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Sambri A, Paganelli C, Parisi SC, Filippini M, Cevolani L, Stimolo D, Bortoli M, Guarino A, Bruschi A, Fiore M, Campanacci DA, Donati DM, De Paolis M. Does Patellar Height Influence Range of Motion and Anterior Knee Pain after Distal Femur Endoprosthesis Reconstruction? J Clin Med 2024; 13:4194. [PMID: 39064234 PMCID: PMC11277792 DOI: 10.3390/jcm13144194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Objectives: This study aims to evaluate the patellar height changes after distal femur (DF) endoprosthetic replacement (EPR) and its impact on anterior knee pain (AKP) and range of motion (ROM). Methods: A retrospective review of three institutions' databases was performed. The patellar height was determined using the modified Insall-Salvati ratio (MIS), the Blackburne-Peel (BP) and the Caton-Deschamps (CD) indexes. Data regarding AKP and ROM were collected. Results: A total of 199 patients were included. The mean age at presentation was 37.9 ± 23.1 years. The mean one-year follow-up MIS, BP and CD were 1.52 (sd: 0.41), 0.82 (sd: 0.33) and 0.93 (sd: 0.33). Patellar height decreased significantly compared to the pre-operative values according to all three scores (p < 0.001). AKP was reported by 34 (17.1%) patients at 1 year follow-up. Patients with patella baja (MIS < 1.2) or pseudo patella baja (CD < 0.6) had a higher incidence of AKP (p = 0.037 and p = 0.024, respectively). The mean flexion ROM was 91°, with a direct correlation with patellar height (MIS p = 0.020, BP p = 0.036 and CD p = 0.036). Conclusion: The restoration of the native position of the joint line in DF EPR is important to maintain optimal patellofemoral biomechanics. Despite surgeons' tendency toward a reduction in patellar height with respect to pre-operative values, an increase in patellar height might help to achieve better knee flexion and reduce AKP.
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Affiliation(s)
- Andrea Sambri
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Chiara Paganelli
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Stefania Claudia Parisi
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Matteo Filippini
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Luca Cevolani
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (L.C.); (D.M.D.)
| | - Davide Stimolo
- Orthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, Italy; (D.S.); (A.G.); (D.A.C.)
| | - Marta Bortoli
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Andrea Guarino
- Orthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, Italy; (D.S.); (A.G.); (D.A.C.)
| | - Alessandro Bruschi
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Michele Fiore
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
| | - Domenico Andrea Campanacci
- Orthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, Italy; (D.S.); (A.G.); (D.A.C.)
| | - Davide Maria Donati
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (L.C.); (D.M.D.)
| | - Massimiliano De Paolis
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.P.); (S.C.P.); (M.F.); (M.B.); (A.B.); (M.F.); (M.D.P.)
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Tran Quoc L, Le Khanh T, Mai Thi Hong N, Pham Son T. Influence of Changes in Patella Indices on Total Knee Replacement Surgery Outcomes. Orthop Rev (Pavia) 2024; 16:116365. [PMID: 38682045 PMCID: PMC11045340 DOI: 10.52965/001c.116365] [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: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 05/01/2024] Open
Abstract
Summary Total knee replacement is increasingly widely prescribed, not only for degenerative joint disease but also for other problems such as articular cartilage disease, misalignment due to causes other than degeneration, bone and joint cancer, and diseases that cause joint destruction. However, changes in knee joint biomechanics as well as complications of the patellofemoral joint after surgery lead to instability, joint pain, patellar rupture, and patellar tendon rupture. These are issues that challenge surgeons as well as make patients hesitant when considering knee replacement surgery. Understanding the changes in patella index that can occur after total knee replacement surgery will help surgeons carefully evaluate patients before surgery and calculate intraoperative techniques to minimize complications. Methods Fifty-eight patients with 62 knees were diagnosed with osteoarthritis and underwent total knee replacement surgery. All patients had clinical and radiographic evaluation of the knee joint before and after surgery. Results Patellar indexes did not change significantly after surgery compared to before surgery. Before surgery, 2 patients (3.23%) had true patella baja. After surgery, 7 patients (11.29%) had true patella baja and 3 patients (4.84%) had pseudo-patella baja. The average knee flexion amplitude after surgery was 103.11±15.440, with only 2 patients losing extension >50º. The average KS score after surgery was 83.69±9.98, significantly improved compared to before surgery 33.44±11.38. Similarly, KFS score after surgery was 81.01±8.84 compared to before surgery 37.05±8.08. Conclusion Changes in index of the patella before and after surgery affect the surgical results, the normal patella group has better results than the group with patella baja.
