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Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction

December 10, 2024/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 105-108 | Prasad Bhagunde, Damini Shah, Nihar Modi DOI: https://doi.org/10.13107/jcorth.2024.v09i02.684 Submitted Date: 10 Sep 2024, Review Date: 02 Oct 2024, Accepted Date: 22 Oct 2024 & Published Date: 10 Dec 2024 Author: Prasad Bhagunde [1, 2, 3, 4], Damini Shah […]

The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?

December 10, 2024/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 100-104 | Abhishek Nighot, Niharika Virkar DOI: https://doi.org/10.13107/jcorth.2024.v09i02.682 Submitted Date: 20 Aug 2024, Review Date: 05 Sep 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024 Author: Abhishek Nighot [1], Niharika Virkar [2] [1] Department of Orthopaedics, […]

Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction

December 10, 2024/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?

December 10, 2024/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

Full Sized Blog Element (Big Preview Pic)

Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction

December 10, 2024/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.684

Submitted Date: 10 Sep 2024, Review Date: 02 Oct 2024, Accepted Date: 22 Oct 2024 & Published Date: 10 Dec 2024

Author: Prasad Bhagunde [1, 2, 3, 4], Damini Shah [5], Nihar Modi [1, 3, 6]

[1] Department of Orthopaedics, Sona Medical Centre, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Saifee Hospital, Mumbai, Maharashtra, India.
[3] Department of Orthopaedics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
[4] Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, Maharashtra, India.
[5] Novo Tissue Bank and Research Centre, Mumbai, Maharashtra, India.
[6] Department of Orthopaedics, Criticare Asia Multispeciality Hospital and Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Prasad Bhagunde,
Director, Sona Medical Centre, Mumbai, Maharashtra, India.
E-mail: prasadbhagunde27@gmail.com

Abstract

Revolutionizing post-TKR care, novel use of Achilles tendon allografts emerge as a game-changer for displaced extensor mechanism, tackling one of the most challenging complications of total knee replacement. By restoring active knee extension and preventing lateral patellar subluxation, this technique empowers patients with improved mobility and independence.
The study included three patients with persistent patellar instability and malalignment were treated with a lateral retinacular release and Achilles tendon allograft fixation around the quadriceps mechanism. At 12 months, functional outcomes improved significantly: the Kujala score increased from 50 to 85, Knee Society Score (KSS) from 60 to 90, and Tegner Activity Level from 2 to 6. Postoperative imaging confirmed successful graft incorporation and alignment correction.
This technique, combining soft-tissue release with robust Achilles tendon allograft reconstruction, offers a promising solution for complex post-TKR patellar maltracking, highlighting the strength and adaptability of the Achilles tendon in restoring knee dynamics.
Overcoming the limitations of autografts and other traditional methods, this novel approach offers unmatched strength and adaptability while addressing critical surgical complexities. Despite potential challenges like stiffness and availability, the outcomes highlight enhanced function, stability, and patient satisfaction. With its innovative approach and tailored rehabilitation protocols, this procedure sets a new benchmark in orthopedic reconstructive surgery, combining precision and patient-centric care to redefine recovery.
Keywords: Quadriceps displacement, extensor mechanism repair, achilles tendon allograft, post-TKR complications

References

1. Ferri, R., Digennaro, V., Panciera, A., Bulzacki Bogucki, B. D., Cecchin, D., Manzetti, M., Brunello, M., & Faldini, C. (2023). Management of patella maltracking after total knee arthroplasty: a systematic review. In Musculoskeletal Surgery (Vol. 107, Issue 2, pp. 143–157). Springer Nature. https://doi.org/10.1007/s12306-022-00764-9
2. de Franco, C., de Matteo, V., Lenzi, M., Marano, E., Festa, E., Bernasconi, A., Smeraglia, F., & Balato, G. (2022). The active knee extension after extensor mechanism reconstruction using allograft is not influenced by “early mobilization”: a systematic review and meta-analysis. In Journal of Orthopaedic Surgery and Research (Vol. 17, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s13018-022-03049-w
3. Hoang, V., Anthony, T., Quattrocelli, M., Farina, E., Meter, J., & Lattermann, C. (2023). Quadriceps Tendon Reconstruction With Achilles Tendon Bone Block Allograft. Arthroscopy Techniques, 12(1), e45–e52. https://doi.org/10.1016/j.eats.2022.08.056
4. Kunze, K. N., Burnett, R. A., Shinsako, K. K., Bush-Joseph, C. A., Cole, B. J., & Chahla, J. (2019). Trapezoidal Achilles Tendon Allograft Plug for Revision Quadriceps Tendon Repair With a Large Tendon Defect. Arthroscopy Techniques, 8(9), e1031–e1036. https://doi.org/10.1016/j.eats.2019.05.015

How to Cite this article: Bhagunde P, Shah D, Modi N. Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction. Journal of Clinical Orthopaedics July-December 2024;9(2):105-108.

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The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?

