Surgical Technique

Single-stage total knee arthroplasty revision with extensor mechanism allograft: surgical technique

¹ Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon North, University Hospital, 69004 Lyon, France
² Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon, France
³ LIBM – EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, 69008 Lyon, France

^* Corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Received: 1 January 2026
Accepted: 2 March 2026

Abstract

Introduction: Chronic rupture of the extensor mechanism is a serious complication that could occur in the context of revision total knee arthroplasty (TKA). Performing combined extensor mechanism allograft reconstruction and revision TKA as a single-stage procedure requires precise surgical technique. Technique: Allograft size and quality were assessed preoperatively. A tibial tubercle osteotomy (TTO) was performed prior to revision TKA. After implantation of the definitive prosthesis, the TTO was fixed to the tibia using screws. The quadriceps tendon was sutured to the allograft using the Pulvertaft weave technique with the knee in full extension. Native patellar retinacula and prepatellar fascia were preserved to optimize graft coverage. Postoperatively, patients were immobilized in full extension for three months before starting progressive mobilization. Results: From January 2017 to April 2024, 20 patients underwent a single-stage revision TKA with total extensor mechanism allograft and were followed for a minimum of one year. Range of motion was recovered at follow-up. Five patients (25%) had failures attributed to the allograft. Conclusion: Single-stage TKA revision combined with extensor mechanism allograft, in the context of multiply operated knees, requires meticulous stepwise execution, including secure tibial fixation, precise graft tensioning, and preservation of native soft tissue coverage, to optimize outcomes in this high-risk setting.