Deep-dished highly congruent tibial insert in CR-TKA does not prevent patellar tendon angle increase and patellar anterior translation

Abstract

Case series, Level IV.

Total knee arthroplasty using ultra-congruent inserts can provide similar stability and function compared with cruciate-retaining total knee arthroplasty

“…Although there are many advantages of PCL retention in TKA, such as physiological femoral rollback, good range of motion, and few patellar complications [1, 2, 6, 7, 10], the post‐surgical function of the PCL may not be ideal because of damage during surgery or rupture during the follow‐up period. Hence, post‐cam mechanisms are often used to substitute for the PCL [9, 18, 22].…”

Does patellofemoral geometry in TKA affect patellar position in mid-flexion?

“…Several researchers investigated patellar tracking in vitro, using cadaver knees or numeric simulations, because of difficulties in recording dynamic measurements in patients [5,20,27,33,42]. Some clinicians studied patellar position in vivo, using static radiographic images, and correlated it with clinical and functional outcomes [3,7,30,41,48,55]. Very few studies, however, compared patellar position in relation to tibiofemoral kinematics before and after knee arthroplasty in vivo [10].…”

“…Very few studies, however, compared patellar position in relation to tibiofemoral kinematics before and after knee arthroplasty in vivo [10]. While the patellar tilt and congruence are commonly measured at 20° to 45° of flexion to assess engagement within the trochlear groove [34,40], the patellar tendon angle (PTA) and height are often measured at 90° of flexion to assess extensor mechanism lever arm and its impact on tibiofemoral kinematics [3,6].…”

“…4), as well as patel-lar flexion and height in the sagittal plane, and patellar rotation and mediolateral position in the frontal plane (Fig. 5) [3,6]. The authors chose to measure patellar position at 90° of flexion because (a) the angle is practical and repeatable for inter-operative measurements [6], (b) it is considered an important turning point where the patellofemoral contact area transfers from the distal trochlea to the anterior condyles [23,29], (c) it ensures the patella is tightly locked within the trochlear groove and unaffected by manual contact and (d) it is where the quadriceps forces are highest and where the patella provides greatest mechanical advantage [15,38,44,50].…”

Alpine Skiing With total knee ArthroPlasty (ASWAP): effect on tendon properties

“…Accordingly, training (Kubo et al, 2001;Reeves et al, 2003;Arampatzis et al, 2007;Kongsgaard et al, 2007) and disuse (de Boer et al, 2007) studies have shown changes in tendon morphological, mechanical, and material properties. It follows that changes in tendon mechanical loading observed in TKA patients (Stagni et al, 2010;Akkawi et al, 2014) may require such adaptations (Galloway et al, 2013) to prevent injury and/or to maintain functional capacity. However, morphological and material adjustments following TKA and/or exercise training are currently undocumented in these patients.…”