December 10, 2024/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.682

Submitted Date: 20 Aug 2024, Review Date: 05 Sep 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024

Author: Abhishek Nighot [1], Niharika Virkar [2]

[1] Department of Orthopaedics, Hip and Knee Arthroplasty Unit, SAANVI Orthopaedics, Mumbai, Maharashtra, India.
[2] Department of Hand and Microsurgery, Pinnacle Hospital, Thane, Maharashtra, India.

Address of Correspondence

Dr. Abhishek Nighot,
Department of Orthopaedics, SICOT Fellow in Hip and Knee Arthroplasty, SAANVI Orthopaedics, Mumbai, Maharashtra, India.
E-mail: abhisheknighot43@gmail.com

Abstract

Introduction: Total knee arthroplasty (TKA) is a proven solution for end-stage knee arthritis, yet traditional mechanical alignment (MA), which aims for a neutral mechanical axis, leaves up to 20% of patients dissatisfied postoperatively. Kinematic alignment (KA) has emerged as an alternative, focusing on restoring the patient’s native anatomy and joint line orientation, achieving balance without extensive soft-tissue releases.
Methods: This article examines the principles of KA and compares it with MA regarding safety, outcomes, and biomechanical balance through a literature review comprising various retrospective studies, randomized controlled trials, and systemic reviews. KA relies on the patient’s unique femoral morphology to guide bone cuts, achieving natural alignment and ligament balance. Evidence suggests that KA offers comparable if not superior, functional outcomes, with higher Oxford knee scores and forgotten joint scores while maintaining similar implant survivorship. Studies also show KA leads to better compartmental balance, reduced knee adduction moments, and more natural gait mechanics. The compartmental pressure alignment knee classification highlights KA’s ability to balance the knee across various lower limb phenotypes.
Conclusion: Although KA shows promise, challenges remain. Concerns about tibial varus have been addressed, with studies confirming no compromise in implant stability or survival. However, long-term data are needed to validate KA’s durability and define its role for specific patient groups.
This article provides a comprehensive overview of KA’s benefits and limitations, offering guidance for surgeons seeking evidence-based alignment strategies. It underscores KA’s potential as a personalized approach in TKA, bridging gaps in satisfaction and functional outcomes while maintaining safety.
Keywords: Kinematic alignment, mechanical alignment, arthroplasty, osteoarthritis.

References

1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57-63.
2. Griffin FM, Insall JN, Scuderi GR. Accuracy of soft tissue balancing in total knee arthroplasty. J Arthroplasty 2000;15:970-3.
3. Rivière C, Iranpour F, Auvinet E, Aframian A, Asare K, Harris S, et al. Mechanical alignment technique for TKA: Are there intrinsic technical limitations? Orthop Traumatol Surg Res 2017;103:1057-67.
4. Beckers G, Meneghini RM, Hirschmann MT, Kostretzis L, Kiss MO, Vendittoli PA. Ten flaws of systematic mechanical alignment total knee arthroplasty. J Arthroplasty 2024;39:591-9.
5. Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: Is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012;470:45-53.
6. Rivière C, Harman C, Boughton O, Cobb J. The kinematic alignment technique for total knee arthroplasty. In: Rivière C, Vendittoli PA, editors. Personalized Hip and Knee Joint Replacement. Ch. 16. Cham, CH: Springer; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565753
7. Roth JD, Howell SM, Hull ML. Native knee laxities at 0°, 45°, and 90° of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Joint Surg Am 2015;97:1678-84.
8. Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: Two-year clinical results. Bone Joint J 2014;96-B:907-13.
9. Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: A prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2017;25:1743-8.
10. Howell SM, Shelton TJ, Hull Ml. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty 2018;33:3678-84.
11. Howell SM, Akhtar M, Nedopil AJ, Hull ML. Reoperation, implant survival, and clinical outcome after kinematically aligned total knee arthroplasty: A concise clinical follow-up at 16 years. J Arthroplasty 2024;39:695-700.
12. Van Essen J, Stevens J, Dowsey MM, Choong PF, Babazadeh S. Kinematic alignment results in clinically similar outcomes to mechanical alignment: Systematic review and meta-analysis. Knee 2023;40:24-41.
13. Laende EK, Richardson CG, Dunbar MJ. A randomized controlled trial of tibial component migration with kinematic alignment using patient-specific instrumentation versus mechanical alignment using computer-assisted surgery in total knee arthroplasty. Bone Joint J 2019;101-B:929-40.
14. Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J 2017;99-B:640-6. Erratum in: Bone Joint J 2021;103-B:1641.
15. Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018;26:1629-35.
16. MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB. Coronal plane alignment of the knee (CPAK) classification. Bone Joint J 2021;103-B:329-37.

How to Cite this article: Nighot A, Virkar N. The Promise of Kinematic Alignment in TKA: Game- Changer or Gimmick? Journal of Clinical Orthopaedics July-December 2024;9(2):100-104.

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Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction

The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?

Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction

The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?

Full Sized Blog Element (Big Preview Pic)

Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction

Author: Prasad Bhagunde [1, 2, 3, 4], Damini Shah [5], Nihar Modi [1, 3, 6]

Abstract

References

The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?

Author: Abhishek Nighot [1], Niharika Virkar [2]

Abstract

References

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