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Shankar DS, Avila A, DeClouette B, Vasavada KD, Jazrawi IB, Alaia MJ, Gonzalez-Lomas G, Strauss EJ, Campbell KA. Home ownership, full-time employment, and other markers of higher socioeconomic status are predictive of shorter time to initial evaluation, shorter time to surgery, and superior postoperative outcomes among lateral patellar instability patients undergoing medial patellofemoral ligament reconstruction. Knee Surg Relat Res 2023; 35:20. [PMID: 37461119 DOI: 10.1186/s43019-023-00193-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify socioeconomic predictors of time to initial evaluation, time to surgery, and postoperative outcomes among lateral patellar instability patients undergoing medial patellofemoral ligament reconstruction (MPFLR). METHODS We conducted a retrospective review of patients at our institution who underwent primary MPFLR with allograft from 2011 to 2019 and had minimum 12-month follow-up. Patients were administered an email survey in January 2022 to assess symptom history, socioeconomic status, and postoperative outcomes including VAS satisfaction and Kujala score. Predictors of time to initial evaluation, time to surgery, and postoperative outcomes were identified using multivariable linear and logistic regression with stepwise selection. RESULTS Seventy patients were included in the cohort (mean age 24.8 years, 72.9% female, mean follow-up time 45.7 months). Mean time to evaluation was 6.4 months (range 0-221) and mean time to surgery was 73.6 months (range 0-444). Having a general health check-up in the year prior to surgery was predictive of shorter time to initial evaluation (β = - 100.5 [- 174.5, - 26.5], p = 0.008). Home ownership was predictive of shorter time to surgery (β = - 56.5 [- 104.7, 8.3], p = 0.02). Full-time employment was predictive of higher VAS satisfaction (β = 14.1 [4.3, 23.9], p = 0.006) and higher Kujala score (β = 8.7 [0.9, 16.5], p = 0.03). CONCLUSION Markers of higher socioeconomic status including having a general check-up in the year prior to surgery, home ownership, and full-time employment were predictive of shorter time to initial evaluation, shorter time to surgery, and superior postoperative outcomes. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA.
| | - Amanda Avila
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA
| | - Brittany DeClouette
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA
| | - Kinjal D Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA
| | - Isabella B Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38Th St, 4Th Floor, New York, NY, 10016, USA
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Van Roekel N, Henry M, Pavlesen S, Rachala S. Extensor Mechanism Centralization Using Autograft Hamstring for Laterally Dislocating Patella. Orthopedics 2023; 46:e186-e188. [PMID: 36623271 DOI: 10.3928/01477447-20230104-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Patellofemoral complications following total knee arthroplasty (TKA) are some of the most commonly cited complications in the literature, accounting for up to 50% of secondary procedures in the literature. Lateral dislocation of the patella, while rare, is one of many causes of extensor mechanism dysfunction. We sought to evaluate a novel patellar centralization procedure by comparing patients' pre- and postoperative clinical and radiographic data. A retrospective case-series study was performed on 12 patient knees (5 male and 7 female) presenting with ambulatory dysfunction due to laterally dislocating patella. All of the knees had component revision combined with hamstring autograft tendon weave and medial reefing of the retinaculum and vastus medialis. The results revealed reliable stabilization of the patella and improved extensor lag at a mean 2.2±2.2 years' short-term follow-up, which correlated with improved postoperative radiographic measurements. Range of motion in both flexion and extension was improved postoperatively. Improvements in radiographic measures of patellar tilt and patellar displacement were statistically significant, with reductions in the mean patellar tilt from 41.5°±25.9° to 3.9°±13.7° (P=.004), and in the mean patellar displacement from 2.8±2.1 cm to 0.8±0.9 cm (P=.012). Our study findings support the use of the extensor mechanism centralization procedure with autograft hamstring in management of laterally dislocating patella after TKA. [Orthopedics. 20XX;XX(X):xx-xx.].
