Influence of prosthetic joint line position on outcome after total knee replacement

Background: The current study had been designed so as to assess whether joint line elevation and change in patellar tendon length influences knee flexion after primary cruciate retaining TKR.Methods: This prospective study involved patients with advanced degenerative joint disease involving one or both knees who presented to the outpatient department of a tertiary care hospital. Exclusion criteria were any prior knee surgery. Surgery was performed under tourniquet with standard medial para-patellar arthrotomy to expose all our knees. In the study radiological assessment was done by true lateral X-ray view of knee in 30 degree of flexion. We choose Caton-Deschamps indices (CI) for diagnosis of post TKR patella infera and joint line elevation. CI<0.6 was defined as patella infera (normal range of CI 0.60-1.45). After all data collection comparison was done between joint line elevation versus without joint line elevation patients (with/without patellar tendon shortening) range of movement.Results: Total of 100 patients (72 females and 28 males) with 176 knees (bilateral=76, unilateral=24) who fulfilled the above said criteria involved in study. The mean age of the patients at the time of surgery was 64.4 years with range of 54 years to 80 years. The average follow up of 24 months, with minimum follow up of 18 months. Average range of motion (ROM) in NO Joint line elevation/patella tendon shortening patient measured 107.2°, and joint line elevation with patellar tendon shortening (prior patella infera) and joint line elevation without patella tendon shortening(prior patella infera) patient average ROM was measured 86.7 and 87.8 degree respectively.Conclusions: In our study patellar tendon shortening and joint line elevation reduces ROM knee. Mechanical factors also explain the association between joint line elevation and patellar tendon length with range of motion. Reduction in length of extensor apparatus reduces the range of flexion.

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Infrapatellar Fat Pad Excision during Total Knee Arthroplasty Did Not Alter the Patellar Tendon Length: A 5-Year Follow-Up Study

The Journal of Knee Surgery ◽

10.1055/s-0036-1593360 ◽

2016 ◽

Vol 30 (05) ◽

pp. 479-483 ◽

Cited By ~ 3

Author(s):

Süleyman Dedeoğlu ◽

Murat Çakar ◽

Haluk Çabuk ◽

Tahsin Bayraktar ◽

Hakan Gürbüz ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patellar Tendon ◽

Infrapatellar Fat Pad ◽

X Rays ◽

Fat Pad ◽

Tendon Length ◽

Patellar Tendon Length ◽

Total Knee ◽

The Mean

AbstractPartial or total resection of the infrapatellar fat pad (IPFP) helps surgeon improve access to lateral tibial plateau for better placement of the knee prosthesis. We aimed to investigate the effect of IPFP excision on clinical and radiologic outcomes including patellar tendon length (PTL), range of motion, and functional scores after total knee arthroplasty (TKA) at 5-year follow-up. We retrospectively evaluated postoperative first X-rays (day 0) and postoperative final 5-year control views of 228 knees in patients with primary osteoarthritis who underwent TKA between September 2006 and December 2009 in our hospital. Exclusion criteria were patients who had lateral release, patellar resurfacing, septic or aseptic loosening, fracture around the replaced knee, any other prior knee surgery, or any systemic inflammatory disease. IPFP was completely resected in all knees to enhance surgical exposure and patellar mobilization. Radiologic evaluation of PTL was performed in early postoperative and 5-year control X-rays comparatively. The mean early postoperative PTL was 47.4 ± 6 (range: 35–72), the mean final postoperative PTL was 47 ± 6.3 (range: 33–68) (p = 0.1). The average preoperative flexion was 115 ± 11 degrees, whereas it was 111 ± 4 degrees, postoperatively (p = 0.73). Both the clinical and functional outcome scores improved in all patients. IPFP excision during TKA did not alter PTL at 5-year follow-up. A focus on other surgical and/or host-related factors may help clarify contradictory patellar tendon shortening reported in the literature.

