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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 6, 873-878.
doi: 10.1302/0301-620X.87B6.15363  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Extensor mechanism reconstruction after proximal tibial replacement

M. J. Oddy, MA, MSc, MRCS, Research Fellow1; C. J. Pendegrass, BSc, Research Fellow1; A. E. Goodship, BVSc, MRCVS, PhD, Professor of Orthopaedic Sciences2; S. R. Cannon, MA, MCh(Orth), FRCS, Consultant Orthopaedic Surgeon3; T. W. R. Briggs, MCh(Orth), FRCS(Ed), FRCS, Consultant Orthopaedic Surgeon3; and G. W. Blunn, BSc, PhD, Professor of Biomedical Engineering1

1 The Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science, University College London, Brockley Hill, Stanmore HA7 4LP, UK.
2 University College London the Royal Veterinary College Royal Veterinary College, Hawkhead Lane, North Mimms, Hertfordshire AL9 7TA, UK.
3 The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.

Correspondence should be sent to Ms C. J. Pendegrass; e-mail: c.pendegrass{at}ucl.ac.uk

We developed an in vivo model of the attachment of a patellar tendon to a metal implant to simulate the reconstruction of an extensor mechanism after replacement of the proximal tibia. In 24 ewes, the patellar tendon was attached to a hydroxyapatite (HA)-coated titanium prosthesis. In 12, the interface was augmented with autograft containing cancellous bone and marrow. In the remaining ewes, the interface was not grafted.

Kinematic gait analysis showed nearly normal function of the joint by 12 weeks. Force-plate assessment showed a significant increase in functional weight-bearing in the grafted animals (p = 0.043). The tendon-implant interface showed that without graft, encapsulation of fibrous tissue occurred. With autograft, a developing tendon-bone-HA-implant interface was observed at six weeks and by 12 weeks a layered tendon-fibrocartilage-bone interface was seen which was similar to a direct-type enthesis.

With stable mechanical fixation, an appropriate bioactive surface and biological augmentation the development of a functional tendon-implant interface can be achieved.




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C. J. Pendegrass, S. Sundar, M. J. Oddy, S. R. Cannon, T. Briggs, and G. W. Blunn
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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General