{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:51:24Z","timestamp":1783075884079,"version":"3.54.6"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Rupture of the extensor mechanism of the knee has severe functional morbidity, and repair can be complicated by infection, allograft degeneration, and recurrent rupture. Techniques of autologous tissue repair utilizing pedicled flaps such as the gastrocnemius offer vascularized methods of reconstruction, with potentially diminished complication rates. The goal of this study was to evaluate the functional outcomes and complications associated with pedicled flap repair of the knee extensor mechanism.<\/jats:p><jats:p>\n          Methods\u2003A systematic review was conducted following the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Publications that focused on local myocutaneous flaps as a means for reconstruction were included. Causes for knee extensor mechanism deficit, flap characteristics, ambulation rate, changes in range of motion pre- and postoperation, and postoperative complications were analyzed. Technique reports including primary suture repairs, synthetic mesh, and allograft use were excluded.<\/jats:p><jats:p>\n          Results\u2003An initial 119 studies were identified, with final review of 22 observational studies encompassing 128 cases of pedicled flap reconstructions. The gastrocnemius (88.2%, n\u2009=\u2009113), quadriceps (6.3%, n\u2009=\u20098), and a combination of the vastus and gastrocnemius flaps (5.5%, n\u2009=\u20097), were the most frequently utilized flaps. Functional outcomes were favorable with 87.2% of patients achieving ambulation without external support. Variability in range of motion outcomes across different flap may be secondary to the patient characteristics as well as extent of initial injury.<\/jats:p><jats:p>\n          Conclusion\u2003Autologous pedicle flap reconstruction of the knee extensor mechanism emerges as a viable option for cases characterized by extensive defects and insufficient soft tissue coverage, which are not amenable to direct suture repairs or allografts. Postoperative assessments revealed that the majority of patients experienced improved ambulation status, with no instances of deterioration noted among the patients.<\/jats:p>","DOI":"10.1055\/a-2355-4073","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T23:21:00Z","timestamp":1719530460000},"page":"287-294","source":"Crossref","is-referenced-by-count":2,"title":["A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism"],"prefix":"10.1055","volume":"41","author":[{"given":"Nayun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlie H.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin T.","family":"McNamara","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Greyson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig A.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Iorio","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,7,15]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1055\/s-0042-1748977","article-title":"Composite free tissue transfer for reconstruction of lower extremity tendon injuries: a systematic review","volume":"39","author":"A A Sayyed","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"04","key":"ref2","first-page":"224","article-title":"Extensor mechanism complications following total knee arthroplasty","volume":"16","author":"J A Rand","year":"2003","journal-title":"J Knee Surg"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S0883-5403(87)80020-7","article-title":"Extensor mechanism complications following total knee arthroplasty","volume":"2","author":"A F Lynch","year":"1987","journal-title":"J Arthroplasty"},{"issue":"244","key":"ref4","first-page":"233","article-title":"Patellar tendon rupture after total knee arthroplasty","author":"J A Rand","year":"1989","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref5","first-page":"37","article-title":"Quadriceps tendon rupture after total knee arthroplasty. Prevalence, complications, and outcomes","volume":"87","author":"R E Dobbs","year":"2005","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.2106\/JBJS.J.01036","article-title":"Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh","volume":"93","author":"J A Browne","year":"2011","journal-title":"J Bone Joint Surg Am"},{"issue":"367","key":"ref7","first-page":"123","article-title":"Extensor mechanism allografts in total knee arthroplasty","author":"D G Nazarian","year":"1999","journal-title":"Clin Orthop Relat Res"},{"issue":"12","key":"ref8","doi-asserted-by":"crossref","first-page":"2694","DOI":"10.2106\/00004623-200412000-00016","article-title":"Extensor mechanism allograft reconstruction after total knee arthroplasty. A comparison of two techniques","volume":"86","author":"R S Burnett","year":"2004","journal-title":"J Bone Joint Surg Am"},{"issue":"416","key":"ref9","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/01.blo.0000092993.90435.69","article-title":"Treating extensor mechanism disruption after total knee arthroplasty","author":"R L Barrack","year":"2003","journal-title":"Clin Orthop Relat Res"},{"issue":"303","key":"ref10","first-page":"79","article-title":"Extensor mechanism reconstruction with an allograft after total knee arthroplasty","author":"R H Emerson Jr","year":"1994","journal-title":"Clin Orthop Relat Res"},{"issue":"11","key":"ref11","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.2106\/00004623-199911000-00009","article-title":"High rate of failure of allograft reconstruction of the extensor mechanism after total knee arthroplasty","volume":"81","author":"S S Leopold","year":"1999","journal-title":"J Bone Joint Surg Am"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.2106\/00004623-200208000-00011","article-title":"Reconstruction of a ruptured patellar tendon with achilles tendon allograft following total knee arthroplasty","volume":"84","author":"L S Crossett","year":"2002","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s11999-012-2532-z","article-title":"Surgical technique: vastus medialis and vastus lateralis as flap transfer for knee extensor mechanism deficiency","volume":"471","author":"L A Whiteside","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"384","key":"ref14","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/00003086-200103000-00024","article-title":"Knee reconstruction with prosthesis and muscle flap after total arthrectomy","author":"P Anract","year":"2001","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/0007-1226(94)90053-1","article-title":"Reconstruction of the quadriceps apparatus following open injuries to the knee joint using pedicled gastrocnemius musculotendinous unit as bridge graft","volume":"47","author":"N V Babu","year":"1994","journal-title":"Br