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Patellar Impingement on Tibial Polyethylene after Primary Total Knee Arthroplasty without Patellar Resurfacing

The Journal of Knee Surgery ◽

10.1055/s-0039-1695704 ◽

2019 ◽

Author(s):

Bo-Hyun Hwang ◽

Kwang-Am Jung ◽

Alvin Ong ◽

Hye-Sun Ahn ◽

Seong-Hwan Moon ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patellar Tendon ◽

Knee Arthroplasty ◽

Multiple Logistic Regression Analysis ◽

Oxford Knee Score ◽

Joint Line ◽

Patellar Resurfacing ◽

Tendon Length ◽

Patellar Tendon Length ◽

Total Knee

AbstractPatellar impingement on tibial polyethylene (PIP) is one potential complication of total knee arthroplasty (TKA). When PIP occurs, it is often related to inaccurate restoration of the joint line or due to soft-tissue contracture. We investigated the prevalence and etiology of PIP in Asian patients with deeply flexed knees following posterior stabilized (PS)-TKA. We retrospectively reviewed 54 patients (65 knees) with PIP after primary PS-TKAs without patellar resurfacing performed between 2008 and 2011. These patients were compared with a group of 124 patients (130 knees) without PIP matched for age, sex, and body mass index (BMI). The minimum follow-up was 5 years (range, 5–8.1 years). Patients were evaluated by blinded, independent observers using the Oxford knee score, the Waters score, and radiographic parameters. Impingement between the patella and the tibial polyethylene had a mean onset of 13.5 months after PS-TKA. The development of PIP was significantly associated with change in patellar tendon length (odds ratio [OR] = 11.4, 95% confidence interval [CI]: 11.2–11.6%), shorter postoperative patellar tendon length (OR = 2.1, 95% CI: 1.8–2.5%), change in the Insall–Salvati ratio (OR = 0.9, 95% CI: 0.8–1.0%), and joint line elevation (OR = 5.3, 95% CI: 4.8–5.8%) on multiple logistic regression analysis. Our findings reinforce the importance of accurate joint line restoration and the avoidance of iatrogenic injury to the patellar tendon, which can lead to shortening of the patellar tendon. This is a retrospective comparative study and its level of evidence is III.

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Patellar Tendon Imbrication Is a Safe and Efficacious Technique to Shorten the Patellar Tendon in Patients With Patella Alta

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959318 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095931

Author(s):

Ronak M. Patel ◽

Michael Gombosh ◽

Joshua Polster ◽

Jack Andrish

Keyword(s):

Patellar Tendon ◽

Patellar Instability ◽

Case Series ◽

Retrospective Chart Review ◽

Patella Alta ◽

Level Of Evidence ◽

Tendon Length ◽

Patellar Tendon Length ◽

The Mean

Background: Patella alta has been noted to be a risk factor for recurrent patellar instability. Purpose: We conducted a radiographic study to determine whether a patellar tendon imbrication technique normalizes patellar height as well as whether the shortened length is maintained at a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A total of 54 consecutive patients were identified after a retrospective chart review was performed on patients who underwent patellar tendon imbrication between 2008 and 2013. Preoperative, 3 weeks postoperative, and minimum 2 years postoperative lateral radiographs were analyzed using Insall-Salvati (IS), Blackburne-Peel (BP), and Caton-Deschamps (CD) indices to determine the amount of shortening that was achieved after the procedure and to what degree that shortening was maintained at a minimum 2-year follow-up. Results: A total of 27 patients (32 knees) completed a minimum 2-year follow-up. The mean patellar tendon length preoperatively was 6.1 cm (range, 5-8 cm). At 3 weeks and 2 years, the mean tendon lengths were 5.1 and 5.2 cm, respectively. Thus, the mean ± SD change in patellar tendon length from preoperative to 3 weeks postoperative was 0.97 ± 0.67 cm. IS, BP, and CD ratios had minimal change (loss of correction) from 3-week to 2-year follow-up; the delta values were 0.04, –0.03, and 0.09, respectively. There were no complications directly related to the technique. Conclusion: Patellar tendon imbrication is a safe and effective procedure to correct patella alta in the setting of lateral patellar instability. On average, the technique allowed 1 cm of patellar tendon shortening and maintained the correction at a minimum 2-year follow-up. In the skeletally immature patient, this technique allows correction of patella alta by avoidance of a tibial tuberosity osteotomy.

