Natural history and pathogenesis of the patella clunk syndrome

Abstract

Given a good surgical technique in component placement and debridement of the peripatella synovium, the design of a total knee prosthesis has a strong bearing on the incidence of the patella clunk syndrome. The natural history of the patella clunk syndrome reveals that for as yet uncertain reasons about 50% will improve with time even when given conservative treatment.

Incidence and Reasons for Nonrevision Reoperation After Total Knee Arthroplasty

“…Our analysis provides an incidence of 2.3% of knees having a NRR for stiffness. Reported incidence of patellar clunk syndrome after TKA varies widely (0%-13.3%) and depends upon femoral component design [1,2,4,6,9,12]. The incidence reported here (0.5%) suggests an improvement in component design and technique.…”

“…Reoperations may include manipulation under anesthesia (MUA), irrigation and débridement (I&D), arthroscopy, open reduction internal fixation (ORIF), and others. While incidences of individual complications requiring such reoperations have been reported [1,2,4,6,7,9,11,12,14,21,25,29] (Table 1), the comprehensive profile of indications for nonrevision reoperation (NRR) following primary TKA is unreported. Knowledge of the incidence, indication, timing, and predictors of NRR will allow for an efficient use of resources in targeting the most common causes for reoperation, continuing research in preventing these complications, and identifying patients at the greatest risk so preventative measures may be taken.…”

The John Insall Award: Control-matched Evaluation of Painful Patellar Crepitus After Total Knee Arthroplasty

“…One notable complication unique to implantation of a PS TKA is patellar crepitus or clunk syndrome. The incidence of this phenomenon ranges from 0% to 14% [1,3,6,7,[9][10][11][12][14][15][16]. The symptoms of patellar crepitus are secondary to peripatellar fibrosynovial hyperplasia at the junction of the superior pole of the patella and the distal quadriceps tendon.…”

Patello-femoral clunk syndrome-current concepts

“…2 The design of a total knee prosthesis has a strong bearing on the incidence of the patella clunk syndrome. 9 Femoral components with a deep trochlear groove and smooth transition of the intercondylar box appear to better accommodate any peripatellar fibrous nodule that may form after total knee arthroplasty. 10 PS designs included a high transition zone from the trochlear groove to the intercondylar box with an abrupt transition to the distal femoral articular Available online at www.sciencedirect.com ScienceDirect journa l h ome page: www.els evier.com /locate/jor geometry.…”