Systematic review of the etiology behind patellar clunk syndrome

Sequeira, Sean B.; Scott, James N.; Novicoff, Wendy M.; Cui, Quanjun

doi:10.5312/wjo.v11.i3.184

Cited by 11 publications

(11 citation statements)

References 45 publications

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“…The PS knee design has several negative attributes not shared with other designs, including a greater incidence of the presence of mechanical sensations [33], greater blood loss [59,60], greater femoral bone loss due to preparation of the notch with the box cut, and higher tourniquet times [59,61]. There are other complications unique to the PS design, including femoral condylar fracture [62], polyethylene wear [63] and fatigue fracture of the post [64], dislocation [65], and patellar clunk syndrome [66,67]. Currently, the continued use of the PS knee in primary knee arthroplasties has been questioned [36].…”

Section: Discussionmentioning

confidence: 99%

Outcomes are Better With a Medial-Stabilized vs a Posterior-Stabilized Total Knee Implanted With Kinematic Alignment

Scott

Gray

2022

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Outcomes are Better With a Medial-Stabilized vs a Posterior-Stabilized Total Knee Implanted With Kinematic Alignment

Scott

Gray

2022

The Journal of Arthroplasty

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“…Patella clunk syndrome has been described following both PPR and PPNR [ 48 ]. The estimated incidence is 0–20% depending on the design of the prosthetic patella [ 49 ]. In a systematic review investigating the aetiology of patella clunk syndrome, 3 of 30 studies identified PPR as a significant risk factor, and 1 of 30 suggested that PPR was a non-significant risk factor, with the remaining making no comment [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…The estimated incidence is 0–20% depending on the design of the prosthetic patella [ 49 ]. In a systematic review investigating the aetiology of patella clunk syndrome, 3 of 30 studies identified PPR as a significant risk factor, and 1 of 30 suggested that PPR was a non-significant risk factor, with the remaining making no comment [ 49 ]. A recent randomised controlled study investigating patella crepitus, a pathology related to patella clunk, in resurfaced and non-resurfaced posterior-stabilised TKAs found the incidence was lower in the PPR group (7.3% vs 23.1%) [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing

et al. 2021

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Background The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon’s preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively. Aims To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty. Method A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae. Results Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors. Conclusion Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.

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“…18 If PCC causes disabilities or disturbances in daily activities, open or arthroscopic removal of suprapatellar tissue is the main procedure to treat PCC. 19 Several studies 4,5 have shown the satisfactory result of arthroscopic debridement procedure to manage PCC. Most of the time arthroscopic fibrous nodule debridement is sufficient in typical PCC.…”

Section: Discussionmentioning

confidence: 99%

“…3 Nodule or scar tissue formation under the tendon of the quadriceps or at the top/superior pole of the patella has been considered the cause of PCC. 4,5 Crepitation may result from fibrous nodule entrapment at the intercondylar area of the femoral component. This fibro-synovial proliferation and entrapment are caused by increased contact forces between the superior aspect of the intercondylar box and the quadriceps tendon.…”

Section: Introductionmentioning

confidence: 99%

Case Report on Painful Patellar Crepitation Following a Knee Replacement with Preserved Patella

Butarbutar

Hananto

Irvan

2023

MKB

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Patellar clunk crepitation is a well-known complication following knee replacement surgery and is associated with posterior stabilized knee replacement surgery and surgical technique. Currently, patellar clunk or crepitation management following knee replacement surgery with preserved patella remains unclear. The purpose of this case report is to discuss whether patellar clunk or crepitation management should include debridement with patellar resurfacing or debridement alone. This case describes a patellar crepitation after knee replacement surgery with the preserved patella. The surgery went uneventfully using the standard medial parapatellar approach. However, the patient was still unsatisfied with the chronic left knee pain (>3 months) and crepitation that developed following the surgery, and the patient was diagnosed with patellar clunk and crepitation (PCC). A patellar resurfacing procedure was performed with a satisfactory clinical outcome. Replicating the original joint line level and placing the tibial component posteriorly play a pivotal role in preventing PCC. Debridement and patellar resurfacing procedures are recommended in this type of case to overcome the valgus knee alignment and the placement of the tibial component.

show abstract

Systematic review of the etiology behind patellar clunk syndrome

Cited by 11 publications

References 45 publications

Outcomes are Better With a Medial-Stabilized vs a Posterior-Stabilized Total Knee Implanted With Kinematic Alignment

Outcomes are Better With a Medial-Stabilized vs a Posterior-Stabilized Total Knee Implanted With Kinematic Alignment

Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing

Case Report on Painful Patellar Crepitation Following a Knee Replacement with Preserved Patella

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