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Affiliation(s)
- Lam Tran Quoc
- Ha Noi University Public Health
- Pham Ngoc Thach General Hospital
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Flevas DA, Brenneis M, Nocon A, Gkiatas I, Pirzada W, Tsakotos G, Sculco PK. Incidence of patella baja and pseudopatella baja in aseptic revision total knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:1703-1712. [PMID: 38488903 DOI: 10.1007/s00402-024-05234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION There are two variants regarding the low location of the patella in relation to the tibio-femoral joint line: patella baja (PB) and pseudo-patella baja (PPB). The purpose of this study is to investigate the incidence of PB and PPB in a cohort of patients that underwent revision total knee arthroplasty (rTKA) for aseptic reasons and describe any differences in each group's ROM. METHODS This retrospective study included 114 patients that underwent aseptic revision TKA surgery between 2017 and 2022. Patients were revised either for stiffness (Group 1) or aseptic loosening/instability (Group 2). The Insall-Salvati ratio (ISR) and Blackburne-Peel ratio (BPR) were used to evaluate the patellar position. ISR < 0.8 defined PB, while cases with ISR ≥ 0.8 and BPI < 0.54 were defined as PPB. ROM was measured and a subanalysis was conducted to investigate the progression of the values of ISR and BPR. RESULTS 55 patients comprised Group 1, and 59 patients comprised Group 2. Overall, 13 cases (11.4%) had PB before rTKA and 24 (21%) had PB after rTKA. Cases with PPB were 13 (11.4%) before and 34 (29.9%) after rTKA. Group 1 patients presented with more PB before and after rTKA (12.8% vs 10.2% and 27.3% vs 15.2% respectively). However, after rTKA Group 1 patients presented with less PPB (20%) compared to Group 2 (39%) (p = 0.02). In Group 1, patients with PPB after rTKA had less ROM compared to those without PPB [83.2 (± 21.9) vs 102.1 (± 19.9) (p = 0.025)]. The subanalysis (69 patients) showed a statistically significant decrease in ISR before and after rTKA (p = 0.041), and from the native knee to post-rTKA (p = 0.001). There was a statistically significant decrease in BPR before and after rTKA (p = 0.001) and from the native knee to both pre- and post-rTKA (p < 001). CONCLUSION After undergoing rTKA, the incidences of both patella baja (PB) and pseudo-patella baja (PPB) increased. Stiffness in the knee was associated with a higher incidence of PB, while non-stiffness cases showed a significantly higher incidence of PPB. Patients with stiff knees and PPB after rTKA experienced a significant reduction in range of motion (ROM). Additionally, the study revealed a noteworthy decrease in ISR and BPR with each subsequent surgery. This information is crucial for healthcare providers, as it sheds light on potential risks and outcomes of rTKA, allowing for improved patient management and surgical decision-making. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dimitrios A Flevas
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA.
| | - Marco Brenneis
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt, Main, Germany
| | - Allina Nocon
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
| | - Ioannis Gkiatas
- Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Wali Pirzada
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
| | - Georgios Tsakotos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter K Sculco
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
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Goicoechea N, Hinarejos P, Gasol B, Torres-Claramunt R, Sánchez-Soler J, Perelli S, Monllau JC. Systematic lateral retinacular release does not reduce anterior knee pain after total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2023; 31:4213-4219. [PMID: 37270463 DOI: 10.1007/s00167-023-07456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of systematic lateral retinacular release (LRR) on anterior knee pain (AKP), as well as its impact on the functional and radiological outcomes after total knee arthroplasty (TKA) with patellar resurfacing. METHODS A prospective randomized study was designed. It included patients scheduled for a TKA procedure with patellar resurfacing, who were recruited and randomized into either the LRR group or the non-release group. 198 patients were included in the final analysis. The pressure pain threshold (PPT) assessed by pressure algometry (PA), the visual analogue scale (VAS), Feller's patellar score, the Knee Society Score (KSS), patellar height, and patellar tilt were recorded both preoperatively and at the 1-year follow-up. The Mann-Whitney U test was performed to determine comparisons between both groups as well as to determine differences' intragroup. RESULTS Relative to the clinical variables and scores, no difference was detected between the two groups at the 1-year follow-up (p = n.s.). However, there was a slight difference in patellar tilt (0.1º vs. 1.4º, p = 0.044), with higher tilt values in the non-release group. There was no difference in terms of improvement in the clinical and radiological scores and variables recorded between the two groups (p = n.s.). CONCLUSION LRR in primary TKA with patellar resurfacing does not show an improvement in AKP and functional outcomes over patellar resurfacing without release. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Nerea Goicoechea
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain.
| | - Pedro Hinarejos
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Berta Gasol
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Simone Perelli
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
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Kwolek K, Grzelecki D, Kwolek K, Marczak D, Kowalczewski J, Tyrakowski M. Automated patellar height assessment on high-resolution radiographs with a novel deep learning-based approach. World J Orthop 2023; 14:387-398. [PMID: 37377994 PMCID: PMC10292056 DOI: 10.5312/wjo.v14.i6.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/06/2023] [Accepted: 05/06/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Artificial intelligence and deep learning have shown promising results in medical imaging and interpreting radiographs. Moreover, medical community shows a gaining interest in automating routine diagnostics issues and orthopedic measurements.
