Scintigraphic Determination of Patellar Viability After Excision of Infrapatellar Fat Pad and/or Lateral Retinacular Release in Total Knee Arthroplasty

McMahon, Mark S.; Scuderi, G R; Glashow, Jonathan; Scharf, Stephen C.; Meltzer, Lon; Scott, W. Norman

doi:10.1097/00003086-199011000-00004

Cited by 81 publications

(43 citation statements)

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“…Our study showed no evidence of avascular necrosis and patellar fracture in the total infrapatellar fat pad excision patients, which corresponds to that reported in the literature [3]. The study on postoperative technetium bone scans after TKA with infrapatellar fat pad excision [15] also found that the excision did not compromise patellar blood supply, patellar tendon contracture, Knee Society Score, or functional score after the operation.…”

Section: Discussionsupporting

confidence: 90%

The Effect of Infrapatellar Fat Pad Excision on Complications After Minimally Invasive TKA: A Randomized Controlled Trial

Pinsornsak

Naratrikun

Chumchuen

2013

Clin Orthop Relat Res

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Background The infrapatellar fat pad is one of the structures that obscures exposure in minimally invasive total knee arthroplasty (MIS TKA). Most MIS TKA surgeons (and many surgeons who use other approaches as well) excise the fat pad for better exposure of the knee. There is still controversy about the result of fat pad excision on patella baja, pain, and function. Questions/purposes In the setting of a randomized controlled trial, we sought to determine whether infrapatellar fat pad excision during MIS TKA causes (1) patellar tendon shortening (as measured by patella baja); (2) increased anterior knee pain; (3) decreases in the Knee Society Score or functional subscore; or (4) more patella-related complications.Methods We randomized 90 patients undergoing MIS TKA at one institution into two groups. In one group, 45 patients underwent MIS TKA with complete infrapatellar fat pad excision and in the other group, 45 patients received MIS TKA without infrapatellar fat pad excision. The patella was selectively resurfaced in these patients; there was no difference between the groups in terms of the percentage of patients whose patellae were resurfaced. We measured patellar tendon shortening, knee flexion, anterior knee pain, Knee Society Score (KSS), functional subscore, and patellar complications at preoperative and postoperative periods of 6 weeks, 3 months, 6 months, and 1 year; complete followup data were available on 86% of patients (77 of 90) who were enrolled.

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Section: Discussionsupporting

confidence: 90%

The Effect of Infrapatellar Fat Pad Excision on Complications After Minimally Invasive TKA: A Randomized Controlled Trial

Pinsornsak

Naratrikun

Chumchuen

2013

Clin Orthop Relat Res

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“…8,9 Scintigraphic studies also showed the incidence of avascular insult after violation of the arterial geniculate circulation. 3,10,11 Midvastus approaches to the knee joint gained popularity because the descending genicular artery is preserved. 23 Limited soft tissue dissection in less invasive knee arthroplasty also avoids splitting of the rectus and limits disruption of patellar blood supply.…”

Section: Discussionmentioning

confidence: 99%

“…9 A scintigraphic study showed a higher incidence of vascular compromise after performance of a lateral release. 10 In five patients, we measured patellar blood flow after osteotomy of the retropatellar surface. As suspected, no negative effect on patellar perfusion was observed.…”

Section: Discussionmentioning

confidence: 99%

“…9 Scintigraphic studies indicated a vascular compromise after arthrotomy and lateral release. 10,11 To date, two intraoperative studies assessed patellar blood flow: Hughes found a 40% decrease of patellar perfusion after quadriceps tenotomy and medial arthrotomy. 7 Another study found a blood flow reduction of 205 to 50%, but no significant difference between the medial and lateral approach.…”

Section: Introductionmentioning

confidence: 99%

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Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetry

Hempfing

Schoeniger

Koch

et al. 2007

Journal Orthopaedic Research

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Patellofemoral complications following knee arthroplasty are a well-known problem. Patellar ischemia has been suspected to be causative for fracture, anterior knee pain, and patella component failure. The purpose of this study was to assess the influence of knee arthroplasty surgical dissection on patellar blood flow. Patellar blood flow was measured by means of intraosseous laser Doppler flowmetry (LDF) in 10 patients undergoing total knee arthroplasty by a standard medial parapatellar approach. The initial blood flow was 121.6 AE 114.7 AU. The signal significantly decreased by 71% (p ¼ 0.0051) when the knee was flexed and lost the pulsatile signal pattern in 80%. After arthrotomy, the signal was 100.1 AE 120.3 AU in extension. The lowest signal was found in flexion and eversion of the patella (mean, 18 AE 10.7 AU) and all signals lost pulsatility. As compared to the initial values, completion of the soft tissue dissection did not lead to a significant change of the blood flow signal (121.3 AE 104.8; p ¼ 0.6835). Flexion of the knee joint markedly reduced patellar perfusion. Standard medial parapatellar approach did not significantly change patellar blood flow. This study does not support the theory of postoperative patellar ischemia as a cause of anterior knee pain or patellofemoral problems. ß

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“…However, compromise to skin and soft tissues, patellar avascular necrosis, and fragmentation can occur. In particular, those that involve an "all-or-nothing," a full-thickness, or an "inside-to-out" technique seem prone to such complications [5][6][7][8][9].…”

mentioning

confidence: 99%

A Technique of Staged Lateral Release to Correct Patellar Tracking in Total Knee Arthroplasty

Strachan

Merican

Devadasan³

et al. 2009

The Journal of Arthroplasty

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Scintigraphic Determination of Patellar Viability After Excision of Infrapatellar Fat Pad and/or Lateral Retinacular Release in Total Knee Arthroplasty

Cited by 81 publications

References 0 publications

The Effect of Infrapatellar Fat Pad Excision on Complications After Minimally Invasive TKA: A Randomized Controlled Trial

The Effect of Infrapatellar Fat Pad Excision on Complications After Minimally Invasive TKA: A Randomized Controlled Trial

Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetry

A Technique of Staged Lateral Release to Correct Patellar Tracking in Total Knee Arthroplasty

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