Patellofemoral Crepitation and Clunk Following Modern, Fixed-Bearing Total Knee Arthroplasty

Peralta-Molero, Juan Vicente; Gladnick, Brian P.; Lee, Yuo Yu; Ferrer, Andres Vergara; Lyman, Stephen; Valle, Alejandro González Della

doi:10.1016/j.arth.2013.08.008

Cited by 21 publications

(36 citation statements)

References 29 publications

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“…We did not observe the 2-7% incidence of patellofemoral complications reported in the literature. 8,38,39 In correlation with these results, an adequate improvement in the FJS score was observed, standing at 34.4 ± 4.2 points after 3 mo and 57.8 ± 8.4 after 12 mo. In the study from Giesinger et al, 40 the FJS was 21 after 2 mo, 42 after 6 mo, 67 after 12 mo, and 81 after 24 mo.…”

Section: Discussionsupporting

confidence: 59%

Functional ligament-guided femoral rotation with patient-specific instruments: description of a new surgical technique

Hommel

Perka

2016

Current Orthopaedic Practice

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Background:There are two basic implantation philosophies in total knee arthroplasty that essentially determine the rotational alignment of the femur. One method, the measured resection technique, uses bony landmarks to determine alignment, while the other, the gap-balancing technique, uses soft-tissue tension as the reference. The use of patient-specific instrumentation (PSI) has so far only been employed in cases where alignment is based on bony landmarks; alignment of the femoral rotation applying the gap-balancing technique is not currently possible.

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Section: Discussionsupporting

confidence: 59%

Functional ligament-guided femoral rotation with patient-specific instruments: description of a new surgical technique

Hommel

Perka

2016

Current Orthopaedic Practice

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“…The literature reports femoropatellar complication rates of 2-7 % following primary TKA [4,49,50]. Functional impairment and an increased risk of revision are also reported [46].…”

Section: Discussionmentioning

confidence: 97%

Gap-balancing technique combined with patient-specific instrumentation in TKA

Hommel

Perka

2015

Arch Orthop Trauma Surg

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“…In the study of Maloney et al, the prevalence of patellar clunk was 3.9% in 179 consecutive Insall-Burstein Ⅱ posterior-stabilized TKA, while with a longer trochlear groove extended distally, no patellar clunks developed in the patients with Advanced posterior-stabilized TKA [28]. In a recently published series, an incidence of 2.76% was observed with a modern posterior-stabilized implant, whereas an incidence of 6% was seen with the use of a different posterior stabilized design [30]. Lengthening the trochlea groove distally make it more difficult for a nodule to develop and become entrapped [28].…”

Section: Discussionmentioning

confidence: 96%

“…In the present study, for the distal trochlear groove, the prosthetic tracking was more medial than that in the native knees, with maximal discrepancy of Furthermore, in the present study, distally, Triathlon, NRG, and NexGen (the angle spans extended to 9 60°, 66°, and 78°, respectively) have shorter trochlear groove compared to that of the native one, MP and Stature (the angle spans both extended to 110°) showed similar trochlear groove length compared to that of the native one. Femoral components with a shorter trochlea appear to have increased incidence of patellar clunk syndrome, which has been associated with posterior-stabilized TKA [28,29,30]. In the study of Maloney et al, the prevalence of patellar clunk was 3.9% in 179 consecutive Insall-Burstein Ⅱ posterior-stabilized TKA, while with a longer trochlear groove extended distally, no patellar clunks developed in the patients with Advanced posterior-stabilized TKA [28].…”

Section: Discussionmentioning

confidence: 99%

“…Lengthening the trochlea groove distally make it more difficult for a nodule to develop and become entrapped [28]. Besides, patella baja or alta, abnormal patellar tracking, anterior placement of the tibial tray, and an increased degree of postoperative knee flexion have also been associated with the development of patellar clunk syndrome [30,31].…”

Section: Discussionmentioning

confidence: 99%

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Differences between native and prosthetic knees in trochlear groove tracking based on a morphometric measurement of three-dimensional reconstruction models in Chinese people

Chen¹,

Xu²,

Gong³

2020

Preprint

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Background Prosthetic trochlear design is important to ideal postoperative patellofemoral kinematics and knee function. But there has been little research on the differences of trochlear groove trackings between the native and prosthetic knees. We aimed to investigate the differences between native and prosthetic knees through the entire trochlear length by three-dimensional computerized quantification.Methods Virtual total knee arthroplasty was performed, using three-dimensional models of 42 healthy knees that were matched to the femoral components of five different prosthesis systems. Coaxial planes were created along the trochlear groove in 3° increments, and the deepest points of the trochlear groove were marked in each plane. Taking the lower extremity mechanical axis as reference line, the differences in the mediolateral location of the groove tracking were analyzed between the native and prosthetic knees.Results From the proximal to the distal end, the native tracking started from 0° cross section and extended laterally and then medially with its turning point located in 69° cross section, while the prosthetic knees showed medial orientation throughout the trochlear length. Compared with the proximal portion of the native tracking, the prosthetic trackings extended along a paradoxical orientation and started from a more proximal and lateral position, with maximal discrepancy to, 3.2 mm in the 0° cross section. Distally, the prosthetic trackings were located significantly medial, with maximal discrepancy, to 2.4 mm in the 69° cross section.Conclusion The prosthetic trochlear design varies among different types, and does not conform to that of the native knee in terms of shape, orientation, and location, which may cause soft tissue tension imbalance and abnormal patellofemoral biomechanics during knee flexion. This study may be helpful for prosthetic trochlear design that accords with native anatomy so as to optimize patellofemoral biomechanics and decrease the risk of patellofemoral complications.

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Patellofemoral Crepitation and Clunk Following Modern, Fixed-Bearing Total Knee Arthroplasty

Cited by 21 publications

References 29 publications

Functional ligament-guided femoral rotation with patient-specific instruments: description of a new surgical technique

Functional ligament-guided femoral rotation with patient-specific instruments: description of a new surgical technique

Gap-balancing technique combined with patient-specific instrumentation in TKA

Differences between native and prosthetic knees in trochlear groove tracking based on a morphometric measurement of three-dimensional reconstruction models in Chinese people

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