Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta‐Analysis of Randomized Controlled Trials

Abstract

The aim of the present study was to evaluate the effect of patellar denervation (PD) in preventing anterior knee pain (AKP) and improving knee function after total knee arthroplasty (TKA) without patellar resurfacing, and to help surgeons decide whether or not to use PD in TKA. Methods: The electronic databases of Pubmed, Embase, Cochrane, Web of Science, and Scopus were searched for all randomized controlled trials (RCT) comparing the outcomes of PD and no patellar denervation (NPD) in TKA without patellar resurfacing. Primary outcomes were incidence of AKP, visual analogue scale for pain (VAS), and patellar score (PS). Secondary outcomes were Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Knee Score (OKS), knee range of motion (ROM), and complications. Results: A total of nine RCT met the inclusion criteria. On meta-analysis, PD significantly reduced the incidence of AKP (odds ratio 0.49; 95% confidence interval [CI] 0.26 to 0.92), reduced the VAS (weighted mean difference [WMD] −0.57; 95% CI −1.02 to −0.11), and improved the WOMAC (WMD −4.63; 95% CI −6.49 to −2.77) and the ROM (WMD 9.60; 95% CI 0.39 to 18.81) during the follow-up within 12 months. In addition, PD improved the PS (WMD 1.01; 95% CI 0.65 to 1.38), KSS (WMD 1.12; 95% CI 0.10 to 2.14), and the WOMAC (WMD −1.41; 95% CI −2.74 to −0.08) during the follow-up after 12 months. Conclusion: Patellar denervation could significantly reduce the VAS and the incidence of AKP in the early stages after TKA as well as improve the clinical outcomes in terms of the PS, the WOMAC, the KSS, and the ROM. This study demonstrates that PD is a safe and recommendable technique that could be routinely performed in TKA.

Influence of patellar denervation on anterior knee pain and knee function following total knee replacement: a systematic review and meta‐analysis

“…Nevertheless, they have also reached mixed results, mainly due to the limited number of trials included and different methodologies. [12][13][14][15] The most recent meta-analysis published by Wang et al only included nine RCTs, and concluded that PD could reduce the prevalence of AKP as well as improve knee function in the early stage following TKR. 15 It is worth mentioning that several RCTs with high quality has been published recently, [16][17][18][19] and were not included and evaluated in previous meta-analyses.…”

“…[12][13][14][15] The most recent meta-analysis published by Wang et al only included nine RCTs, and concluded that PD could reduce the prevalence of AKP as well as improve knee function in the early stage following TKR. 15 It is worth mentioning that several RCTs with high quality has been published recently, [16][17][18][19] and were not included and evaluated in previous meta-analyses. Therefore, we performed this systematic review and meta-analysis to re-evaluate the effects of PD on AKP and knee function after TKR.…”

Effects of magnesium sulfate on periarticular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial

“…TKA features osteotomy, soft tissue release, and deep surgical sites and can lead to exposure of the sensory nerve fibers located around the patella with insufficient protection of the soft tissues, forcing patients to endure severe postoperative pain [ 1 , 21 , 22 ]. The use of perioperative analgesia is of great significance for patients undergoing TKA to return to exercise and enhance recovery [ 2 ].…”

Osteophytes mediate the associations between cartilage morphology and changes in knee symptoms in patients with knee osteoarthritis

“…According to the existing literature, patellofemoral OA is the most common cause of anterior knee pain [ 40 ]. The WOMAC is an important tool for assessing anterior knee pain [ 41 , 42 ], which may explain why patellar osteophytes mediated the association between cartilage morphology and change in WOMAC pain. In the subgroup analysis stratified by vitamin D intervention or not, there were no significant associations between cartilage morphology and change in knee symptoms in the vitamin D group.…”