AIM To verify the accuracy of automated patellar height assessment using deep learning-based bone segmentation and detection approach on high resolution radiographs.
METHODS 218 Lateral knee radiographs were included in the analysis. 82 radiographs were utilized for training and 10 other radiographs for validation of a U-Net neural network to achieve required Dice score. 92 other radiographs were used for automatic (U-Net) and manual measurements of the patellar height, quantified by Caton-Deschamps (CD) and Blackburne-Peel (BP) indexes. The detection of required bones regions on high-resolution images was done using a You Only Look Once (YOLO) neural network. The agreement between manual and automatic measurements was calculated using the interclass correlation coefficient (ICC) and the standard error for single measurement (SEM). To check U-Net's generalization the segmentation accuracy on the test set was also calculated.
RESULTS Proximal tibia and patella was segmented with accuracy 95.9% (Dice score) by U-Net neural network on lateral knee subimages automatically detected by the YOLO network (mean Average Precision mAP greater than 0.96). The mean values of CD and BP indexes calculated by orthopedic surgeons (R#1 and R#2) was 0.93 (± 0.19) and 0.89 (± 0.19) for CD and 0.80 (± 0.17) and 0.78 (± 0.17) for BP. Automatic measurements performed by our algorithm for CD and BP indexes were 0.92 (± 0.21) and 0.75 (± 0.19), respectively. Excellent agreement between the orthopedic surgeons’ measurements and results of the algorithm has been achieved (ICC > 0.75, SEM < 0.014).
CONCLUSION Automatic patellar height assessment can be achieved on high-resolution radiographs with the required accuracy. Determining patellar end-points and the joint line-fitting to the proximal tibia joint surface allows for accurate CD and BP index calculations. The obtained results indicate that this approach can be valuable tool in a medical practice.
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Affiliation(s)
- Kamil Kwolek
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Dariusz Grzelecki
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Konrad Kwolek
- Department of Orthopaedics and Traumatology, University Hospital, Krakow 30-663, Poland
| | - Dariusz Marczak
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Jacek Kowalczewski
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Marcin Tyrakowski
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
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Tischer T, Geier A, Lutter C, Enz A, Bader R, Kebbach M. Patella height influences patellofemoral contact and kinematics following cruciate-retaining total knee replacement. J Orthop Res 2023; 41:793-802. [PMID: 35949157 DOI: 10.1002/jor.25425] [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: 09/17/2021] [Revised: 06/02/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate-retaining (CR) TKA. We implemented a CR bicondylar TKA with a dome patellar button in a validated dynamic musculoskeletal multibody model of a male human knee joint. Retropatellar dynamics (contact force [N], shear force [N], patellar shift [mm], tilt [°], and rotation [°]) were evaluated during dual-limb squat motion (flexion from 0° to 90°) with simulated active muscle forces and the effects of different patella heights (Blackburne-Peel [BP] ratio of 0.39, 0.49, 0.65, 0.85, 1.01, and 1.1 were systematically examined). As active knee flexion increased, PF contact force also increased. Patella alta (BP = 1.1) resulted in higher PF contact forces compared to normal patella height (BP = 0.65) by up to 16%. Contrarily, patella baja was associated with decreased PF forces by 7%. Compared to patella baja (BP = 0.39), patella alta (BP = 1.1) considerably increased the contact force by up to 25%. Different patellar heights mainly affected PF shear forces during early knee flexion. Concerning PF kinematics, patella alta (BP = 1.1) yielded a greater lateral tilt of more than 4° and higher patellar rotation by up to 3° during deep knee flexion, compared to normal patella height (BP = 0.65). Our computational study indicates that patella alta is associated with the highest PF contact and shear force after the implantation of a CR bicondylar TKA. This should be considered in PF disorders following TKA.