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Shatrov J, Colas A, Fournier G, Batailler C, Servien E, Lustig S. Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction? Arthroplast Today 2022; 16:130-139. [PMID: 35677944 PMCID: PMC9168055 DOI: 10.1016/j.artd.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to describe outcomes of patients who had undergone medial patellofemoral ligament reconstruction (MPFLr) to treat patellofemoral instability (PFI) following total knee arthroplasty (TKA). Material and methods This is a retrospective case series of consecutive patients treated for PFI after TKA. Patients were included if they had radiographic documentation of patella dislocation or subluxation and component position was adequate. MPFLr was performed using a quadriceps tendon autograft. The graft was fixed with either an interference or additional suspensory fixation. A tibial tubercle osteotomy was performed in select indications. Patients were assessed with Kujala and International Knee Score (IKS) at a minimum 12-month follow-up and radiographically with plain radiographs. Results A total of 22 patients (23 procedures) were included. The mean follow-up period was 38 months (range 12-72). Average preoperative femoral component rotation on computed tomography was 0.10° external rotation (range 3° internal rotation to 3° external rotation). All patients had improved clinical and radiographic outcomes postoperatively. At the last follow-up, the mean IKS knee score was 77.6 ± 13.1, mean IKS function score was 75.2 ± 23.3, and mean Kujala score was 60.2/100 ± 10.9. There was 1 mechanical failure, which occurred following MPFLr with interference fixation. There were 6 complications (28.1%) postoperatively. Patients receiving double fixation of the MPFLr graft had higher clinical and radiographic scores; however, this difference was not statistically significant. MPFLr had a patella-lowering effect, 0.97 preoperatively to 0.74 postoperatively (P = .069). Conclusion MPFLr in appropriately selected patients is a satisfactory option to treat PFI following TKA.
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Affiliation(s)
- Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Sydney Orthopaedic Research Institute (SORI) – St. Leonards, Sydney, Australia
| | - Antoine Colas
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Gaspard Fournier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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Shatrov J, Colas A, Fournier G, Batailler C, Servien E, Lustig S. Tibial tuberosity osteotomy and medial patellofemoral ligament reconstruction for patella dislocation following total knee arthroplasty: A double fixation technique. SICOT J 2022; 8:23. [PMID: 35699459 PMCID: PMC9196027 DOI: 10.1051/sicotj/2022023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Patella instability post total knee arthroplasty (TKA) is a rare complication. Tibial tubercle osteotomy (TTO) with medial patellofemoral ligament reconstruction (MPFLr) has not been well described for this indication. This paper describes a surgical technique to address the unique challenges faced when performing TTO and MPFLr in the prosthetic knee. Technique: This technique and video describe a TTO and MPFLr via an extensile incision and medial sub-vastus approach. A 6 cm long TTO is performed, if indicated, to medialise the extensor mechanism up to 1 cm and fixed with ×2 4.5 mm cortical screws. For the MPFLr, a quadriceps tendon autograft is utilized, with the natural insertion to the superior pole of the patella being left undisturbed. The graft is first attached with an interference screw and then reinforced with an endobutton to provide crucial cortical fixation to overcome the problem of low bone mineral density encountered in this area of the femur following TKA. Results: Five patients underwent MPFLr using the described technique. No failures or recurrence of instability occurred at the last follow-up. Pre-operative mean patella tilt and shift were 44° and 3.5 cm, respectively. Post-operatively, mean tilt and shift were 4.1° and 0.4 cm, respectively. There was one wound dehiscence requiring surgical debridement and closure. Conclusion: This paper describes a surgical technique to perform a TTO and MPFLr for patella instability post-TKA. The described method highlights key adaptations to address the unique challenges in this patient population.
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Affiliation(s)
- Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Antoine Colas
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Gaspard Fournier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
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Feng R, Zhong Q, Zheng L, Ye H, Luo D, Ding M, Pang N, Li J, Yao Y. Study on the morphological characteristics and rotational alignment axis of placement plane of the tibial component in total knee arthroplasty for hemophilia-related knee arthritis. J Orthop Surg Res 2022; 17:315. [PMID: 35701787 PMCID: PMC9195305 DOI: 10.1186/s13018-022-03176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Abnormal epiphyseal growth plate development of the proximal tibia in hemophilia patients leads to notable morphological changes in the mature knee joint. This study aimed to compare the morphological characteristics of tibial component placement cut surface in patients with hemophilic arthritis (HA) and osteoarthritis (OA) and to determine the tibial component rotational alignment axis’ best position for HA patients. Methods Preoperative computed tomography scans of 40 OA and 40 HA patients who underwent total knee arthroplasty were evaluated using a three-dimensional (3D) software. The tibial component’s placement morphological parameters were measured. The tibial component’s rotational mismatch angles were evaluated, and the most appropriate 0°AP axis position for HA patients was investigated. Results In the two groups, the morphology was significantly different in some of the parameters (p < 0.05). The tibial component rotational mismatch angles were significantly different between both groups (p < 0.05). The medial 9.26° of the medial 1/3 of the patellar tendon was the point through which 0°AP axis passed for the HA patients. Similarly, the medial 13.02° of the medial 1/3 of the tibial tubercle was also the point through which the 0°AP axis passed. Conclusions The ratio of the anteroposterior length to the geometric transverse length of the placement section of the tibial component in HA patients was smaller than that in OA patients. The medial 9.26° of the medial 1/3 of the patellar tendon or the medial 13.02° of the medial 1/3 of the tibial tubercle seem to be an ideal reference position of the rotational alignment axis of the tibial component for HA patients.
