Is Further Treatment Necessary for Patellar Crepitus After Total Knee Arthroplasty?

Hwang, Bo-Hyun; Nam, Chang-Hyun; Jung, Kwang Am; Ong, Alvin; Lee, Su-Chan

doi:10.1007/s11999-012-2634-7

Cited by 11 publications

(12 citation statements)

References 32 publications

(61 reference statements)

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“…59 Furthermore, there are more options for the attainment of proper patellar tracking, including using a patella friendly femoral prosthesis 59 and performing appropriate patelloplasty. 39 Lateral retinacular release may stimulate scar tissue formation up to the synovial lining overlying the top of the femoral component and the peripatellar soft tissue. As the detailed mechanism of the association between PCC and lateral retinacular release remains unknown, the indications for lateral release should be considered carefully.…”

Section: Discussionmentioning

confidence: 99%

“…There were also other factors for which the data from different studies could not be pooled due to inconsistent data forms, a broad range of definitions, or the data being reported only in a single study. The potential risk factors for PCC that were not included in the pooled analyses due to high heterogeneity and inconsistent data forms included patellar thickness, 10,29,52 postoperative joint line, 29,38,40 posterior femoral condylar offset, 10,29,39,52 patellar tendon length, 10,39,52 Z distance, 38,40 "P distance" (position of the proximal pole of the patella with reference to the distal end of the femoral prosthesis), 38,40 lateral displacement of the patella, 38,40 and preoperative knee flexion. 10,29 We were also unable to pool the data on the patellar, femoral, and tibial component sizes.…”

Section: Discussionmentioning

confidence: 99%

“…Previous surgery was found to be a risk factor for PCC in one study 10 but not in others. 29,39 Similarly, increased patellar tilt was a risk factor for PCC in some studies 30,38 but not in others. 39,40 It is also debatable whether increases in joint line changes 38,39 or postoperative flexion 10,40 are risk factors for PCC.…”

mentioning

confidence: 96%

“…29,39 Similarly, increased patellar tilt was a risk factor for PCC in some studies 30,38 but not in others. 39,40 It is also debatable whether increases in joint line changes 38,39 or postoperative flexion 10,40 are risk factors for PCC. Further studies are needed to clarify these controversies.…”

mentioning

confidence: 96%

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Risk Factors for Patellar Clunk or Crepitation after Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis

et al. 2020

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Patellar clunk and crepitation (PCC) have been reported as a consequence of primary total knee arthroplasty (TKA). The incidence and contributing factors have not been fully defined. We performed this systematic review to evaluate factors associated with PCC following primary TKA. We identified studies on PCC following TKA from an electronic search of articles in Medline, Embase and the Cochrane databases (dated up to May 2018). Eighteen studies altogether, including 600 cases of PCC within 8,131 TKAs, were included in the meta-analysis. Several factors including demographic, intraoperative, clinical variables, and radiographic measurements were pooled for meta-analysis. Among intraoperative and clinical variables, patients involved with patellar retention (odds ratio [OR] = 9.420; confidence interval [CI]: 5.770–13.070), lateral reticular release (OR = 2.818; CI: 1.114–7.125), and previous surgery (OR = 2.724; CI: 1.549–4.790) were more likely to having PCCs. Among radiographic measurements, increased anterior tibial offset (weighted mean difference [WMD] = 0.387; CI: 0.139–0.634), increased joint line changes (WMD = 1.325; CI: 0.595–2.055), and increased knee flexion angle (WMD = 3.592; CI: 1.811–5.374) were considered risk factors associated with PCC. Demographic factors (age, gender, body mass index [BMI], and diagnosis) and other reported radiographic measurements were not associated with PCCs. This study identified intraoperative variables (patellar retention and lateral reticular release), clinical variables (previous surgery), and radiographic measurements (increased anterior tibial offset, increased joint line changes, and increased postoperative knee flexion angle) that contribute to an increased risk for PCC. Modifiable factors (patellar retention and lateral reticular release) should be considered and addressed to limit the risk for PCC following TKA. Patients with conditions that may not be modifiable may benefit from counseling about their increased risks for PCC to limit potential dissatisfaction with their procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 96%

mentioning

confidence: 96%

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Risk Factors for Patellar Clunk or Crepitation after Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis

et al. 2020

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“…The etiology and pathogenesis of AKP after TKA remain unclear, although several contributing factors have been identified, like patellar instability and maltracking [4,5]. Patellar crepitus is defined as a grinding sensation in the region of the distal quadriceps tendon over the patella when the knee is brought from flexion to extension, and secondary to fibrosynovial proliferation on the posterior aspect of the distal quadriceps tendon [6]. A previous study reported that up to one-third of patients who underwent TKA experienced mild to moderate AKP at the 1-year follow-up [7].…”

Section: Introductionmentioning

confidence: 99%

Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

Huang

Gao

Ding

et al. 2020

BMC Musculoskelet Disord

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Background: The incidence of patient dissatisfaction due to anterior knee pain (AKP) and patellar crepitus after total knee arthroplasty (TKA) remains a concern. However, it has been shown that improvements in the femoral component of traditional prostheses could reduce these instances of pain in the case of TKA performed with patellar resurfacing. This study aims to investigate whether TKA without patellar resurfacing can also benefit from the aforementioned femoral component modification in reducing AKP and patellar crepitus post-TKA. Methods: Sixty-two patients (85 knees) who underwent TKA using the modern prosthesis and 62 age-and sexmatched patients (90 knees) fitted with the traditional prosthesis were enrolled in this study. The occurrence of AKP and patellar crepitus as well as the Knee Society Score (KSS) were consequently recorded, and the data was analyzed in order to determine whether there was a statistically significant difference between the two groups. Results: The incidence of AKP was significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (4.7% vs. 13.3% [p = 0.048] and 3.5% vs. 13.3% [p = 0.021], respectively). In addition, the incidence of patellar crepitus was also significantly lower in the study group compared with the control group at the 3-month and 1-year follow-ups (15.3% vs. 34.4% [p = 0.004] and 10.6% vs. 28.9% [p = 0.002], respectively). There was no significant difference in the KSS between the two groups. Conclusions: These results revealed that TKA without patellar resurfacing will indeed benefit from the modified femoral implant design in reducing AKP and patellar crepitus, a finding that may be beneficial to surgeons who select implants for their patients when patellar resurfacing is not planned or not possible due to other reasons.

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Is a “sulcus cut” technique effective for determining the level of distal femoral resection in total knee arthroplasty?

Kuriyama

Hyakuna

Inoue

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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Is Further Treatment Necessary for Patellar Crepitus After Total Knee Arthroplasty?

Abstract: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 11 publications

References 32 publications

Risk Factors for Patellar Clunk or Crepitation after Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis

Risk Factors for Patellar Clunk or Crepitation after Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis

Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing

Is a “sulcus cut” technique effective for determining the level of distal femoral resection in total knee arthroplasty?

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