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Affiliation(s)
- Thomas Tischer
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Andreas Geier
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christoph Lutter
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Andreas Enz
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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Schreiner AJ, Spiegel L, Yan SG, Konrads C, Erne F, Hemmann P, Schmidutz F. Evaluation of modified and newly applied patella height indices in primary total knee arthroplasty. Skeletal Radiol 2023; 52:73-82. [PMID: 35943544 PMCID: PMC9666313 DOI: 10.1007/s00256-022-04142-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this radiological study was to compare several relevant modified and newly applied patella height indices (PHI) in navigated primary total knee arthroplasty (TKA) to determine intra- and interobserver reliability in order to give a recommendation for clinical application in measuring patella height (PH) in primary TKA. MATERIALS AND METHODS A retrospective data analysis assessing different PHI (modified Insall-Salvati index (mISI), Caton-Deschamps index (mCDI), Blackburne-Peel index (mBPI), Plateau-Patella Angle (mPPA); Miura-Kawaramura index (MKI), Knee-Triangular index (KTI)) on lateral knee radiographs was performed by two blinded observers using the same software three months pre- and postoperatively. Concordance correlation coefficient and Pearson's correlation respectively were determined for intra- and interobserver rating as well as a categorization according to Landis and Koch and Cohen. RESULTS A total of 337/291 patients of a 5-year period could be analyzed pre-/postoperatively. Excellent postoperative interrater results according to the categorization of Landis and Koch were achieved for the mBPI (Pearson 0.98) > mPPA (0.90) > KTI (0.86), good results for the MKI (0.79) and the mCDI (0.69), and moderate results for the mISI (0.52) with a predominantly strong Cohen correlation in almost all cases. Preoperatively, the mBPI and the KTI were the best interrated PHI. No PH changes could be found postoperatively for the mISI, KTI, MKI, and mPPA. CONCLUSION The mBPI, the mPPA, and the KTI can be recommended for PH assessment in TKA. The mPPA might be the easiest one to use in a daily clinical set-up.
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Affiliation(s)
- Anna Janine Schreiner
- Orthopaedic Clinic Markgroeningen, Markgroeningen, Germany ,grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Lena Spiegel
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Shuang Gen Yan
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.412679.f0000 0004 1771 3402Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No. 1 Baicao Road, Hefei, 230088 China
| | - Christian Konrads
- grid.10392.390000 0001 2190 1447Department of Orthopaedic Surgery, University of Tuebingen, Tuebingen, Germany
| | - Felix Erne
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Philipp Hemmann
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Florian Schmidutz
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.5252.00000 0004 1936 973XDepartment of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany ,Orthopedic Surgery, Orthopedic Center Rosenheim, Rosenheim, Germany
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Konrads C, Schreiner AJ, Cober S, Schüll D, Ahmad SS, Alshrouf MA. Evaluation of patella height in native knees and arthroplasty: an instructional review. SICOT J 2022; 8:36. [PMID: 35997518 PMCID: PMC9397114 DOI: 10.1051/sicotj/2022037] [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: 06/22/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Total knee arthroplasty (TKA) is the gold standard for treating advanced knee osteoarthritis. Among the postoperative complications of TKA are true patella infera (TPI) and pseudo patella infera (PPI), which should be differentiated since TPI exhibits significantly worse clinical outcomes. Multiple radiological patella height indices (PHI) exist; some were modified or originally designed for knees with implanted endoprostheses. However, there is no consensus on measuring and comparing patella height. Due to the lack of established, simple, reliable, and reproducible concepts for assessing patella height for arthroplasty, measuring patella height and the change of patella height by or after TKA have been challenging tasks for clinicians and researchers. This is a review of the current literature on methods for measuring patella height, with special attention to the ability to differentiate between the TPI and PPI after TKA. All literature on the topic was retrieved, and references from relevant articles were investigated until the end of April 2022.
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Affiliation(s)
- Christian Konrads
- Department of Orthopaedic Surgery, University of Tübingen, 72076 Tübingen, Germany
| | | | - Simone Cober
- Department of Orthopaedic Surgery, University of Tübingen, 72076 Tübingen, Germany
| | - Daniel Schüll
- Department of Orthopaedic Surgery, University of Tübingen, 72076 Tübingen, Germany
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany
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Dos-Santos G, Gutierres M, Leite MJ, Barros AS. Pseudo-patella baja after total knee arthroplasty: Radiological evaluation and clinical repercussion. Knee 2021; 33:334-341. [PMID: 34753025 DOI: 10.1016/j.knee.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/03/2021] [Accepted: 10/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior knee pain is an important complication after total knee arthroplasty (TKA). One possible contributor is the elevation of the joint line, known as pseudo-patella baja (PPB). Limited research has been conducted regarding this condition impacting TKA management. This study aims to evaluate the incidence, identify possible related factors and assess PPB clinical repercussions. METHODS A total of 813 consecutive TKAs were retrospectively reviewed. Patients were submitted to the same surgical procedure and information regarding TKA characteristics was collected. Lateral postoperative knee radiographs were analyzed using the modified Insall-Salvati Ratio and the Blackburne-Peel Index. A clinical evaluation was conducted on 112 knees where the Oxford Knee and Kujala Scores were applied. Range of motion was evaluated, and knee pain was assessed using the numeric pain rating scale, in addition to analgesic consumption. RESULTS A cohort of 612 knees was analyzed, of which 64 knees developed PPB (10.5% incidence). Statistically significant differences were found for advance components sizes (femoral P = 0.026 and tibial P < 0.001), polyethylene thickness (P < 0.001) and patients' height (P = 0.022) with smaller implant sizes, greater insert thicknesses and lower height showing an association with PPB. The PPB group had a significantly lower median Kujala score (P = 0.011), higher frequency of flexion contracture and of anterior knee pain (P = 0.039). CONCLUSION PPB has a clinical relevance that should not be overlooked. Its prevention through the recreation of the natural position of the joint line and correct choice of implant sizes and polyethylene thickness is of major importance and should always be considered.
