Extensor Mechanism Reconstruction With Marlex Mesh

Matthew P. Abdel, MD

Arlen D. Hanssen, MD

Dr. Abdel or an immediate family member serves as a paid consultant to or is an employee of Stryker and serves as a board member, owner, officer, or committee member of the American Association of Hip and Knee Surgeons, the International Congress for Joint Reconstruction, and the Minnesota Orthopaedic Society. Dr. Hanssen or an immediate family member has received royalties from Stryker and serves as a board member, owner, officer, or committee member of the International Congress for Joint Reconstruction.

INTRODUCTION

Extensor mechanism reconstruction with Marlex mesh is a durable and reliable technique for addressing one of the most catastrophic complications after total knee arthroplasty. At most recent follow-up (mean of 4 years), 65 of 77 mesh reconstructions were in place at the Mayo Clinic. Of the 12 patients who were re-revised, 5 were due to patellar tendon ruptures, 5 for quadriceps tendon disruptions, and 2 for symptomatic lengthening of the mesh. There were four additional patients who had mesh failures, but they did not undergo revision mesh reconstructions. The mean improvement in extensor lag was 26°, with a mean extensor lag of 9° at most recent follow-up (P < 0.001). Moreover, Knee Society scores significantly improved (P < 0.001).

PATIENT SELECTION

Extensor mechanism reconstruction with Marlex mesh using a stepwise surgical approach results in excellent functional outcomes with a mean improvement in extensor lag of 26° and 84% of the mesh reconstructions in place at time of most recent follow-up.¹^,²^,³^,⁴

The indications for an extensor mechanism reconstruction with Marlex mesh include quadriceps tendon rupture during or after total knee arthroplasty (TKA) leading to extensor lag (either partial or complete), patellar tendon rupture during or after TKA leading to extensor lag (either partial or complete), and/or catastrophic patella fracture during or after TKA leading to extensor lag (either resurfaced or un-resurfaced).¹ In addition, native quadriceps tendon or patellar tendon ruptures leading to extensor lag may be treated with this technique as well.³ The only relative contraindication to an extensor mechanism reconstruction with Marlex mesh is active infection.²

PREOPERATIVE (DIAGNOSTIC) IMAGING

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