Extensor mechanism failure in total knee arthroplasty (TKA) can present as quadriceps tendon rupture, patella fracture or patella tendon rupture.Component malrotation, excessive joint line elevation and previous lateral release are some of the risk factors contributing to extensor mechanism failure in TKA.Partial quadriceps tendon rupture and undisplaced patella fracture with intact extensor mechanism function can be treated conservatively.Extensor mechanism failure in TKA with disruption of the extensor mechanism function should be treated operatively as it is associated with poor function and extensor lag.It is recommended that acute repair of patella or quadriceps tendon rupture are augmented due to the high risk of re-rupture.Chronic ruptures of the extensor mechanism must be reconstructed as repair has a high failure rate. Reconstruction can be performed using autograft, allograft or synthetic graft. Cite this article: EFORT Open Rev 2021;6:181-188. DOI: 10.1302/2058-5241.6.200119.
Purpose: Total trapeziectomy is the most widely used technique to treat isolated thumb trapeziometacarpal joint osteoarthritis. However, this technique has been associated with proximal migration of the thumb metacarpal, which has led some physicians to consider partial trapeziectomy as a valid alternative. The purpose of this study was to assess whether partial trapeziectomy improves final key pinch strength compared with total trapeziectomy. Methods: We randomized 34 patients with basal thumb osteoarthritis into 2 groups to undergo partial or total trapeziectomy with interposition arthroplasty. Key pinch strength at 12 months was the primary outcome measure. Other variables measured included trapezial space height, range of motion, grip strength, change in key pinch strength, patient-reported outcome measures, and pain. Results: No difference between groups was detected regarding final pinch strength, trapezial space height, grip strength, range of motion, change in pinch strength, patient-reported outcomes (Quick-Disabilities of the Arm, Shoulder, or Hand), or pain. Conclusions: We cannot conclude that partial trapeziectomy provides an advantage over total trapeziectomy at 1 year after surgery. Although trapeziometacarpal space was substantially preserved in the partial trapeziectomy group at 12 months, this difference was not statistically or clinically significant. Type of study/level of evidence: Diagnostic III.
Purpose: Partial trapeziectomy is performed to decrease the risk for first ray collapse. However, the incidence of scaphotrapezoidal (ST) joint osteoarthritis (OA) in the presence of advanced trapeziometacarpal joint OA is around 40%. The purposes of this study were to analyze the progression of the ST joint after partial trapeziectomy and to establish the potential link between radiographic findings and patient outcomes. Methods: We reviewed a series of 22 patients (26 thumbs) with base of the thumb OA who underwent partial trapeziectomy and interposition arthroplasty. Standardized radiographs of the ST joint were classified by 2 independent observers. Measured outcomes were pain, mobility (degrees of abduction, Kapandji score, and anteversion [in centimeters]), force (in kilograms]) and the short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Results: Median follow-up was 8 years. The modified Eaton-Glickel scale was used to rate the degree of ST joint arthritis: 2 thumbs were classified as grade 1, 11 as grade 2, 12 as grade 3, and 1 as grade 4. No parameters analyzed demonstrated a statistically significant correlation between patients' outcomes and joint radiographic arthritis. Conclusions: Our study cannot demonstrate that the radiographic presence of ST arthritis correlates with the patient's main symptoms after partial trapeziectomy. Type of study/level of evidence: Therapeutic IV.