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Affiliation(s)
| | - Manuel Gutierres
- Faculty of Medicine, University of Porto, Porto, Portugal; Orthopedics and Traumatology Department, São João University Hospital, Porto, Portugal
| | - Maria João Leite
- Orthopedics and Traumatology Department, São João University Hospital, Porto, Portugal
| | - António S Barros
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal
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Cui LK, Kang K, Zheng XZ, Jiang SG, Huang WT, Gao SJ. A Sagittal Patellar Angle Linear Equation Reflecting Patellofemoral Kinematics: Evaluation of Patellar Height at any Degree of Knee Flexion Angle. Orthop Surg 2021; 14:3-9. [PMID: 34783159 PMCID: PMC8755871 DOI: 10.1111/os.13166] [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: 08/08/2020] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To confirm whether a novel sagittal patellar angle linear equation used for evaluating patellar height by calculating expected sagittal patellar angle (SPA) at any degree of knee flexion angle is suitable for patients older than 17 years and its reliability compared with other commonly used methods. Methods From September 2016 to September 2019, a total number of 202 consecutive outpatients' knee lateral X‐ray radiographs were retrospectively measured and evaluated using a recently proposed linear equation Y = 1.94 + 0.74 × knee flexion(KF) angle. Patients were divided by ages into ayounger group, whose ages were between 17–49 years, and an older group, whose ages were older than 49 years, which has not been validated in the original study. Parameters such as KF, SPA, patella and patella tendon length and so on were measured on computer with picture archiving and communication system by two independent observers at an interval of 1 month. Insall‐Salvati (IS) index, Caton‐Deschamps (CD) index and Y value, correlation coefficients were calculated and compared using SPSS 22.0 software. Results In the younger group, 143 patients (165 knees) were included, ages were 17–49 (31.62 ± 11.38) years, males/females were 70 (48.95%)/73 (51.05%), left knees/right knees were 83 (50.30%)/82 (49.70%), mean value of Y was 31.50° ± 10.07°, and SPA was 34.38° ± 12.38°, mean value of IS was 1.06 ± 0.17, mean value of CD was 1.04 ± 0.18. While in older group, 59 patients (78 knees) were included, ages were 50–60 (mean 54.61 ± 2.99) years, there were 32 males (54.24%) and 27 females (45.76%), 42 knees were left (53.85%) and 36 knees were right (46.15%), mean values of Y and SPA were 25.90° ± 11.55° and 29.36° ± 14.22°, mean IS index in older group was 1.06 ± 0.18, mean CD index was 1.00 ± 0.16. Intra‐ and inter‐observer reliabilities of Y in younger and older groups were 0.999, 0.999, 1.000 and 0.999, meaning high reliability and reproducibility, but low Pearson's correlation coefficients with IS and CD index were showed as −0.213 and − 0.216 in younger group and − 0.113 and − 0.316 in older group. Conclusions In patients older than 17 years, the linear equation Y = 1.94 + 0.74 × KF is a reliable and practical method to evaluate SPA regardless of age and knee flexion angle, but has weak correlation coefficients with the IS and CD index.