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Affiliation(s)
- Ru Feng
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China
| | - Qigang Zhong
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China
| | - Liujie Zheng
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China
| | - Houlong Ye
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China
| | - Dasheng Luo
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China
| | - Mingyang Ding
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China
| | - Nanyu Pang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China
| | - Jiale Li
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China
| | - Yunfeng Yao
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, 230601, China.
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Zhang H, Cao C, Zhang H, Han S. Determining the rotational alignment of the tibial component referring to the tibial tubercle during total knee arthroplasty: the tibial tubercle-trochlear groove can be an aid. J Orthop Surg Res 2022; 17:253. [PMID: 35509006 PMCID: PMC9069815 DOI: 10.1186/s13018-022-03139-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background There is no consensus on anatomic landmarks or reference axes with which to accurately align rotational position of tibial component. Using the tibial tubercle, commonly referring to the Akagi line and the Insall line, for anatomic reference was widely accepted. However, it is unknown about the predictors that may affect the reliability of using the tibial tubercle for aligning tibial component rotation. The aims of our study were (1) to investigate the reproducibility and accuracy of using the tibial tubercle for aligning tibial component rotation and (2) to determine predictors resulting in discrepancies of the tibial component rotation when referring to the tibial tubercle. Method A total of 160 patients with osteoarthritis were recruited before total knee arthroplasty. The angle α formed by the tibial anteroposterior (AP) axis and the Akagi line and the angle β formed by the tibial AP axis and the Insall line were measured to quantify the discrepancies of the Akagi line and the Insall line. Independent variables, including the tibial tubercle-to-trochlear groove distance (TT-TG), tibial tubercle to posterior cruciate ligament (TT-PCL), and knee rotation angle (KRA), hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), and tibial bowing (TB), were measured. Pearson’s product moment correlation coefficients and multivariable linear regression analysis were calculated to assess relationships between independent variables and the two defined angles. Results All defined measurement were available for 140 patients. The Akagi line rotated internally with 1.03° ± 4.25° in regard to the tibial AP axis. The Insall line rotated externally in regard to the tibial AP axis with 7.93° ± 5.36°. Three variables, including TT-TG, TT-PCL, and KRA, tended to be positively correlated with the angle α and the angle β. In terms of a cutoff of TT-TG = 9 mm, 100% cases and 97% cases for using the Akagi line and Insall line, respectively, were located in the defined safe zone (− 5° to 10°). Conclusion The tibial tubercle (the Akagi line and Insall line) is found to be a useful and promising anatomic landmark for aligning the tibial component rotation. The TT-TG, with a cutoff value of 9 mm, is helpful to choose the Akagi line or Insall line, alternatively.
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Affiliation(s)
- He Zhang
- Handan Branch, Huabeiyiliao Jiankangjituan Fengfeng Zongyiyuan, Handan, 056000, Hebei, China
| | - Chengming Cao
- Handan Branch, Huabeiyiliao Jiankangjituan Fengfeng Zongyiyuan, Handan, 056000, Hebei, China
| | - Han Zhang
- Handan Branch, Huabeiyiliao Jiankangjituan Fengfeng Zongyiyuan, Handan, 056000, Hebei, China
| | - Shoujiang Han
- Department of Orthopaedic Surgery, Huabeiyiliao Jiankangjituan Fengfeng Zongyiyuan, Handan, 056000, Hebei, China.
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Kubota Y, Tanaka K, Hirakawa M, Iwasaki T, Kawano M, Itonaga I, Tsumura H. Patellar dislocation following distal femoral replacement after extra-articular knee resection for bone sarcoma: A case report. World J Clin Cases 2022; 10:3561-3572. [PMID: 35611187 PMCID: PMC9048549 DOI: 10.12998/wjcc.v10.i11.3561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/09/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND For the treatment of bone sarcoma in the distal femur, wide-margin resection and knee reconstruction with tumor endoprosthesis are standard therapies. Extra-articular knee resection is required in cases of tumor invasion of the knee joint; however, the incidence of complications, such as aseptic loosening, prosthesis infection, and implant failure, is higher than that following intra-articular knee resection. To the best of our knowledge, there are three reports of patellar dislocations after replacement of a tumor endoprosthesis.
