Decrease of tibial tuberosity trochlear groove distance following mechanically aligned total knee arthroplasty

Zimmermann, Stefan M.; Scherrer, Yves; Zaleski, Martin; Jentzsch, Thorsten; Fucentese, Sandro F.

doi:10.1007/s00167-022-06952-1

Cited by 2 publications

(1 citation statement)

References 41 publications

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“…Furthermore, no postoperative CT scan was available to assess postoperative TT‐TG distance, patellar tilt or displacement, which could have confounded the scores. TT‐TG distance, for example, is expected to significantly decrease independently of preoperative mechanical leg axis [46]. Further study is however warranted to evaluate alteration of TT‐TG distance as a potential cause for postoperative patellofemoral maltracking and pain.…”

Section: Discussionmentioning

confidence: 99%

Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated

Flury

Hoch

Cirigliano

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Recent data suggest that individual morphologic factors should be respected to restore preoperative patellofemoral alignment and thus reduce the likelihood of anterior knee pain. The goal of this study was to investigate the effect of excessive femoral torsion (FT) on clinical outcome of TKA. Methods Patients who underwent TKA and complete preoperative radiographic evaluation including a long-leg radiograph and CT scan were included. 51 patients showed increased FT of > 20° and were matched for age/sex to 51 controls (FT < 20°). Thirteen patients were lost to follow-up. Thirty-eight matched pairs were compared after a 2 year follow-up clinically (Kujala and patellofemoral score for TKA) and radiographically (FT, frontal leg axis, TT-TG, patellar thickness, patellar tilt, and lateral displacement of patella). Functional alignment of TKA was performed (hybrid-technique). All patellae were denervated but no patella was resurfaced. Results There was no significant difference between clinical scores two years after surgery between patients with normal and excessive FT (n.s.). Kujala score was 64.3 ± 16.7 versus 64.8 ± 14.4 (n.s.), and patellofemoral score for TKA was 74.3 ± 21 versus 78.5 ± 20.7 (n.s.) for increased FT group and control group, respectively. There was no correlation between preoperative FT and clinical scores. Other radiographic parameters were similar between both groups. No correlations between clinical outcomes and preoperative/postoperative frontal leg axis or total leg axis correction were found (n.s.). Conclusion If the leg axis deformity is corrected to a roughly neutral alignment during cemented TKA, including patellar denervation, then excessive FT was not associated with patellofemoral pain or instability. Level of evidence. Prospective comparative study, level II.

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Section: Discussionmentioning

confidence: 99%

Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated

Flury

Hoch

Cirigliano

et al. 2022

Knee Surg Sports Traumatol Arthrosc

Self Cite

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Optimizing the patellofemoral compartment in total knee arthroplasty: Is it time for dynamic assessment?

Koutserimpas,

Saffarini,

Bonnin

et al. 2024

Knee surg. sports traumatol. arthrosc.

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Despite improvements in implant design, surgical techniques and assistive technologies for total knee arthroplasty (TKA), anterior knee pain (AKP) remains frequently reported, even by satisfied patients. This persistent problem calls for better understanding and management of the patellofemoral or anterior compartment during surgery, just as the techniques and strategies deployed to optimize the flexion and extension spaces through personalized alignment, bone cuts and ligament balancing. Assistive technologies such as navigation and robotics provide new tools to manage this ‘third space’ through precise pre‐operative planning and dynamic intra‐operative assessment. Such endeavors must start with clear definitions of the ‘third space’, how it should be measured, what constitutes its ‘safe zone’, and how it affects outcomes. There are yet no established methods to evaluate the patellofemoral compartment, and no clear thresholds to define over‐ or under‐stuffing. Static assessment using lateral radiographs provides a limited understanding and depends considerably on flexion angle, while dynamic evaluation at multiple flexion angles or using intra‐operative computer or robotic‐assistance enables a broader perspective and solutions to manage patellar tracking and anterior offset. Future studies should investigate the impact of variations in anterior offset in TKA, define its safe zone, and understand the effects of of thresholds for over‐ or under‐stuffing. Experimental methods such as in‐vivo motion analysis and force sensors could elucidate the influence of anterior offset on flexion and extension biomechanics.

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Decrease of tibial tuberosity trochlear groove distance following mechanically aligned total knee arthroplasty

Cited by 2 publications

References 41 publications

Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated

Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated

Optimizing the patellofemoral compartment in total knee arthroplasty: Is it time for dynamic assessment?

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