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Affiliation(s)
- Lu-Kuan Cui
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China.,First Department of Traumatic Orthopedics, Cangzhou Hospital of Integrated Traditional and Western Medicine·Hebei Province, Cangzhou, China
| | - Kai Kang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-Zuo Zheng
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shi-Gang Jiang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen-Tao Huang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shi-Jun Gao
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
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Infrapatellar Fat Pad Resection or Preservation during Total Knee Arthroplasty: A Systematic Review. J Knee Surg 2021; 34:415-421. [PMID: 31505700 DOI: 10.1055/s-0039-1696692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Considerations of how to improve postoperative outcomes for total knee arthroplasty (TKA) have included preservation of the infrapatellar fat pad (IPFP). Although the IPFP is commonly resected during TKA procedures, there is controversy regarding whether resection or preservation should be implemented, and how this influences outcomes. Therefore, the purpose of this systematic review was to evaluate how IPFP resection and preservation impacts postoperative flexion, pain, Insall-Salvati Ratio (ISR), Knee Society Score (KSS), patellar tendon length (PTL), and satisfaction in primary TKA. PubMed, EBSCO host, and SCOPUS were queried to retrieve all reports evaluating IPFP resection or preservation during TKA, which resulted into 488 studies. Two reviewers independently reviewed these articles for eligibility based on pre-established inclusion and exclusion criteria. Eleven studies were identified for final analysis, which reported on 11,996 cases. Patient demographics, type of surgical intervention, follow-up duration, and clinical outcome measures were collected and analyzed. Complete resection was implemented in 3,723 cases (31%), partial resection in 5,458 cases (45.5%), and preservation of the IPFP in 2,815 cases (23.5%). Clinical outcome measures included PTL (5 studies), knee flexion (4 studies), pain (6 studies), KSS (3 studies), ISR (3 studies), and patient satisfaction (1 study). No differences were found following IPFP resection for patient satisfaction (p = 0.98), ISR (p > 0.05), and KSS (p > 0.05). There was mixed evidence for PTL, pain, and knee flexion following IPFP resection versus preservation. Studies of shorter follow-up intervals suggested improved pain following resection, while reports of longer follow-up times indicated that resection resulted in increased pain. Given the mixed data available from the current literature, we were unable to conclude that one surgical technique can definitively be considered superior over the other. More extensive research, including randomized controlled trials, is required to better elucidate potential differences between the surgical handling choices. Future studies should focus on patient conditions in which one technique would be best indicated to establish guidelines for best surgical outcomes in those patients.
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Creteur V, De Angelis R, Absil J, Kyriakidis T, Madani A. Sonographic and radiographic evaluation of the extensor tendons in early postoperative period after total knee arthroplasty. Skeletal Radiol 2021; 50:485-494. [PMID: 32803377 DOI: 10.1007/s00256-020-03574-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 08/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To prospectively assess the early changes in the quadriceps and patellar tendons before and after total knee arthroplasty using ultrasound, shear wave elastography, and X-rays. MATERIALS AND METHODS Radiographs, ultrasound, and shear wave elastography were performed on 23 patients (16 women; aged 51-85, mean 66 ± 9 years) before and after surgery at 6 weeks and on 11 patients at 3 months. Patellar position and patellar tendon lengths were evaluated by radiography; joint effusion or synovitis, quadriceps and patellar tendon lengths, and thicknesses, echogenicity, vascularity, and stiffness were assessed with ultrasound and shear wave elastography. RESULTS In the early postoperative period, 87% of the patients had joint effusion, and 43% had signs of synovitis. There was a significant thickening of the quadriceps tendon in 51.5% (p < .0001) and of the patellar tendon in 93.8% (p < .0001) of patients with a significant shortening of the patellar tendon in 7.8% (p < .0001). A hypoechoic defect on the medial aspect of the quadriceps tendon was found in 87% of the patients. There was a significant increase in Young's modulus in the quadriceps tendon (p = .0006) but not in the patellar tendon. CONCLUSION The following should not be considered to be pathological findings at early postoperative imaging: joint effusion, synovitis, increasing of stiffness and thickening of quadriceps tendons by more than 50%, thickening of patellar tendon by more than 90%, focal defect through the medial aspect of the quadriceps tendon, and shortening of the patellar tendon by 8%.
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Affiliation(s)
- Viviane Creteur
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Riccardo De Angelis
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Theofylaktos Kyriakidis
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Afarine Madani
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium.