CASE SUMMARY A 36-year-old man with no significant past medical history was admitted to our institution with continuous pain in his left knee for 4 mo. An open biopsy was performed, and the patient was diagnosed with a left distal femoral malignant bone tumor. Extra-articular knee resection and knee reconstruction with a tumor endoprosthesis were performed. Although the alignment of the tumor prosthesis was acceptable, knee instability was noticed postoperatively. The axial radiographic view of the patellar and computed tomography showed lateral patellar dislocation at 4 wk postoperatively. The patient had to undergo a lateral release and proximal realignment. He could perform his daily activities at 9 mo postoperatively. Radiography revealed no patellar re-dislocation.
CONCLUSION Proximal realignment may be considered during primary surgery if there is an imbalance in the forces controlling the patellar tracking.
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Affiliation(s)
- Yuta Kubota
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Kazuhiro Tanaka
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Masashi Hirakawa
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Tatsuya Iwasaki
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Masanori Kawano
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Ichiro Itonaga
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Hiroshi Tsumura
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
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András G, Németh G, Oláh CZ, Lénárt G, Drén Z, Papp M. The personalized Berger method is usable to solve the problem of tibial rotation. J Exp Orthop 2021; 8:116. [PMID: 34897564 PMCID: PMC8665959 DOI: 10.1186/s40634-021-00432-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose The revision of any total knee replacement is carried out in a significant number of cases, due to the excessive internal rotation of the tibial component. The goal was to develop a personalized method, using only the geometric parameters of the tibia, without the femoral guidelines, to calculate the postoperative rotational position of tibial component malrotation within a tolerable error threshold in every case. Methods Preoperative CT scans of eighty-five osteoarthritic knees were examined by three independent medical doctors twice over 7 weeks. The geometric centre of the tibia was produced by the ellipse annotation drawn 8 mm below the tibial plateau, the sagittal and frontal axes of the ellipse were transposed to the slice of the tibial tuberosity. With the usage of several guide lines, a right triangle was drawn within which the personalized Berger angle was calculated. Results A very good intra-observer (0.89-0.925) and inter-observer (0.874) intra-class correlation coefficient (ICC) was achieved. Even if the average of the personalized Berger values were similar to the original 18° (18.32° in our case), only 70.6% of the patients are between the clinically tolerable thresholds (12.2° and 23.8°). Conclusion The method, measured on the preoperative CT scans, is capable of calculating the required correction during the planning of revision arthroplasties which are necessary due to the tibial component malrotation. The personalized Berger angle isn’t altered during arthroplasty, this way it determines which one of the anterior reference points of the tibia (medial 1/3 or the tip of the tibial tuberosity, medial border or 1/6 or 1/3 or the centre of the patellar tendon) can be used during the positioning of the tibial component. Level of evidence Level II, Diagnostic Study (Methodological Study).
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Affiliation(s)
- Gömöri András
- Department of Traumatology, Semmelweis University - Medicine and Health Sciences, Borsod-Abaúj-Zemplén County Hospital, Üllői út 26., Budapest, 1085, Hungary.
| | - Gábor Németh
- Department of Ophthalmology, Borsod-Abaúj-Zemplén County Hospital, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary
| | - Csaba Zsolt Oláh
- Department of Neurosurgery, Borsod-Abaúj-Zemplén County Hospital, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary
| | - Gábor Lénárt
- Department of Radiology, Borsod-Abaúj-Zemplén County Hospital, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary
| | - Zsanett Drén
- Department of Radiology, Borsod-Abaúj-Zemplén County Hospital, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary
| | - Miklós Papp
- TritonLife Róbert Magánkórház, Department of Orthopaedics, Miskolci Egyetem, Egészségtudományi kar, Egyetemváros, Miskolc, 3515, Hungary
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Shen XY, Zuo JL, Gao JP, Liu T, Xiao JL, Qin YG. New treatment of patellar instability after total knee arthroplasty: A case report and review of literature. World J Clin Cases 2020; 8:5487-5493. [PMID: 33269288 PMCID: PMC7674709 DOI: 10.12998/wjcc.v8.i21.5487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patellar instability is an uncommon complication after total knee arthroplasty (TKA). Partial lateral patella facetectomy (LPF) with lateral retinaculum release treatment of patellar instability is rarely reported.
CASE SUMMARY We present a case of patellar instability 8 mo after primary TKA. Treatment of this complication was adapted to address the cause of the dislocation. To eliminate patellar instability, we restored the vastus medialis and performed LPF with lateral retinaculum release. We achieved normal patellar tracking. Clinical and radiographic evaluations at the 1-year postoperative follow-up were satisfactory.
CONCLUSION LPF with lateral retinaculum release represents a promising option to restore central patellar tracking in patients with patellar instability after TKA in cases without component malposition.
