The length of the patellar tendon after unicompartmental and total knee replacement

Weale, A. E.; Murray, D.W.; Newman, John H.; Ackroyd, C. E.

doi:10.1302/0301-620x.81b5.0810790

Cited by 90 publications

(105 citation statements)

References 24 publications

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“…In one patient there was posterior instability due to weakness of the capsule and soft tissues, and in another detachment of the patellar tendon. Patella infera is often responsible for restriction of knee movement and pain [21]: in the AL group the worst results with stiff knee were found in patients with a shortening of the patellar tendon. Hyperextension and atypical knee pattern were present in two patients, one with patellar tendon detachment and the other one with posterior instability of the knee.…”

Section: Discussionmentioning

confidence: 98%

“…Patellar tendon length difference at the time of gait analysis was expressed as a percentage of the length measured before and after surgery. The patella was considered alta for a lengthening or infera for a shortening of 10% or more in the length of the tendon [21]. Moreover, the size and position of the allograft with respect to the femoral epiphysis was measured to check joint matching.…”

Section: Methodsmentioning

confidence: 99%

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Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Colangeli

Donati

Benedetti

et al. 2007

International Orthopaedics (SICO

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Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement in bone tumours of the proximal tibia. The aim of this study was to compare two groups of patients with total knee modular megaprosthesis and osteochondral allograft through an objective analysis. Eighteen patients, ten treated with prosthesis (TKR group) and eight with osteochondral allografts (AL group), were included in the study. X-ray, muscular strength measurements, and studies of gait analysis including electromyography (EMG) were used to compare functional results of patients. In the TKR group a higher incidence of knee extension lag was found. While the TKR group had a prevalent knee stiff/hyperextension pattern with reduced rectus femoris activity, the AL group had a higher percentage of normal knee pattern. Knee extensor muscular strength was reduced in the TKR group. TKR functional performance during gait is in most cases abnormal, consistent with the weakness of the extensor apparatus and knee extension lag. Although a greater rate of normal walking was found in the AL group, problems related to a short patellar tendon, knee instability, and joint mismatching were considered to be responsible for abnormal knee kinematics. An allograft, when optimal reconstruction is performed, gives better functional results.Résumé Les prothèses totales massives et les allogreffes ostéochondrales sont utilisées pour préserver le mouvement articulaire dans les tumeurs du tibia proximal. Le but de cette étude était de comparer 2 groupes de patients ayant reçus ces traitements. 18 patients étaient inclus dans l'étude, 10 traités par prothèse (groupe TKR) et 8 par allogreffe ostéochondrale (groupe AL). Les radiographies, la mesure de la force musculaire, l'étude de la boiterie incluant l'EMG étaient utilisées pour comparer les résultats fonctionnels. Dans le groupe TKR une plus grande incidence de perte d'extension était notée. Tandis que le groupe TKR avait une réduction de l'activité du Rectus fémorus , le groupe AL avait un plus grand pourcentage de fonction normale. La force musculaire des extenseurs était réduite dans le groupe TKR. La performance fonctionnelle durant la marche des TKR étaient la plupart du temps anormal avec faiblesse de l'appareil extenseur et perte d'extension. Bien qu'un taux plus élevé de marche normale était trouvé dans le groupe AL, les problèmes dû à un tendon rotulien court, une instabilité articulaire et à une articulation mal adaptée étaient supposés responsable d'une cinématique anormale du genou. L'allogreffe, quand une reconstruction optimale était réalisée donnait un meolleur résultat fonctionnel.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Colangeli

Donati

Benedetti

et al. 2007

International Orthopaedics (SICO

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“…Our primary study hypothesis was that there would be a difference in the patellar tendon length and other parameters in both groups until final followup. A sample size of 27 participants in each group was calculated to provide 80% power to detect a 5% difference in change of the patellar tendon length between the groups based on the previous study of 7% patellar tendon length shortening after TKA [22]. For purposes of this study, we defined MIS TKA as a TKA in which we used a shorter, anteromedially based incision in which we used specially designed MIS instruments (The side-cutting MIS Quad-Sparing TM instrument; Zimmer, Warsaw, IN, USA) and standard implants, in which we did not evert the patella and performed a limited medial parapatellar approach 2 cm above the superior pole of the patella.…”

Section: Methodsmentioning

confidence: 99%

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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“…2,3,12,22 The suggested reasons for patella baja were extensive surgical exposure and patellar eversion. Despite use of a standard TKA technique with routine eversion of the patella at our center, a high incidence of patella baja was not observed as mentioned in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,[9][10][11][12][13][15][16][17] However there is a lack of evidence regarding the fact whether patellar eversion really leads to shortening of the patellar tendon. The present study is aimed to focus on whether a standard medial parapatellar knee arthrotomy with eversion of patella, leads to patella baja by shortening of the patellar tendon, and to estimate its incidence.…”

Section: Introductionmentioning

confidence: 99%

Incidence of patella baja following patellar eversion in total knee arthroplasty

et al. 2017

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Background: Patella baja is a rare complication of total knee arthroplasty (TKA) leading to decreased mechanical advantage of the extensor mechanism, decreased knee range of motion, anterior knee pain and increased wear of the tibial and patellar polyethylene. There exists a lack of evidence on whether patellar eversion leads to shortening of the patellar tendon. The present study aims to determine if eversion of patella during TKA leads to patella baja.Methods: Between August 2014 and August 2016, 55 knees undergoing primary TKA with a standard medial parapatellar arthrotomy and eversion of patella were included in this two point cross sectional study. Preoperative X-rays were taken to assess the length of the patellar tendon and Insall Salvati ratio (ISR). Postoperatively the Blackburne Peel Index (BPI), ISR and patellar tendon lengths were assessed on lateral X-rays to look for any incidence of patella baja.Results: The postoperative change in the length of the patellar tendon was unpredictable; though most of them decreased. The pre and post op difference in the length of patellar tendon was statistically significant in females (4.43±0.20 cm vs. 4.35±0.24 cm; p value-0.005). Significant decrease in length of patellar tendon was seen in patients aged 66-70 years (p= 0.024) and patients with BMI >30 kg/m2. No case of true patella baja was found postoperatively. No significant correlation could be established between ISR and age, sex or BMI of the patients.Conclusions: The different risk factors for post TKA shortening of patellar tendon include female gender and higher BMI (>30 Kg/m²). However eversion of patella during TKA may not lead to an increased incidence of true patella baja.

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The length of the patellar tendon after unicompartmental and total knee replacement

Cited by 90 publications

References 24 publications

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

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

Incidence of patella baja following patellar eversion in total knee arthroplasty

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