Good Operative Effects of Patellofemoral Arthroplasty Combined With the Tibial Tubercle Transfer for Isolated Patellofemoral Arthritis Patients With an Increased Tibial Tuberosity-trochlear Groove Distance

Purpose: The objective of present study was to investigate the operative effect of patellofemoral arthroplasty combined with the tibial tubercle transfer for isolated patellofemoral arthritis patients with an increased tibial tuberosity-trochlear groove distance (>20mm).Methods: A prospective study was performed between November 2012 and December 2017. Finally, thirty-six cases, with a mean age of 61.1 ± 7.3 years, were admitted to our study. A total of 17 patients underwent patellofemoral arthroplasty combined with tibial tubercle transfer, and 19 patients underwent patellofemoral arthroplasty only. All eligible patients had CT scans preoperatively and at 12 months follow-up, to assess the stability of the patellofemoral joint on axial slices. In addition, the demographic and clinical features of all the patients were asked. Knee balance was assessed with the single leg stance test and timed get up and go, and functionality was evaluated with stair climbing test and the Western Ontario and McMaster Universities Osteoarthritis Index score. (P>0.05)Results: Preoperatively, the data regarding the knee balance and functionality were not significantly different between the two Groups (P>0.05). Many measurements showed significant differences between the two groups at the last follow-up. Significant differences were seen in well-known measurements such as the SLST (Group I, 28.9 s (SD 7.5); Group II, 20.3 s (SD 5.9); p < 0.001), TGUG (Group I, 13.4 s (SD 3.2); Group II, 16.8 s (SD 3.1); p < 0.001), and SCT (Group I, 18.6 s (SD 6.8); Group II, 24.5 s (SD 8.7); p < 0.001). Additionally, the median WOMAC score was improved from 62.7 (SD 11.2) preoperatively to 25.7 (SD 8.2) one year postoperatively in Group I and from 64.1 (SD 10.7) to 36.2 (SD 9.7) in Group II, which were also significantly different between the groups.Conclusion: For such special IPA patients with an increased TT-TG (>20mm), the combined operation of PFA combined with TTT can better restore the involutional relationship of patellofemoral joint and further improve the balance and function of knee joint.

Good Operative Effects of Patellofemoral Arthroplasty Combined With the Tibial Tubercle Transfer for Isolated Patellofemoral Arthritis Patients With an Increased Tibial Tuberosity-Trochlear Groove Distance

BackgroundThe objective of present study was to investigate the operative effect of patellofemoral arthroplasty combined with the tibial tubercle transfer for isolated patellofemoral arthritis patients with an increased tibial tuberosity-trochlear groove distance (>20mm). MethodsA prospective study was performed between November 2012 and December 2017. Finally, thirty-six cases, with a mean age of 61.1 ± 7.3 years, were admitted to our study. A total of 17 patients underwent patellofemoral arthroplasty combined with tibial tubercle transfer, and 19 patients underwent patellofemoral arthroplasty only. All eligible patients had CT scans preoperatively and at 12 months follow-up, to assess the stability of the patellofemoral joint on axial slices. In addition, the demographic and clinical features of all the patients were asked. Knee balance was assessed with the single leg stance test and timed get up and go, and functionality was evaluated with stair climbing test and the Western Ontario and McMaster Universities Osteoarthritis Index score. (P>0.05) ResultsPreoperatively, the data regarding the knee balance and functionality were not significantly different between the two Groups (P>0.05). Many measurements showed significant differences between the two groups at the last follow-up. Significant differences were seen in well-known measurements such as the SLST (Group I, 28.9 s (SD 7.5); Group II, 20.3 s (SD 5.9); p < 0.001), TGUG (Group I, 13.4 s (SD 3.2); Group II, 16.8 s (SD 3.1); p < 0.001), and SCT (Group I, 18.6 s (SD 6.8); Group II, 24.5 s (SD 8.7); p < 0.001). Additionally, the median WOMAC score was improved from 62.7 (SD 11.2) preoperatively to 25.7 (SD 8.2) one year postoperatively in Group I and from 64.1 (SD 10.7) to 36.2 (SD 9.7) in Group II, which were also significantly different between the groups. ConclusionsFor such special IPA patients with an increased TT-TG (>20mm), the combined operation of PFA combined with TTT can better restore the involutional relationship of patellofemoral joint and further improve the balance and function of knee joint.