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Affiliation(s)
- Xian-Yue Shen
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jian-Lin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jian-Peng Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jian-Lin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yan-Guo Qin
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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Yamagami R, Inui H, Taketomi S, Tanaka S. Combined patellofemoral arthroplasty and medial patellofemoral ligament reconstruction for chronic patellar instability with trochlear dysplasia: a report of two cases. Mod Rheumatol Case Rep 2020; 4:135-140. [PMID: 33086962 DOI: 10.1080/24725625.2019.1638048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Deepening trochleoplasty combined with other patella stabilization procedures is often performed to correct patellar instability with trochlear dysplasia. However, various complications following trochleoplasty including patellofemoral osteoarthritis and anterior knee pain can be negative factors affecting the clinical results. Here, we describe two cases of chronic patellar instability with trochlear dysplasia on whom we performed patellofemoral arthroplasty (PFA), instead of trochleoplasty, in conjunction with medial patellofemoral ligament (MPFL) reconstruction. In both cases, PFA, acting as metallic trochleoplasty, improved the congruency of patellofemoral joint, and achieved good clinical results for up to 3 years postoperatively without recurrent patellar instability. This procedure could be considered as one option for cases of chronic patellar instability with trochlear dysplasia.
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Affiliation(s)
- Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Revision total knee arthroplasty for patellar dislocation in patients with malrotated TKA components. Arch Orthop Trauma Surg 2020; 140:777-783. [PMID: 32372239 DOI: 10.1007/s00402-020-03468-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Patellar dislocation is a serious complication leading to patient morbidity following total knee arthroplasty (TKA). The cause can be multifactorial. Extensor mechanism imbalance may be present and result from technical errors such as malrotation of the implants. We sought to understand the reasons for post-arthroplasty patellar dislocation and the clinical outcomes of patients in whom it occurs. METHODS This is a retrospective cohort study assessing the outcomes of revision surgery for patellar dislocation in patients with component malrotation in both primary and revision TKAs. Patient demographics, dislocation etiology, presurgical deformity, intraoperation component position, complications, reoperation, and Knee Society Scores (KSS) were collected. RESULTS Twenty patients (21 knees) were identified. The average time from primary arthroplasty to onset of dislocation was 33.6 months (SD 44.4), and the average time from dislocation to revision was 3.38 months (SD 2.81). Seventeen knees (80.9%) had internal rotation of the tibial component and seven knees (33.3%) had combined internal rotation of both the femoral and tibial components. Fifteen knees (71.4%) were treated with a condylar constrained implant at the time of revision, and five knees were converted to a hinged prosthesis. The average follow-up time was 56 months. During this time, one patient (4.54%) had a recurrent dislocation episode, requiring further surgery. At final follow up, the mean KSS was 86.2. CONCLUSION Revision TKA following patellar dislocation for patients with malrotated components was associated with high success rates. After revision surgery, patients had a low recurrence of patellar dislocation, low complication rates, and excellent functional outcomes.
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Ma Y, Mizu-Uchi H, Ushio T, Hamai S, Akasaki Y, Murakami K, Nakashima Y. Bony landmarks with tibial cutting surface are useful to avoid rotational mismatch in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1570-1579. [PMID: 29995165 DOI: 10.1007/s00167-018-5052-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to define various anteroposterior axes of the tibial component as references and to evaluate their accuracy and variability using virtual surgery. It was hypothesized that (1) Akagi's Line could result in high accuracy and low variability in varus osteoarthritic knees; (2) anteroposterior axes defined by using the tibial bony cutting surface as a landmark might be good substitutes for Akagi's Line; and (3) extra-articular bony landmarks might influence the variability of the anteroposterior axis. METHODS Three-dimensional bone models