Marlex mesh may be durable, reliable in reconstruction for extensor mechanism disruption
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Key takeaways:
- Patients with extensor mechanism disruption had a 20% cumulative incidence of a mesh failure requiring mesh revision.
- Patients also had a cumulative incidence of any mesh revision of 27% at 10 years.
GRAPEVINE, Texas — Results presented at the American Association of Hip and Knee Surgeons Annual Meeting showed synthetic mesh reconstructions for extensor mechanism disruption may be a durable and reliable technique.
“It is a good solution for a bad problem,” Matthew P. Abdel, MD, said in his presentation here. “Not a perfect solution, but a difficult cohort of patients.”
Abdel and colleagues used the cumulative incidence of failure of a synthetic Marlex mesh (C.R. Bard) requiring mesh revision, any mesh revision and any revision among 93 patients with extensor mechanism disruption who underwent either Marlex mesh reconstruction in the aseptic setting (n=77) or Marlex mesh reconstruction and reimplantation (n=16). Clinical outcomes included extension lag and active knee range of motion with an immobilization period of 3 months.
“The cumulative incidence of a mesh failure requiring mesh revision was 20% at 10-years,” Abdel said. “That would mean that at 10 years, 80% of the mesh were in situ in this cohort of 77 aseptic ones and 16 at reimplantation with a two-stage exchange arthroplasty.”
Of the 28 mesh failures, Abdel said 11 patients experienced patellar tendon rerupture, nine patients experienced symptomatic lengthening and eight patients experienced quadriceps tendon reruptures.
“The question then arises, what do you do with these patients?” Abdel said. “Seventeen were treated with mesh rerevision and 11 patients were treated nonoperatively in the drop lock brace per the recommendations of the surgeon and patient combined.”
He added patients had a cumulative incidence of any mesh revision of 27% at 10 years, which included 17 patients who had mesh rerevision and seven patients who underwent mesh removal for recurrent periprosthetic joint infection. Patients had a cumulative incidence of any revision of 15% at 10 years, with 85% of patients without a component revision, according to Abdel.
“The mean extensor lag was 37° pre-mesh reconstruction to 9° after and that was statistically significant,” Abdel said. “A question we often get is what is the mean flexion? That most recent follow-up indicates that the mean flexion of these patients is about 100°.”
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Abdel MP, et al. Paper 2. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 2-5, 2023; Grapevine, Texas.
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