Chronic Extensor Mechanism Failure After Primary or Revision Total Knee Arthroplasty: Reconstructive and Augmentation Options

Extensor mechanism failure is a rare but severe adverse event after primary or revision total knee arthroplasty (TKA). Its prevalence is reported to be between 0.1% and 2.5% in all TKA, but revision TKA is considered to carry a higher risk. Reconstructive and augmentation alternatives of chronic extensor mechanism failure comprise autograft, allograft, synthetic graft, and medial gastrocnemius flap. A systematic review found that synthetic mesh demonstrated equivalent extensor mechanism reconstruction success as allograft but with much lower cost, near universal availability, lack of illness transmission, and potential for reducing graft stretch-out. Complication and reoperation percentages are high, regardless of extensor mechanism reconstruction procedure. Consequently, extensor mechanism disruption following TKA remains problematic.