J Plast Surg"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/01.SAP.0000063752.33986.97","article-title":"Medial gastrocnemius muscle flap in limb-sparing surgery of malignant bone tumors of the proximal tibia: mid-term results in 25 patients","volume":"51","author":"M Buchner","year":"2003","journal-title":"Ann Plast Surg"},{"issue":"428","key":"ref17","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/01.blo.0000148593.44691.30","article-title":"Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty","author":"B T Busfield","year":"2004","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/S0883-5403(97)90183-2","article-title":"One-stage reconstruction of skin defect and patellar tendon rupture after total knee arthroplasty. A new technique","volume":"12","author":"H M Chiou","year":"1997","journal-title":"J Arthroplasty"},{"issue":"02","key":"ref19","first-page":"196","article-title":"Pedicled gastrocnemius flap: clinical application in limb sparing surgical resection of sarcoma around the knee region and popliteal fossa","volume":"20","author":"M El-Sherbiny","year":"2008","journal-title":"J Egypt Natl Canc Inst"},{"issue":"08","key":"ref20","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/j.injury.2016.05.020","article-title":"Medial gastrocnemius flap for reconstruction of the extensor mechanism of the knee following high-energy trauma. A minimum 5 year follow-up","volume":"47","author":"E Hohmann","year":"2016","journal-title":"Injury"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"866","DOI":"10.2106\/00004623-199706000-00010","article-title":"Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty","volume":"79","author":"J W Jaureguito","year":"1997","journal-title":"J Bone Joint Surg Am"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.knee.2017.01.012","article-title":"Patellar tendon reconstruction using an extended gastrocnemius flap following cryogenic injury to the knee","volume":"24","author":"R H Kim","year":"2017","journal-title":"Knee"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/01.sap.0000192031.46986.9b","article-title":"Vastus medialis muscle flap and hemi V-Y skin flap for knee extensor and soft tissue reconstruction","volume":"56","author":"Y Kubota","year":"2006","journal-title":"Ann Plast Surg"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/00005131-199402000-00009","article-title":"Reconstruction of extensor mechanism after trauma and infection by transposition of the Achilles tendon: report of technique and four cases","volume":"8","author":"K S Leung","year":"1994","journal-title":"J Orthop Trauma"},{"issue":"239","key":"ref25","first-page":"231","article-title":"Limb-sparing surgery for high-grade malignant tumors of the proximal tibia. Surgical technique and a method of extensor mechanism reconstruction","author":"M M Malawer","year":"1989","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1080\/02844310601012015","article-title":"Gastrocnemius muscle flap including Achilles tendon after extensive patellectomy for soft tissue sarcoma","volume":"42","author":"T Osanai","year":"2008","journal-title":"Scand J Plast Reconstr Surg Hand Surg"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/BOT.0b013e31819b83b5","article-title":"Knee extensor mechanism reconstruction with an extended gastrocnemius flap and a saphenous neurocutaneous flap","volume":"23","author":"J W Park","year":"2009","journal-title":"J Orthop Trauma"},{"issue":"398","key":"ref28","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/00003086-200205000-00025","article-title":"Knee extensor mechanism reconstruction with medial gastrocnemius flap","author":"N S Patel","year":"2002","journal-title":"Clin Orthop Relat Res"},{"issue":"377","key":"ref29","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/00003086-200008000-00021","article-title":"Gastrocnemius myotendinous flap for patellar or quadriceps tendon repair, or both","author":"M Rhomberg","year":"2000","journal-title":"Clin Orthop Relat Res"},{"issue":"07","key":"ref30","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00167-008-0533-y","article-title":"A \u201cbiologic technique\u201d for the treatment of a disruption of the extensor mechanism after revision total knee arthroplasty: a case report","volume":"16","author":"N Roidis","year":"2008","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"04","key":"ref31","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00264-023-05716-x","article-title":"Medial gastrocnemius rotational flap for the reconstruction of extensor mechanism disruption in periprosthetic knee infections: a retrospective series with minimum two year follow-up","volume":"47","author":"A Russo","year":"2023","journal-title":"Int Orthop"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.bjps.2018.11.002","article-title":"ALT flap with vascularized fascia lata for one-stage functional patellar tendon reconstruction","volume":"72","author":"G Sapino","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"12","key":"ref33","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1111\/j.1445-2197.2006.03951.x","article-title":"Extended medial gastrocnemius myocutaneous flap in repair of the quadriceps extension mechanism","volume":"76","author":"S K Warrier","year":"2006","journal-title":"ANZ J Surg"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/s11999-013-3101-9","article-title":"Surgical technique: muscle transfer restores extensor function after failed patella-patellar tendon allograft","volume":"472","author":"L A Whiteside","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref35","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1097\/CORR.0000000000000564","article-title":"Does patellar tendon repair with gastrocnemius flap augmentation effectively restore active extension after proximal tibial sarcoma resection?","volume":"477","author":"C A Cipriano","year":"2019","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref36","doi-asserted-by":"crossref","first-page":"603","DOI":"10.5312\/wjo.v5.i5.603","article-title":"Flap reconstruction of the knee: a review of current concepts and a proposed algorithm","volume":"5","author":"A Gravvanis","year":"2014","journal-title":"World J Orthop"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2355-4073.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T23:28:07Z","timestamp":1744414087000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2355-4073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,27]]},"references-count":36,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2025,4,11]]},"published-print":{"date-parts":[[2025,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2355-4073","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,6,27]]},"published":{"date-parts":[[2024,6,27]]}}}