The external patello-tibial transfixation (EPTT). Part II: Clinical application and results

In part I of the paper the biomechanical and technical background of the EP TT using the MPT fixator and the indications for this procedure have been d escribed. In part II we report about the clinical application of the EPTT i n 67 patients with a wide spectrum of repairs and reconstructions of the ex tensor mechanism. 48 patients had fresh injuries, 18 of them with severe co ncomitant knee lesions and 19 patients had neglected rsp. unsuccessfully op erated injuries. There were 4 deep infections, two of them related to the M PT fixator. In the patients with uneventful healing the fixator remained in place for 7.3 weeks in average. The clinical, isokinetic and radiological results were reviewed in 17 patients with an average follow-up time of 37.3 months. There were 5 patients with partial patellectomy and tendon reattac hment because of lower patella pole comminution and 12 patients with tendon reattachment ruptured at the inferior patella pole or suture repair in mid substance rupture. The clinical results according to the IKDC score were ra ted in 3 patients as normal, in 10 patients as nearly normal and in 4 patie nts as abnormal. This rating was highly dependend on the subjective judgeme nt by the patients who considered their operated knees not as normal as the contralateral knees. From our clinical experiences and results we can deri ve that the EPTT enables the surgical management of extensor mechanism disr uptions with a minimum of interna I fixation material and provides a safe p rotection of the repairs and reconstructions during the healing period. The EPTT allows immediate unrestricted functional rehabilitation and early wal king without crutches. Thus the EPTT represents an effective alternative to the patello-tibial cerclage with a wire or synthetic ligaments.