were reconstructed from the preoperative computed tomography data of 111 osteoarthritic knees with varus deformities. Seven different anteroposterior axes of the tibial component were defined: Akagi's Line, Axis MED, Axis 1/6MED, Axis 1/3MED, Axis of Oval Shape, Axis of Anterior Crest, and Axis Second Metatarsus. The rotational mismatch angle was measured between the tibial anteroposterior axis and the line perpendicular to the transepicondylar axis projected on the cutting surface (positive value: external rotation of the tibial anteroposterior axis). RESULTS The average rotational mismatch angles (referring to the projected anatomical/surgical epicondylar axes) were - 2.7° ± 5.8°/1.0° ± 6.0° (Akagi's Line), - 4.2° ± 7.7°/- 0.5° ± 7.8°, 2.9° ± 7.2°/6.6° ± 7.2°, 9.8° ± 7.0°/13.5° ± 6.8° (Axis MED, Axis 1/6MED, Axis 1/3MED), - 5.1° ± 7.9°/- 1.4° ± 7.8° (Axis of Oval Shape), and 19.3 ± 9.5°/23.0° ± 9.6°, - 2.0° ± 11.3°/1.7° ± 11.4° (Axis Anterior Crest, Axis Second Metatarsus), respectively. CONCLUSIONS Akagi's Line provided the best accuracy and least variability in varus osteoarthritic knees. Axis 1/6MED and Axis MED are good substitutes for Akagi's Line due to the difficulty of identifying the attachment site of the posterior cruciate ligament after the proximal tibia has been cut. Extra-articular bony landmarks should not be used for alignment due to their high variability. This study will aid surgeons in choosing the proper anteroposterior axis of the tibial component to reduce rotational mismatch and thus achieve good clinical knee outcomes. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Yuan Ma
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Tetsuro Ushio
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Putman S, Boureau F, Girard J, Migaud H, Pasquier G. Patellar complications after total knee arthroplasty. Orthop Traumatol Surg Res 2019; 105:S43-S51. [PMID: 29990602 DOI: 10.1016/j.otsr.2018.04.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 02/02/2023]
Abstract
Patellar complications are a source of poor total knee arthroplasty (TKA) outcomes that can require re-operation or prosthetic revision. Complications can occur with or without patellar resurfacing. The objective of this work is to answer six questions. (1) Have risk factors been identified, and can they help to prevent patellar complications? Patellar complications are associated with valgus, obesity, lateral retinacular release, and a thin patella. Selecting a prosthetic trochlea that will ensure proper patellar tracking is important. Resurfacing is an option if patellar thickness is greater than 12mm. (2) What is the best management of patellar fracture? The answer depends on two factors: (a) is the extensor apparatus disrupted? and (b) is the patellar implant loose? When either factor is present, revision surgery is needed (extensor apparatus reconstruction, prosthetic implant removal). When neither factor is present, non-operative treatment is the rule. (3) What is the best management of patellar instability? Rotational malalignment should be sought. In the event of femoral and/or tibial rotational malalignment, revision surgery should be considered. If not performed, options consist of medial patello-femoral ligament reconstruction and/or medialization tibial tuberosity osteotomy. (4) What is the best management of patellar clunk syndrome? When physiotherapy fails, arthroscopic resection can be considered. Recurrence can be treated by open resection, despite the higher risk of complications with this method. (5) What is the best management of anterior knee pain? The patient should be evaluated for causes amenable to treatment (fracture, instability, clunk, osteonecrosis, bony impingement on the prosthetic trochlea). If patellar resurfacing was performed, loosening should be considered. Otherwise, secondary resurfacing is appropriate only after convincingly ruling out other causes of pain. A painstaking evaluation is mandatory before repeat surgery for anterior knee pain: surgery is not in order in the 10% to 15% of cases that have no identifiable explanation. (6) What can be done to treat patellar defects? Available options include re-implantation (with bone grafting, cement, a biconvex implant, or a metallic frame), bone grafting without re-implantation, patellar reconstruction, patellectomy (best avoided due to the resulting loss of strength), osteotomy, and extensor apparatus allograft reconstruction. LEVEL OF EVIDENCE: V, expert opinion.
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Affiliation(s)
- Sophie Putman
- Université de Lille Nord de France, 59037 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille, place de Verdun, 59037 Lille, France.
