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Patellar tendon buckling in post-operative total knee arthroplasty patients is more prominent than in healthy controls.

ABSTRACT: Recent evidence suggests the patellar tendon undergoes buckling during normal knee flexion, which likely contributes to the functioning of the extensor mechanism. Thus, evaluating buckling in patients following total knee arthroplasty (TKA), where extensor mechanism dysfunction remains a common complication, may be relevant. The study goals were to identify whether post-TKA patients exhibit differences in patellar tendon buckling from healthy, similarly-aged adults and whether such buckling correlates with knee and patellar tendon health. Patellar tendon buckling was assessed during passive knee flexion using ultrasound in post-TKA patients (n?=?20; 12M, 68 ± 8 years) and compared with previously reported data from healthy adults (n?=?12; 12M; 70 ± 8 years). Patients exhibited significantly larger (p < 0.01) buckling magnitude and angles than healthy adults, and reduced distal buckling was linked with better Knee Society Scores (p?=?0.04, R2 = 0.24). The greater patellar tendon buckling observed in post-TKA patients could arise due to factors related to the surgery itself (e.g. infrapatellar fat pad resection) or it may be that post-TKA patients had greater patellar tendon buckling before their procedure. Alterations in patellar tendon buckling may predispose individuals to post-surgical complications including instability, anterior knee pain, and extensor mechanism dysfunction, with further work necessary to elucidate potential links.

SUBMITTER: Slane LC

PROVIDER: S-EPMC6612598 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Patellar tendon buckling in post-operative total knee arthroplasty patients is more prominent than in healthy controls.

Slane Laura Chernak LC Dandois Félix F Bogaerts Stijn S Scheys Lennart L Vandenneucker Hilde H

Medical engineering & physics 20190618

Recent evidence suggests the patellar tendon undergoes buckling during normal knee flexion, which likely contributes to the functioning of the extensor mechanism. Thus, evaluating buckling in patients following total knee arthroplasty (TKA), where extensor mechanism dysfunction remains a common complication, may be relevant. The study goals were to identify whether post-TKA patients exhibit differences in patellar tendon buckling from healthy, similarly-aged adults and whether such buckling corr ...[more]

PMID: 31221515

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Project description:IntroductionThe effect of post-operative patella tilt on functional outcomes after total knee arthroplasty remains unclear. Our study aimed to analyze the relationship of post-operative patellar tilt with functional outcome scores after total knee arthroplasty.Materials and methodsPatient data were retrieved from our institution's prospectively maintained total knee arthroplasty. Three hundred three patients who underwent unilateral TKA from Jan 2012 to March 2017 were included in the study. After excluding patients with incomplete and lost follow-up data, 213 patients were analyzed. Radiographs of pre-operative and post-operative skyline views were used for patella tilt and patella displacement measurement at pre-op, post-op 1 year, and post-op 2 years. Three functional outcome scoring systems, SF-36, KSS, and WOMAC, were applied for function evaluation at different post-operative time points. Patients were divided into three subgroups according to the patella tilt, which includes less than 5°, 5.1-10°, and more than 10°. Statistical analysis was done to identify the relationship between patella tilt and functional outcomes.ResultsMean post-operative patella tilt was significantly lower than the mean pre-operative patella tilt (3.35 ± 3.91 vs. 5.65 ± 4.41, p < 0.001). There was no significant difference in patella displacement among pre- and post-operative status. KSS functional score was significantly poor at post-op 1 year and KSS objective score at post-op 2 years in patients with more than 10° patella tilt. SF-36 and WOMAC were not significantly different among the groups. There was no significant difference in post-operative function between non-resurfaced and resurfaced patella patients evaluated with three scoring systems.ConclusionWe have found significantly less post-operative patella tilt after TKA than pre-operative patella tilt with or without patella resurfacing. Increased post-operative patella tilt of more than 10° can affect specific functional outcomes. Patella resurfacing does not affect the post-operative functional outcome compared to non-resurfacing of the patella post-op 2 years.Level of evidenceIII.Supplementary informationThe online version contains supplementary material available at 10.1007/s43465-023-01077-0.

Project description:PurposeThis study was carried out to investigate the accuracy of referring different locations of the patellar tendon attachment site and the geometrical center of the osteotomy surface for tibial rotational alignment and observe the influences of gender differences on the results.MethodsComputed tomography scans of 135 osteoarthritis patients (82 females and 53 males) with varus deformity was obtained to reconstruct three-dimensional (3D) models preoperatively. The medial boundary, medial one-sixth, and medial one-third of the patellar tendon attachment site were marked on the tibia. These points were projected on the tibial osteotomy plane and connected to the geometrical center (GC) of the osteotomy plane or the middle of the posterior cruciate ligament (PCL) to construct six tibial rotational axes (Akagi line, MBPT, MSPT1, MSPT2, MTPT1 and MTPT2). The mismatch angle between the vertical line of the SEA projected on the proximal tibial osteotomy surface and six different reference axes was measured. In additional, the effect of gender differences on rotational alignment for tibial component were assessed.ResultsRelative to the SEA, rotational mismatch angles were - 1.8° ± 5.1° (Akagi line), - 2.5° ± 5.3° (MBPT), 2.8° ± 5.3° (MSPT1), 4.5° ± 5.4° (MSPT2), 7.3° ± 5.4° (MTPT1), and 11.6° ± 5.8° (MTPT2) for different tibial rotational axes in all patients. All measurements differed significantly between the male and female. The tibial rotational axes with the least mean absolute deviation for the female or male were Akagi line or MSPT, respectively. There was no significant difference in whether the GC of the osteotomy surface or the midpoint of PCL termination was chosen as the posterior anatomical landmark when the medial boundary or medial one-sixth point of the patellar tendon attachment site was selected as the anterior anatomical landmark.ConclusionWhen referring patellar tendon attachment site as anterior anatomical landmarks for tibial rotational alignment, the influence of gender difference on the accuracy needs to be taken into account. The geometric center of the tibial osteotomy plane can be used as a substitute for the middle of the PCL termination when reference the medial boundary or medial one-sixth of the patellar tendon attachment site.

Dataset Information

Patellar tendon buckling in post-operative total knee arthroplasty patients is more prominent than in healthy controls.

Publications

Patellar tendon buckling in post-operative total knee arthroplasty patients is more prominent than in healthy controls.

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