Enhanced Biomechanical Performance of a Modern Polyester Surgical Mesh for Extensor Mechanism Reconstruction in Total Knee Arthroplasty.

Abstract Background Extensor mechanism (EM) disruption following total knee arthroplasty (TKA) is a devastating postoperative complication. Reconstruction with a synthetic mesh is one treatment option, though the optimal mesh material remains unknown. This study sought to compare the mechanical properties of two mesh material types that can be used for EM reconstruction. Methods Mechanical properties of a polypropylene mesh (Marlex Mesh; CR Bard, Franklin Lakes, NJ) and LARS mesh (Corin; United Kingdom) were compared using force-displacement data from a material testing machine simulating knee movement during normal human gait. Tension to failure/ultimate tensile load (UTL), stiffness coefficients, axial strain, and cyclic hysteresis testing were measured and calculated. Results Compared to polypropylene mesh, LARS mesh demonstrated a significantly higher mean UTL (2,223 N versus 1,245 N, p = 0.002) and stiffness coefficient (255 N/mm versus 14 N/mm, p = 0.035) in tension to failure testing, and significantly more energy dissipation (hysteresis) in hysteresis testing (771 kJ versus 23 kJ; p ≤ 0.040). LARS mesh also demonstrated significantly less maximum displacement compared to the polypropylene mesh (9.2 mm versus 90.4 mm; p ≤ 0.001). Discussion Compared to polypropylene mesh, LARS mesh showed superior performance related to force-displacement testing. The enhanced mechanical performance of LARS mesh may correlate clinically to fewer failures, increased longevity and higher resistance to plastic deformation (extensor lag). Future research should evaluate survivorship and clinical outcomes of these meshes when used for EM reconstruction.