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Reliability of a Caton-Deschamps-derived patella height index for knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:2001-2005. [PMID: 33471223 PMCID: PMC8338832 DOI: 10.1007/s00264-020-04931-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/29/2020] [Indexed: 12/01/2022]
Abstract
Purpose The original Caton-Deschamps index (oCDI) detects functional patella height. It cannot be used in knees with an implanted endoprosthesis. The “modified Caton-Deschamps index” (mCDI) for knee arthroplasty can miss pseudo-patella-infera (PPI), which is common after TKA. A derivate of the oCDI could be a simple analogue to the index published in 1982 using a modified tibial reference point at the anterior proximal point of the inlay, which can indirectly be located on the lateral knee radiograph. It was the aim of this study to determine the intra- and inter-rater agreement of a derived Caton-Deschamps index (dCDI) for knee arthroplasty. We hypothesized that the derived Caton-Deschamps index (dCDI) is a reliable radiological measure for patella height in knee arthroplasty. Methods Several patella height indices were measured by three independent raters in two passes. The second pass was performed after 6 weeks in random order. Intra- and inter-observer agreements were determined and analyzed using the intraclass correlation coefficient (ICC). For radiographic evaluation, digital lateral radiographs of 150 knees before and after primary TKA were used. Results We found high interrater reliability for all analyzed indices. We found the highest agreements for the ISI preop (ICC = 0.914) and postop (ICC = 0.920), respectively. We also found very good intra-rater reliability for the CDI (ICCpreop = 0.954), dCDI (ICCpostop = 0.945), ISI (ICCpreop = 0.960; ICCpostop=0.940) and BPI (ICCpreop = 0.969; ICCpostop = 0.955). Fourteen cases (9.3%) with insignificant PPI were found. Conclusion The derived Caton-Deschamps index (dCDI) can easily be used in knee arthroplasty and demonstrated high intra- and interrater agreement, which was similar to other commonly used and established patella height indices.
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Konrads C, Rejaibia J, Grosse LC, Springer F, Schreiner AJ, Schmidutz F, Erne F. Patella-height analysis and correlation with clinical outcome after primary total knee arthroplasty. J Orthop 2021; 23:169-174. [PMID: 33542595 DOI: 10.1016/j.jor.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/02/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022] Open
Abstract
Background It is the aim of this study to conceptualize a scheme for patellar-height analysis suitable for knees without and with implanted endoprosthesis. Furthermore, patellar-height and change of patellar-height by total-knee-arthroplasty (TKA) should be studied and correlated with clinical outcomes. We hypothesize that not only True-Patella-Infera (TPI) but also Pseudo-Patella-Infera (PPI) might be correlated with elevated anterior-knee-pain and reduced range-of-motion. Methods Several patellar-height indices were measured by three independent raters in two passes. Indices were analyzed and intra- and interobserver agreements were determined. For radiographic and clinical evaluation of 92 knee arthroplasties, the Insall-Salvati Index (ISI) and the Caton-Deschamps Index (CDI) were used to determine patellar-height and especially the amounts of TPI and PPI. Patellar-height was correlated with clinical outcome parameters: pain, ROM, Oxford Knee Score, Knee Society Score, Kujala Score, SF-36, Tegner and Lysholm. Results All used patellar-height indices demonstrated good intra- and interobserver agreement. Low preoperative ROM was correlated with low postoperative ROM after primary TKA. Postoperatively, 2.2% of the patients had a TPI and 9.8% had a PPI. Patella infera was not correlated with reduced subjective or objective clinical outcome parameters. Conclusions Preoperative ROM is a good predictor of postoperative ROM after primary TKA. Patellar-height analysis can be sufficiently performed using the ISI and the CDI, respectively the derived CDI (dCDI) in cases with implanted endoprosthesis. As an alternative to the CDI/dCDI, the BPI/mBPI can be used. There seems to be a certain threshold of acceptable patellar-height reduction, in which clinical outcome is not deteriorated.
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Affiliation(s)
- Christian Konrads
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Jesin Rejaibia
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Lucia C Grosse
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Fabian Springer
- Department of Radiology, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Anna J Schreiner
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Florian Schmidutz
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany.,Department of Orthopaedics, University of Munich (LMU), Munich, Germany
| | - Felix Erne
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
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A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:768. [PMID: 33220714 PMCID: PMC7680598 DOI: 10.1186/s12891-020-03794-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background The measurement of patellar height and restoration of the natural position of the joint line are crucial to total knee arthroplasty (TKA). However, there remains a lack of consensus on an optimal measurement method to associate the patellar height with the joint line position. The objective of this study was to introduce a new method and validate the application in TKA both preoperatively and postoperatively. Methods Instead of taking marginal landmarks as the tibial references, the tibial shaft axis was used to construct the new measurement method, which comprises the axis-patella (AP), joint axis-patella (jAP) indices and joint line height (JLH). Patellar heights were measured using the Insall-Salvati (IS), modified Insall-Salvati (mIS), Blackburne-Peel (BP), Caton-Deschamps (CD) indices, and the new method in 175 knees both preoperatively and postoperatively. Intraclass correlation coefficients and Pearson’s correlation analyses were respectively used to evaluate the reliabilities and correlations. Results There were good correlations between the proposed method and the mIS, CD, and BP indices. High inter-observer reproducibility was found for AP (preoperative and postoperative 0.83), jAP (preoperative 0.82; postoperative 0.86) indices and JLH (preoperative 0.88; postoperative 0.95). High intra-observer repeatability was also found for AP (preoperative 0.85; postoperative 0.87), jAP (preoperative 0.83; postoperative 0.87) indices and JLH (preoperative 0.80; postoperative 0.92). Conclusions The new method is reliable for measuring patellar height before and after TKA, providing an alternative to distinguish between true and pseudo patella baja. Furthermore, JLH can be applied to assess and restore the joint line position in TKA.
