Biomechanical and Kinematic Influences of a Total Infrapatellar Fat                     Pad Resection on the Knee

Bohnsack, Michael; Wilharm, Arne; Hurschler, Christof; Rühmann, O.; Stukenborg-Colsman, Christina; Wirth, Carl Joachim

doi:10.1177/0363546504263946

Cited by 64 publications

(48 citation statements)

References 30 publications

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“…Patella infera after TKA has been reported in 10%65% of cases and has been linked to patellar eversion, radical excision of the fat pad, and lateral release. 5,6 In a prospective randomized controlled trial of 84 patients who had either TKA or UKA, 7 Weale et al reported 34% (14 of 41) of the TKA group developed patella infera, defined as 10% or more shortening of the patellar tendon postoperatively, compared with 5% (two of 43) in the UKA group. None of the above studies have reported an effect of fat pad excision on patellar tendon height five years following total knee replacement (see Fig.…”

Section: Discussionmentioning

confidence: 99%

Effects of fat pad excision on length of the patellar tendon after total knee replacement

Chougule

Stefanakis

Stefan

et al. 2015

Journal of Orthopaedics

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Total knee replacementPatellar tendon length a b s t r a c t Purpose: We report our results of the effect that total fat pad excision has on patellar tendon length following total knee replacement. Method:We retrospectively reviewed radiographs of the knees of 133 patients who had Depuy LCS uncemented TKR between January 2009 to December 2009. We excluded patients who had patella resurfacing, lateral release, knee replacement for other than osteoarthritis and who had other implants used. We measured the length of the patellar tendon using the Insall-Salvati ratio.. Changes in the length of the tendon were calculated both as an absolute evaluation and as a percentage of the original length.Results: We effect of fat pad excision on patellar tendon length at 1 year and 5 years following surgery. At one year we observed no change in patellar tendon length in 81.1%, patella infera in 17.3% and patella alta in 1.6% of these 133 patients. We manage to follow up 50 of these patients at 5 years following surgery. In comparison to pre-operative length, at one year 86% showed no change, 14% had patella infera and none had patella alta. At 5 years we observed no change in 98% and patella infera in 2% of patients.Forty nine percent of our patients with patella infera developed anterior knee pain, mean flexion in those patients was 95.625 and mean oxford score was 52.31.Conclusions: In our patients following single implant design used patella infera developed in up to 18% at one year following surgery. Two percent of fifty patients who had five years follow up showed further shortening of patellar tendon after one year. We conclude that complete fat pad excision during total knee replacement does affect patellar tendon length. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Effects of fat pad excision on length of the patellar tendon after total knee replacement

Chougule

Stefanakis

Stefan

et al. 2015

Journal of Orthopaedics

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“…2 The main function of the Hoffa's fat pad is not fully understood. It is considered to be associated with knee kinetics and patellar biomechanics, 3 express algesic molecules such as the substance P, and cause pain in the anterior knee compartment. 8 In the acute phase of Hoffa's syndrome, inflammation occurs following impingement, fibrin-hemosiderin builds up in macrophages and degenerative lipocytes develop.…”

Section: Discussionmentioning

confidence: 99%

“…However, its endocrine functions are not fully understood. 3 Wicham et al 4 showed that the IFP contains multipotent root cells capable of changing into chondrocyte, osteoblast and adipocyte cells under suitable culture conditions. In recent years, many radiologists and clinicians have been working on the development of IFP into metaplasia and chondroma due to these mesenchymal cells.…”

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confidence: 99%

Function of the Infrapatellar Fat Pad and Advanced Hoffa's Disease With Ossification

et al. 2014

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“…Second, shortening of the patellar tendon may arise with fat pad resection [24–26]. Third, fat pad resection has an influence on the biomechanics of the knee joint [33], as it seems to stabilize the knee joint, especially during extremes of knee motion (flexion angles of less than 20° and greater than 100°) [6]. …”

Section: Discussionmentioning

confidence: 99%

The Patellar Arterial Supply via the Infrapatellar Fat Pad (of Hoffa): A Combined Anatomical and Angiographical Analysis

Nemschak

Pretterklieber

2012

Anatomy Research International

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Even though the vascular supply of the human patella has been object of numerous studies until now, none of them has described in detail the rich arterial supply provided via the infrapatellar fat pad (of Hoffa). Therefore, we aimed to complete the knowledge about this interesting and clinically relevant topic. Five human patellae taken from voluntary body donators were studied at the Department of Applied Anatomy of the Medical University of Vienna. One was dissected under the operation microscope, a second was made translucent by Sihlers-solution, and three underwent angiography using a 3D X-ray unit. The results revealed that the patella to a considerable amount is supplied by arteries coursing through the surrounding parts of the infrapatellar fat pad. The latter were found to branch off from the medial and lateral superior and inferior genicular arteries. Within the infrapatellar fat pad, these arteries formed a dense network of anastomoses which are all contributing to the viability of the patellar bone. Due to the rich arterial supply reaching the patella via the infrapatellar fat pad, it seems advisable to preserve the fat pad during surgery of the knee in order to reduce the risk of vascular impairment of the patella.

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Biomechanical and Kinematic Influences of a Total Infrapatellar Fat Pad Resection on the Knee

Abstract: The infrapatellar fat pad may have a biomechanical function and may play a role in anterior knee pain syndrome.

Cited by 64 publications

References 30 publications

Effects of fat pad excision on length of the patellar tendon after total knee replacement

Effects of fat pad excision on length of the patellar tendon after total knee replacement

Function of the Infrapatellar Fat Pad and Advanced Hoffa's Disease With Ossification

The Patellar Arterial Supply via the Infrapatellar Fat Pad (of Hoffa): A Combined Anatomical and Angiographical Analysis

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