| | - Florian Boureau
- Université de Lille Nord de France, 59037 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille, place de Verdun, 59037 Lille, France
| | - Julien Girard
- Université de Lille Nord de France, 59037 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille, place de Verdun, 59037 Lille, France
| | - Henri Migaud
- Université de Lille Nord de France, 59037 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille, place de Verdun, 59037 Lille, France
| | - Gilles Pasquier
- Université de Lille Nord de France, 59037 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille, place de Verdun, 59037 Lille, France
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Takahashi T, Takeshita K. Medial Patellofemoral Ligament Reconstruction Using the Hamstring Tendon for Patellofemoral Joint Instability in an 81-Year-Old Female. Open Orthop J 2017; 11:1028-1034. [PMID: 28979605 PMCID: PMC5612026 DOI: 10.2174/1874325001711011028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 07/19/2017] [Accepted: 08/06/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction: Chronic patellofemoral instability occurs mainly in adolescent females and can also be induced by medial patellofemoral ligament (MPFL) injury. There are no case reports of MPFL reconstruction for chronic patellofemoral instability due to MPFL injury in aged populations. Case Presentation: 81-year-old female presented with left knee pain, giving way, and patellar instability while climbing stairs, which continued for 18 months. Patellar apprehension test was positive, and roentgenogram showed lateral patellar subluxation. Conservative therapy was not successful; hence, we performed a lateral release and MPFL reconstruction surgery. Operative Procedure: After arthroscopic lateral release, the hamstring tendon was harvested, and a graft composite made of doubled hamstring tendon and polyester tape with a suspensory fixation device was prepared. Then, a femoral bone tunnel was constructed in a socket shape at the anatomical footprint of the MPFL. The graft was passed through the femoral tunnel, and free ends of the graft composite were sutured to the periosteum of the patella, using two suture anchors at 60° of knee flexion with patellar reduction. Physiotherapy was gradually started using a patella-stabilizing orthosis on the first postoperative day. Her Kujala score improved from 66 to 97 points, and Barthel index score improved from 70 to 100 points at 1 year after surgery. She neither developed patellofemoral joint OA nor had any recurrence of symptoms at the 5-year postoperative follow up. Conclusion MPFL reconstruction using the hamstring tendon is an effective procedure for patients with chronic patellofemoral instability even after the age of 80 years.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
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Kim JI, Jang J, Lee KW, Han HS, Lee S, Lee MC. Anterior tibial curved cortex is a reliable landmark for tibial rotational alignment in total knee arthroplasty. BMC Musculoskelet Disord 2017; 18:252. [PMID: 28606122 PMCID: PMC5469063 DOI: 10.1186/s12891-017-1609-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Rotational alignment of the tibial component is important for long-term success of total knee arthroplasty (TKA). This study aimed to compare five axes in normal and osteoarthritic (OA) knees to determine a reliable landmark for tibial rotational alignment in TKA. Methods One hundred twenty patients with OA knees and 40 with normal knees were included. The angle between a line perpendicular to the surgical transepicondylar axis and each of five axes were measured on preoperative computed tomography. The five axes were as follows: a line from the center of the posterior cruciate ligament (PCL) to the medial border of the patellar tendon (PCL-PT), medial border of the tibial tuberosity (PCL-TT1), medial one-third of the tibial tuberosity (PCL-TT2), and apex of the tibial tuberosity (PCL-TT3), as well as the anteroposterior axis of the tibial prosthesis along the anterior tibial curved cortex (ATCC). Results For all five axes tested, the mean angles were smaller in OA knees than in normal knees. In normal knees, the angle of the ATCC axis had the smallest mean value and narrowest range (1.6° ± 2.8°; range, −1.7°–7.7°). In OA knees, the mean angle of the ATCC axis (0.8° ± 2.7°; range, −7.9°–9.2°) was larger than that of the PCL-TT1 axis (0.3° ± 5.5°; range, −19.7°–10.6°) (P = 0.461), while the angle of the ATCC axis had the smallest SD and narrowest range. Conclusion The ATCC was found to be the most reliable and useful anatomical landmark for tibial rotational alignment in TKA.
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Affiliation(s)
- Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, Korea
| | - Jak Jang
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
| | - Ki Woong Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
| | - Hyuk Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
| | - Sahnghoon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
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Drexler M, Backstein D, Studler U, Lakstein D, Haviv B, Schwarzkopf R, Rutenberg TF, Warschawski Y, Rath E, Kosashvili Y. The medial border of the tibial tuberosity as an auxiliary tool for tibial component rotational alignment during total knee arthroplasty (TKA). Knee Surg Sports Traumatol Arthrosc 2017; 25:1736-1742. [PMID: 27017213 DOI: 10.1007/s00167-016-4072-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/01/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The objective of this study was to quantify the amount of ensuing internal rotation of the tibial component when positioned along the medial border of the tibial tubercle, thus establishing a reproducible intraoperative reference for tibial component rotational alignment during total knee arthroplasty (TKA). METHODS The angle formed from the tibial geometric centre to the intersection of both lines from the middle of the tibial tuberosity and its medial border was measured in 50 patients. The geometric centre was determined on an axial CT slice at 10 mm below the lateral tibial plateau and transposed to a slice at the level of the most prominent part of the tibial tuberosity. Similar measurements were taken in 25 patients after TKA, in order to simulate the intraoperative appearance of the tibia after making its proximal resection. RESULTS This angle was found to be similar (n.s.) in normal and post-TKA tibiae [median 20.4° (range 15°-24°) vs. 20.7° (range 16°-25°), respectively]. In 89.3 % of the patients, the angle ranged from 17° to 24°. No statistical difference (p n.s.) was found between women and men in both normal [median -20.7° (range 16°-25°) vs. 19.9° (range 15°-24°)] and post-TKA tibiae [median 21.4° (range 19°-24°) vs. 20° (range 16°-25°)]. CONCLUSION This study found that in 90 % of the patients, the medial border of the tibial tuberosity is internally rotated 17°-24° in relation to the line connecting the middle of the tuberosity to the tibial geometric centre. Since this anatomical landmark may be more easily identifiable intraoperatively than the commonly used "medial 1/3", it can provide a better quantitative reference point and help surgeons achieve a more accurate tibial implant rotational position. LEVEL OF EVIDENCE Cohort and case control studies, Level III.