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Is Pseudo-Patella Baja Really a Serious Complication of Total Knee Arthroplasty? J Arthroplasty 2020; 35:557-562. [PMID: 31615703 DOI: 10.1016/j.arth.2019.09.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/10/2019] [Accepted: 09/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The available evidence on pseudo-patella baja (PPB) is limited. The purpose of this study is to investigate prospectively the occurrence of PPB after primary total knee arthroplasty and its clinical consequences in a large series of patients with a minimum follow-up of 2 years. PPB was defined as a patella distally displaced in relationship to the femoral trochlea with absence of patellar tendon shortening (Grelsamer RP. J Arthroplasty 2002;17:66-69) due to elevation of the joint line. METHODS This study is a prospective case series of 354 patients with a mean age of 71.7 (range 52-87) years. Clinical evaluation was performed by the Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form 12-item (SF12), and range of motion. Patellar height was assessed by the Insall-Salvati and Blackburne-Peel ratios. RESULTS The mean follow-up was 3.6 (range 2.0-6.6) years. Postoperatively, 286 (80.7%) patients had a normal patellar height, 17 (4.8%) had true patella baja (TPB), and 51 (14.4%) had PPB. There were no significant differences between the 3 groups in mean KSS-function (P = .107), range of motion (P = .408), WOMAC-pain (P = .095), WOMAC-stiffness (P = .279), or SF12-mental (P = .363). Between normal and PPB groups, there were no significant differences in mean KSS-knee (P = .903), WOMAC-function (P = .294), or SF12-physical (P = .940). However, the TPB group had significantly lower mean KSS-knee (P = .031), WOMAC-function (P = .018), and SF12-physical (P = .005) as compared with either 2 other groups. CONCLUSION PPB was a relatively common finding, but no significant differences in terms of clinical outcomes were found as compared to patients with postoperative normal patellar height. TPB was infrequent, but these patients had significantly worse clinical outcomes than those with PPB or normal patellar height.
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Bei M, Tian F, Liu N, Zheng Z, Cao X, Zhang H, Wang Y, Xiao Y, Dai M, Zhang L. A Novel Rat Model of Patellofemoral Osteoarthritis Due to Patella Baja, or Low-Lying Patella. Med Sci Monit 2019; 25:2702-2717. [PMID: 30979862 PMCID: PMC6476235 DOI: 10.12659/msm.915018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Patella baja, or patella infera, consists of a low-lying patella that results in a limited range of motion, joint pain, and crepitations. Patellofemoral joint osteoarthritis (PFJOA) is a subtype OA of the knee. This study aimed to develop a reproducible and reliable rat model of PFJOA. Material/Methods Three-month-old female Sprague-Dawley rats (n=24) included a baseline group (n=8) that were euthanized at the beginning of the study. The sham group (n=8), and the patella ligament shortening (PLS) group (n=8) were euthanized and evaluated at ten weeks. The PLS model group (n=8) underwent insertion of a Kirschner wire under the patella tendon to induce patella baja. At ten weeks, the sham group and the PLS group were compared using X-ray imaging, macroscopic appearance, histology, immunohistochemistry, TUNEL staining for apoptosis, and micro-computed tomography (micro-CT). The patella height was determined using the modified Insall-Salvati (MIS) ratio. Results The establishment of the rat model of patella baja in the PLS group at ten weeks was confirmed by X-ray. In the PLS group, patella volume, sagittal length, and cross-sectional area were significantly increased compared with the sham group. The PFJ showed typical lesions of OA, confirmed macroscopically and histologically. Compared with the sham group, in the rat model of PFJOA, there was increased cell apoptosis, and immunohistochemistry showed increased expression of biomarkers of osteoarthritis, compared with the sham group. Conclusions A rat model of PFJOA was developed that was confirmed by changes in cartilage and subchondral bone.
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Affiliation(s)
- Mingjian Bei
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Faming Tian
- Meical Research Center, North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Ning Liu
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Zhiyuan Zheng
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Xuehui Cao
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Hongfei Zhang
- Meical Research Center, North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Yudan Wang
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Yaping Xiao
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Muwei Dai
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Department of Orthopedic Surgery, Meitan General Hospital, Beijing, China (mainland)
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