{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T21:36:33Z","timestamp":1789767393181,"version":"4.0.1"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Extensor mechanism disruption following total knee arthroplasty (TKA) is a devastating complication that causes high failure rates. There is controversy on what is the best way to do an extensor mechanism reconstruction. This study aims to compare both allograft and synthetic reconstructive techniques for success, reoperation, and infection rates and functional outcomes. The search on PubMed, MEDLINE, Embase, BIOSIS, and Cochrane databases was performed on March 15, 2019, using the following keyword groups: (1) \u201cextensor mechanism\u201d and \u201ctotal knee arthroplasty,\u201d (2) \u201cextensor mechanism\u201d and \u201cknee arthroplasty,\u201d (3) \u201cextensor mechanism\u201d and \u201crevision total knee arthroplasty,\u201d and (4) \u201cextensor mechanism\u201d and \u201crevision knee arthroplasty\u201d. Only studies on extensor mechanism disruption after TKA that included sufficient data to compare these two surgical techniques were included. Meta-analysis was performed with random effect model using the DerSimonian\u2013Laird method. Thirty studies were included. The overall success rate of the reconstruction was 73.3% (95% confidence interval [CI]: 0. 651, 0.814). The success rate of allograft (72.8%, 95% CI: 0.626, 0.829) was not significantly different from synthetic material (78%, 95% CI: 0.707, 0.852, p\u2009=\u20090.416). There was no significant difference in revision rates between allograft (14.2%, 95% CI: 0.095, 0.189) and synthetic material (16%, 95% CI: 0.096, 0.223, p\u2009=\u20090.657). The overall relative risk of infection was 4.301 (95% CI: 1.885, 9.810). There was no significant difference in relative risk of infection between allograft (3.886, 95% CI: 1.269, 11.903) and synthetic material (4.851, 95% CI: 1.433, 16.419, p\u2009=\u20090.793). No statistically significant difference was found in mean postoperative Knee Society score (73.109 [95% CI: 67.296, 78.922] vs. 72.679 [95% CI: 69.184, 76.173], p\u2009=\u20090.901) between allograft and mesh reconstruction groups. There were no significant differences in overall failures, infections, functional outcomes, or revision reconstructions between allograft and synthetic material extensor mechanism reconstructions. Our results demonstrate the difficulty in treating this serious injury, independent of technique, as well as the significant risk for overall failure and infection.<\/jats:p>","DOI":"10.1055\/s-0039-1696656","type":"journal-article","created":{"date-parts":[[2019,8,30]],"date-time":"2019-08-30T19:08:05Z","timestamp":1567192085000},"page":"338-350","source":"Crossref","is-referenced-by-count":21,"title":["Meta-analysis Comparing Allograft to Synthetic Reconstruction for Extensor Mechanism Disruption after Total Knee Arthroplasty"],"prefix":"10.1055","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6010-7748","authenticated-orcid":false,"given":"Matthew E.","family":"Deren","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Massachusetts Medical School, Worcester, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejbir S.","family":"Pannu","sequence":"additional","affiliation":[{"name":"Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus M.","family":"Villa","sequence":"additional","affiliation":[{"name":"Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Firtha","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo M.","family":"Riesgo","sequence":"additional","affiliation":[{"name":"Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Higuera","sequence":"additional","affiliation":[{"name":"Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,8,30]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"3134","DOI":"10.1016\/j.arth.2017.05.005","article-title":"Reconstruction of disrupted extensor mechanism after total knee arthroplasty","volume":"32","author":"C T Lim","year":"2017","journal-title":"J Arthroplasty"},{"issue":"416","key":"ref2","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":"260","key":"ref3","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/00003086-199011000-00026","article-title":"Reconstruction of patellar tendon rupture after TKA with an extensor mechanism allograft","author":"R H Emerson Jr","year":"1990","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.arth.2016.06.031","article-title":"Survivorship of extensor mechanism allograft reconstruction after total knee arthroplasty","volume":"32","author":"B F Ricciardi","year":"2017","journal-title":"J Arthroplasty"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s11999-014-3540-y","article-title":"Current modes of failure in TKA: infection, instability, and stiffness predominate","volume":"472","author":"D H Le","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref6","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":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"715","DOI":"10.2106\/JBJS.M.01534","article-title":"Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery","volume":"97","author":"K Thiele","year":"2015","journal-title":"J Bone Joint Surg Am"},{"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. 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