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Patellar tendon length after anterior cruciate ligament reconstruction

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.76b2.8113275 ◽

1994 ◽

Vol 76-B (2) ◽

pp. 198-199 ◽

Cited By ~ 37

Author(s):

DJ Dandy ◽

SS Desai

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Patellar Tendon ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Cruciate Ligament Reconstruction ◽

Tendon Length ◽

Patellar Tendon Length ◽

Anterior Cruciate

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Patellar Tendon Length is Associated with Lower Extremity Length but Not Gender

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00046-1 ◽

2020 ◽

Vol 54 (3) ◽

pp. 352-357

Author(s):

Gloria M. Hohenberger ◽

Manuel Dreu ◽

Harald Kreuzthaler ◽

Gerald Gruber ◽

Regina Riedl ◽

...

Keyword(s):

Lower Extremity ◽

Patellar Tendon ◽

Tendon Length ◽

Patellar Tendon Length

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MRI observations of patellar tendon length change after ACL reconstruction with hamstring autografts

Journal of Huazhong University of Science and Technology [Medical Sciences] ◽

10.1007/s11596-017-1775-z ◽

2017 ◽

Vol 37 (4) ◽

pp. 577-581

Author(s):

Hao-huan Li ◽

Xiao-long Zhang ◽

Gota Ooi ◽

Numazaki Hironori ◽

Miho Sekiguchi ◽

...

Keyword(s):

Acl Reconstruction ◽

Patellar Tendon ◽

Length Change ◽

Tendon Length ◽

Patellar Tendon Length

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Avoiding Allograft Length Mismatch during Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546506298584 ◽

2007 ◽

Vol 35 (6) ◽

pp. 986-989 ◽

Cited By ~ 29

Author(s):

John A. Brown ◽

Robert H. Brophy ◽

John Franco ◽

Allyson Marquand ◽

Thomas C. Solomon ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Patellar Tendon ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Ligament Length ◽

Cruciate Ligament Reconstruction ◽

Tendon Length ◽

Patellar Tendon Length ◽

Anterior Cruciate

Background Given the increasing use of allografts in anterior cruciate ligament reconstruction, selection of appropriate-sized grafts may help individual surgeons as well as the efficiency of the overall system for graft distribution. Hypothesis Recipient patient height can predict the desired length for the tendinous portion of a patellar bone-tendon-bone allograft in anterior cruciate ligament reconstruction. Study Design Cohort study (Prognosis); Level of evidence, 2. Methods A series of 414 knees in 392 consecutive patients undergoing magnetic resonance imaging evaluation of knee pain were enrolled in the study. Data collected from magnetic resonance imaging included patella and patellar tendon length and intra-articular length of the anterior cruciate ligament. Patient age, height, weight, and gender were recorded. Linear regression analysis assessed the correlation between patient height and intra-articular length of the anterior cruciate ligament as well as patellar tendon length. The effect of variance in age, weight, and gender on anterior cruciate ligament intra-articular length was also measured. Results A strong positive correlation was found between intra-articular length of the anterior cruciate ligament and patient height (Pearson r = 0.73; P < .001). Anterior cruciate ligament length (y, in millimeters) as a function of height (x, in inches) can be expressed as y = 1.17x — 41.29. As a function of height (x, in centimeters), anterior cruciate ligament length (y, in millimeters) can be expressed as y = 0.4606x — 41.29. Age, gender, and weight did not significantly influence this relationship. A weak positive association was found between patient height and patellar tendon length. Conclusion Patient height can predict the desired length of the tendinous portion of a patellar bone-tendon-bone allograft. An addition of 10 mm is made to the predicted anterior cruciate ligament length to allow for aperture tibial and femoral fixation. Patellar bone-tendon-bone allografts can be requested based on recipient patient height as follows: 5 ft, 0 in to 5 ft, 6 in: tendinous length/total length, 45 mm/95 mm; 5 ft, 7 in to 6 ft, 1 in: 50 mm/100 mm; >6 ft, 1 in: 55 mm/105 mm.

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