Changes in patella tendon length over 5 years after different types of knee arthroplasty

Davies, Gareth Sion; Duren, Bernard H van; Shorthose, Matthew; Roberts, Philip; Morley, John; Monk, Paul; Murray, David; Pandit, Hemant

doi:10.1007/s00167-016-4170-6

Cited by 39 publications

(44 citation statements)

References 21 publications

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“…Previous studies have proved that the patella baja is a common complication of TKA [2,9], which can be classi ed as a true patella baja caused by the shortening of the patellar tendon and the pseudo patella baja caused by the elevating of the joint line [12,32]. The incidence of the pseudo patella baja following TKA had been published in 34% − 65% [11].…”

Section: Discussionmentioning

confidence: 99%

A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty

Han

Zhang

2020

Preprint

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Abstract Background: The measurement of patellar height and restoration of the natural position of the joint line are crucial to total knee arthroplasty (TKA). However, there remains a lack of consensus on an optimal measurement method to associate the patellar height with the joint line position. The objective of this study was to introduce a new method and validate the application in TKA both preoperatively and postoperatively.Methods: Instead of taking marginal landmarks as the tibial references, the tibial shaft axis was used to construct the new measurement method, which comprises the axis-patella (AP), joint axis-patella (jAP) indices and joint line height (JLH). Patellar heights were measured using the Insall-Salvati (IS), modified Insall-Salvati (mIS), Blackburne-Peel (BP), Caton-Deschamps (CD) indices, and the new method in 175 knees both preoperatively and postoperatively. Intraclass correlation coefficients and Pearson’s correlation analysis were respectively used to evaluate the reliabilities and correlations.Results: There was good correlation between the proposed method and the mIS, CD, and BP indices. High inter-observer reproducibility was found for AP (preoperative and postoperative 0.83), jAP (preoperative 0.82; postoperative 0.86) indices and JLH (preoperative 0.88; postoperative 0.95). High intra-observer repeatability was also found for AP (preoperative 0.85; postoperative 0.87), jAP (preoperative 0.83; postoperative 0.87) indices and JLH (preoperative 0.80; postoperative 0.92). Conclusions: The new method is reliable for measuring patellar height before and after TKA, providing an alternative to distinguish between true and pseudo patella baja. Furthermore, JLH can be applied to assess and restore the joint line position in TKA.

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Section: Discussionmentioning

confidence: 99%

A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty

Han

Zhang

2020

Preprint

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“…Shortening of the patella tendon directly as a result of soft tissue misalignment or tissue accumulation may be present immediately post operatively, whereas a more chronic shortening may progress secondary to increasing patellofemoral compartment pressures and subsequent pull and tearing of the misaligned extensor mechanism as the knee moves into flexion . This is thought to result in scar tissue formation, contracture and permanent shortening of the patella tendon that is not present immediately after surgery . Shortening of the patella tendon is also hypothesised to occur indirectly as a result of an excessively tight skin closure.…”

Section: Discussionmentioning

confidence: 99%

Does knee position during wound closure alter patella height following total knee arthroplasty?

Clark¹,

Tee²,

Sutherland³

2019

ANZ Journal of Surgery

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Background: Patella infera is a known complication of total knee arthroplasty, and the method of soft tissue closure is a possible contributing factor. The aim of our study was to evaluate the effect of knee position during surgical closure of capsule, subcutaneous tissue and skin on patella tendon length after total knee arthroplasty. Methods: A three arm retrospective cohort study was conducted in a single institution over a 3-year period; 75 patients were divided, by surgeon preference, into three groups (Flexed, Extended and Hybrid) of 25 patients. All groups had standardized prosthesis, intraoperative and postoperative protocols, and differed in knee position at closure. Patellar tendon length was assessed radiologically using Insall Salvati ratio (ISR) and modified Insall Salvati ratio, with a 12-month follow-up. Intraclass correlation coefficients were used to assess intraobserver variability. Results: There was a small but significant difference in preoperative to initial postoperative ISR change between Flexed and Extended groups (Extended group mean ISR change = −0.05; t = −2.31, P = 0.025, independent samples t-test), which was not sustained at 12 months. The incidence of patella infera was similar in Flexed and Extended groups at 12 months with only one case seen in the Hybrid group. Conclusion: Our study suggests that knee position during soft tissue closure does not have a sustained impact on patella tendon length after knee replacement. A small but statistically significant reduction in patella height was found in the Extended group initially after surgery but this effect was not sustained at 12 months.

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“…But perhaps the best in vivo evidence for adult human tendon length adaptation is evidenced following knee arthroplasty. Davies et al [ 106 ] provides data reporting substantial patellar tendon length adaptation over five year periods following knee arthroplasty. After examining 50 patients (n = 150 procedures), Davies et al [ 106 ] reports that following total knee arthroplasty, 38% of patellar tendons shortened by at least 10% after 5 years, while uni-compartment knee arthroplasty resulted in patellar tendon lengthening by at least 10% in 24% of patients after one year, and 22% after five years.…”

Section: Discussionmentioning

confidence: 99%

“…Davies et al [ 106 ] provides data reporting substantial patellar tendon length adaptation over five year periods following knee arthroplasty. After examining 50 patients (n = 150 procedures), Davies et al [ 106 ] reports that following total knee arthroplasty, 38% of patellar tendons shortened by at least 10% after 5 years, while uni-compartment knee arthroplasty resulted in patellar tendon lengthening by at least 10% in 24% of patients after one year, and 22% after five years. Multiple additional studies on patellar tendon lengthening and shortening following knee replacement clearly demonstrate the capacity of adult human patellar tendon to remodel its length [ 107 – 109 ].…”

Section: Discussionmentioning

confidence: 99%

Adaptive Remodeling of Achilles Tendon: A Multi-scale Computational Model

et al. 2016

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While it is known that musculotendon units adapt to their load environments, there is only a limited understanding of tendon adaptation in vivo. Here we develop a computational model of tendon remodeling based on the premise that mechanical damage and tenocyte-mediated tendon damage and repair processes modify the distribution of its collagen fiber lengths. We explain how these processes enable the tendon to geometrically adapt to its load conditions. Based on known biological processes, mechanical and strain-dependent proteolytic fiber damage are incorporated into our tendon model. Using a stochastic model of fiber repair, it is assumed that mechanically damaged fibers are repaired longer, whereas proteolytically damaged fibers are repaired shorter, relative to their pre-damage length. To study adaptation of tendon properties to applied load, our model musculotendon unit is a simplified three-component Hill-type model of the human Achilles-soleus unit. Our model results demonstrate that the geometric equilibrium state of the Achilles tendon can coincide with minimization of the total metabolic cost of muscle activation. The proposed tendon model independently predicts rates of collagen fiber turnover that are in general agreement with in vivo experimental measurements. While the computational model here only represents a first step in a new approach to understanding the complex process of tendon remodeling in vivo, given these findings, it appears likely that the proposed framework may itself provide a useful theoretical foundation for developing valuable qualitative and quantitative insights into tendon physiology and pathology.

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Changes in patella tendon length over 5 years after different types of knee arthroplasty

Abstract: Retrospective, comparative study, Level III.

Cited by 39 publications

References 21 publications

A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty

A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty

Does knee position during wound closure alter patella height following total knee arthroplasty?

Adaptive Remodeling of Achilles Tendon: A Multi-scale Computational Model

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