Coverage Techniques for Soft-tissue Defects Around the Knee

Abstract

Loss of the quadriceps tendon, patella, and patellar tendon creates an anterior defect in the leg that may be difficult to close, and compromises the strength of extension of the knee. Allografting of the extensor mechanism of the knee can be used to substitute for severe quadriceps deficiency, but late failure is common with such substitution, and major quadriceps deficiency occurs after removal of the allograft material. This article describes a surgical procedure that uses transfer of the vastus medialis or vastus lateralis muscle and these muscles' tibial attachments, or both muscles and their distal expansions, together with the use of flaps of the gastrocnemius and soleus muscles, to cover major deficiencies in the anterior portion of the knee. All patients who have been treated with this method of knee reconstruction have healed without synovial fluid leakage or flap necrosis, and have regained extensor function of the knee. The magnitude of the extensor lag following reconstruction tends to be smaller in knees that include a gastrocnemius or soleus muscle transfer. The vastus medialis and vastus lateralis muscles provide adequate coverage for anterior soft-tissue deficits of the knee.

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