Operative Treatment Options for Patellofemoral Arthritis: An Expert Recommendation of the AGA Patellofemoral Committee

Background: The operative therapy of patellofemoral arthritis requires an individual approach depending on the underlying injury. However, the literature lacks recommendations for its course of action. Purpose: To generate an expert recommendation of therapy for different patellofemoral abnormalities in patients suffering from isolated patellofemoral arthritis. Study Design: Consensus statement. Methods: To generate recommendations, the AGA Patellofemoral Committee performed a consensus process using the Delphi method based on the available literature on isolated patellofemoral arthritis. Results: In most statements and recommendations, a high percentage of consensus could be found. However, also in the expert group of the AGA Patellofemoral Committee, some controversies on the treatment of patellofemoral arthritis exist. Conclusion: The operative therapy of isolated patellofemoral arthritis is a challenging topic that leads to controversial discussions, even in an expert group. With this consensus statement of the AGA Patellofemoral Committee, recommendations on different operative treatment options were able to be generated, which should be considered in clinical practice.

Patellar Morphology and Osteoarthritis: A Cadaveric Analysis

Previous studies have attempted to characterize patellar morphology and its relation to patellofemoral osteoarthritis but have utilized relatively small samples. We designed a large-scale cadaveric analysis to elucidate any potential relationship. Patellar morphology in 1,032 patellae was characterized using patellar facet concavity patterns initially developed by Wiberg and using the ratio of the lateral and medial facet lengths. Patellofemoral arthritis grading for specimens was previously completed based primarily on osteophytic burden. The average age at time of death was 56 ± 10 years. Wiberg's grading returned kappa values of 0.43 for intrarelator reliability and 0.27 for interrelator reliability. Using multiple regression analysis, Wiberg's type II was found to be correlated with patellofemoral arthritis (p = 0.003). Lateral to medial facet ratio measurements returned intraclass coefficients of 0.91 for intrarelator reliability and 0.85 for interrelator reliability. There was no association between lateral to medial facet ratio and osteoarthritis. Regression analysis between Wiberg's typing and lateral-to-medial ratio (L:M) resulted in a coefficient of determination of 0.14. To our knowledge, this is the largest study evaluating the relationship between patellar morphology and arthritis. Although there was a relationship between Wiberg's type II and patellofemoral arthritis, the Wiberg systems was not easily reproducible in our study and returned a correlation with arthritis different then anatomically expected. A more reproducible system of lateral to medial facet ratio was investigated but did not find an association with arthritic changes. Given these findings, we did not find a patella morphology grading system which is both reliable and valid in regard to association with patellofemoral arthritis.

Has the modern design of Attune total knee replacement improved outcome in patients with isolated patellofemoral arthritis?

Introduction and Aim: Modern knee replacements aim to improve patient function in arthritis affecting different compartments of the knee. This study evaluates the Patient Reported Outcome Measure (PROM) and functional outcome of a modern total knee replacement (Attune, DePuy) in patients with isolated patellofemoral arthritis. Methods: A total of 50 consecutive patients with isolated unilateral patellofemoral arthritis having had Attune total knee replacements at a single institution between 2010 and 2016 were prospectively studied. Five patients who developed symptoms on the opposite side during the study and two patients lost to follow-up were excluded. One patient needed early revision for loosening, leaving a total of 42 patients to be followed up over a period of 4 years. The Oxford Knee score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded pre-operatively and at follow-up was compared. A Functional assessment at around 8 months after operation was undertaken. Results: At average follow-up of 24 months the mean OKS score improved by 15 points and the KOOS score improved by 20 points. Final KOOS sub-score for Pain was 80, Symptom 80, and ADL 82, Sports & Recreation 32 and QOL 60. Functional assessment at mean 8 months showed that a significant number of patients were able to Kneel (50%); Sit cross legged (23%); sit on their heel (23%) and were able do a single leg dip test (86%). Conclusion: This unique study of a modern design total knee replacement (Attune) in patients with isolated unilateral patellofemoral arthritis shows good PROM scores at 2 years and good functional assessment results at 8 months. The PROM scores are marginally better than the published results with Attune’s predecessor, in a similar cohort of patients, but falls short of the published results of patellofemoral replacement implants. Large randomised comparative studies between traditional and the modern implant design is recommended to answer the question if design modification has influenced clinical outcome in patients with patellofemoral arthritis.