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Affiliation(s)
- Michael Drexler
- Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel.
| | - David Backstein
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Ueli Studler
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Dror Lakstein
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Barak Haviv
- Hasharon Campus, Rabin Medical Center Hospital, Derech Ze'ev Jabotinsky 39, 4941492, Petah Tikva, Israel
| | - Ran Schwarzkopf
- Department of Orthopaedics, NYU Langone Medical Center Hospital for Joint Diseases, New York, NY, 10003, USA
| | - Tal Frenkel Rutenberg
- Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel
| | - Yaniv Warschawski
- Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel
| | - Ehud Rath
- Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel
| | - Yona Kosashvili
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
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Lamotte A, Neri T, Kawaye A, Boyer B, Farizon F, Philippot R. Medial patellofemoral ligament reconstruction for patellar instability following total knee arthroplasty: A review of 6 cases. Orthop Traumatol Surg Res 2016; 102:607-10. [PMID: 27317639 DOI: 10.1016/j.otsr.2016.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 03/02/2016] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patellar instability is a frequent cause of total knee arthroplasty (TKA) failure. In cases of post-arthroplasty patellar instability, the medial structures may be damaged. The objective of this study was to study the effectiveness of medial patellofemoral ligament (MPFL) reconstruction. We hypothesized that MPFL reconstruction will effectively realign the patella, making it a viable treatment option for managing post-arthroplasty patellar instability. MATERIAL AND METHODS In this retrospective study of six patients treated by four different surgeons, patients were included if they had a recurring or permanent patellar dislocation after undergoing TKA. Patients were excluded if the patellar instability was painful but did not result in dislocation. Each patient underwent MPFL reconstruction using the gracilis; additional procedures could be performed depending on the diagnosis. One patient required TKA revision because of an abnormally rotated femoral implant. The main outcome measure was the non-recurrence of the dislocation. The IKDC and Kujala functional scores, joint range of motion and patellar tilt on X-rays were analyzed preoperatively and at the last follow-up. RESULTS At a mean follow-up of 23 months (6-46), none of the patients experienced a recurrence of the patellar dislocation. Only one patient had no improvements in the functional outcome scores. The patellar tilt was reduced in all patients. CONCLUSION MPFL reconstruction-in isolation or with femoral component revision-is effective at treating post-arthroplasty patellar instability. It has its place in the treatment of patellar dislocation following TKA and its indications must be based on exact analysis of the reasons for the instability. LEVEL OF EVIDENCE IV - Retrospective cohort study.
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Affiliation(s)
- A Lamotte
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France.
| | - T Neri
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France; Laboratoire de physiologie de l'exercice, EA 4338, 42000 Saint-Étienne, France
| | - A Kawaye
- Service d'orthopédie et traumatologie, centre hospitalier du Forez, 42600 Montbrison, France
| | - B Boyer
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France
| | - F Farizon
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France; Laboratoire de physiologie de l'exercice, EA 4338, 42000 Saint-Étienne, France
| | - R Philippot
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France; Laboratoire de physiologie de l'exercice, EA 4338, 42000 Saint-Étienne, France
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Goto T, Hamada D, Iwame T, Suzue N, Takeuchi M, Egawa H, Sairyo K. Medial patellofemoral ligament reconstruction for patellar dislocation due to rupture of the medial structures after total knee arthroplasty: a case report and review of the literature. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 61:409-12. [PMID: 25264063 DOI: 10.2152/jmi.61.409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patellar dislocation is a well-recognized major complication after total knee arthroplasty (TKA). Treatment of this injury is determined according to the cause of the dislocation. In particular, proximal realignment, distal realignment, and lateral retinaculum release are options if patellar instability is not caused by prosthetic malposition. Here we report a case of patellar dislocation following TKA due to rupture of the medial structures that was treated by medial patellofemoral ligament reconstruction and lateral retinacular release. In addition, we provide a brief review of the related literature.
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Affiliation(s)
- Tomohiro Goto
- Department of Orthopedics, Institute of Health Biosciences, the University of Tokushima Graduate School
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Lording T, Heimstra L, Fink C, Getgood A. Strategies for Reconstruction of the Medial Patellofemoral Ligament. OPER TECHN SPORT MED 2015. [DOI: 10.1053/j.otsm.2015.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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