplasty is a reliable option for treatment.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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