Wiberg Type III patellae and J-sign during extension compromise outcomes of total knee arthroplasty without patellar resurfacing

Butnaru, Michael; Sigonney, Guillaume; Müller, Jacobus H.; Senioris, Antoine; Saffarini, Mo; Courage, Olivier

doi:10.1016/j.knee.2020.04.005

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…Wiberg patellar shape has been shown to affect clinical outcomes after TKA; specifically, nonresurfaced Wiberg type C patellae have been associated with poorer outcomes after TKA. 3,4 Although Barbieri Mestriner et al 2 found no relationship between trochlear morphology (dysplasia vs normal trochlear anatomy) and PROMs after ACI for chondral defects of the patellofemoral joint, no previous studies have evaluated the effect of patellar shape on outcomes after cell-based cartilage repair. The present study builds on the existing literature by examining the effect of patellar shape on clinical outcomes and survival after cell-based cartilage repair for the treatment of patellar chondral defects.…”

Section: Discussionmentioning

confidence: 99%

“…The American Journal of Sports Medicine 2024;52(3):705-709 DOI: 10.1177/03635465231220028 Ó 2024 The Author(s) compared with those with nonresurfaced Wiberg type A and Wiberg type B patellae. 3,4 The only previous investigation of the effect of patellofemoral morphology on outcomes after ACI for the patellofemoral joint has evaluated trochlear dysplasia. The authors found that trochlear dysplasia did not affect clinical results of ACI in the patellofemoral joint.…”

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confidence: 99%

“…Two previous studies have demonstrated worse clinical outcomes of nonresurfaced Wiberg type C patellae in patients undergoing total knee arthroplasty (TKA) compared with those with nonresurfaced Wiberg type A and Wiberg type B patellae. 3,4 The only previous investigation of the effect of patellofemoral morphology on outcomes after ACI for the patellofemoral joint has evaluated trochlear dysplasia. The authors found that trochlear dysplasia did not affect clinical results of ACI in the patellofemoral joint.…”

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confidence: 99%

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Impact of Wiberg Patellar Type on Outcomes and Survival Following Cell-Based Cartilage Repair for Patellar Chondral Lesions at Midterm Follow-up

Retzky,

Thacher,

Palhares

et al. 2024

Am J Sports Med

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Background: Cell-based cartilage repair procedures of the patellofemoral joint have less reliable outcomes than those of the tibiofemoral joint. No previous studies have evaluated the influence of patellar shape on cell-based cartilage repair outcomes. Patellar dysplasia may predispose patients to worse outcomes after cell-based cartilage repair. Purpose/Hypothesis: The purpose of this study was to evaluate the relationship between Wiberg patellar type and outcomes after cell-based cartilage repair (autologous chondrocyte implantation or particulated juvenile allograft cartilage transplantation) for the treatment of patellar chondral lesions at a minimum 2-year follow-up. It was hypothesized that Wiberg classification of patellar shape would have no effect on patient-reported outcome measures (PROMs) or graft survival. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing autologous chondrocyte implantation or particulated juvenile allograft cartilage transplantation for full-thickness patellar chondral defects between 2016 and 2020 were retrospectively reviewed after institutional review board approval. The change in PROMs, including International Knee Documentation Committee (IKDC), Kujala, and Veterans RAND 12-item Health Survey Mental and Physical scores, from pre- to postoperatively and the percentage of patients who achieved the minimal clinically important difference (MCID) for IKDC and Kujala scores were compared for the Wiberg type A versus Wiberg type B versus Wiberg type C groups. The log-rank test was used to evaluate for differences in survival between subgroups. Results: A total of 59 patients (63 knees) were included, with a mean age of 33.3 ± 8.6 years, median body mass index of 26.0 (IQR, 21.8-30.2), and median follow-up time of 3.5 years (IQR, 2.6-4.2 years). In total, 26 (41%) patellae were Wiberg type A, 29 (46%) were Wiberg type B, and 8 (13%) were Wiberg type C. There were no differences between Wiberg type A versus Wiberg type B versus Wiberg type C groups with respect to change in PROMs from pre- to postoperatively or the percentage of patients who achieved the MCID for IKDC or Kujala scores (P > .05 for all). There were no differences in survival between groups (P = .45). Conclusion: Wiberg patellar type has no effect on patient-reported outcomes or graft survival at midterm follow-up. Patellar dysplasia should not be seen as a contraindication for cell-based cartilage repair procedures.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Impact of Wiberg Patellar Type on Outcomes and Survival Following Cell-Based Cartilage Repair for Patellar Chondral Lesions at Midterm Follow-up

Retzky,

Thacher,

Palhares

et al. 2024

Am J Sports Med

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“…Patellofemoral joint symptoms after TKA vary between Wiberg classifications. Previous studies [ 1 , 32 , 33 ] have shown that Wiberg type III patella with small patellofemoral surface angles results in smaller patellofemoral joint contact areas and greater contact pressures. Additionally, the uneven patellofemoral joint pressure distribution due to the different contact areas of the medial and lateral patellofemoral surfaces is the main cause of patellofemoral joint pain.…”

Section: Discussionmentioning

confidence: 99%

The effect of femoral prosthesis design on patellofemoral contact stresses in total knee arthroplasty: a case–control study with mid-term follow-up minimum 3-year follow-up

Kong,

Lin,

Kang

et al. 2023

J Orthop Surg Res

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Background To investigate the differences in postoperative patellofemoral pressures and patellar tracking during at least three years of follow-up in patients using three prostheses of different designs in total knee arthroplasty (TKA) without patellar resurfacing. Methods: Radiographic investigations The study included 401 patients who had a total of 480 knee prostheses implanted without patellar resurfacing. The prostheses used were Genesis II (external rotation design of femoral prosthesis), Triathlon (design with deep trochlear grooves), and Gemini MK II (deepening of trochlear groove and lateral condylar protrusion that closely follows the anatomical shape). The patients' patellar tracking was assessed by measuring patellar tilt and displacement during postoperative follow-up. Furthermore, postoperative knee function and pain were evaluated through range of motion, Knee Society scores (KSS), and Forgotten Joint Score (FJS) to compare the different groups. Finite element analysis Constructing a finite element model of the knee joint of a normal volunteer after total knee arthroplasty using different prostheses for nonpatellar replacement. The three models' von Mises stress distribution heat map, peak contact pressure, and patellar transverse displacement were compared at 30°, 60°, and 90°, respectively. Results: Radiographic investigations A total of 456 knees of 384 patients were investigated at a 3-year follow-up after TKA without patellar resurfacing. There were no significant differences in patellar tracking between the three groups. Patients with all three prostheses demonstrated favorable clinical outcomes at 3 years postoperatively, with no statistically significant differences in knee scores (91.9 vs 92.3 vs 91.8) or range of motion (127.9° vs 128.5° vs 127.7°) between the groups. However, there was a significant difference between Genesis II and Gemini MK II in the Forgotten Joint Score (59.7 vs 62.4). Patients with persistent postoperative anterior knee pain were present in all three groups (16 vs 12 vs 10), but the incidence was not significantly different. Finite element analysis The von Mises stress distribution heat map showed that during flexion, the patellofemoral stresses were mainly concentrated on the lateral side of the prosthesis side, and the contact site gradually shifted downward with increasing flexion angle. At the same time, the peak contact stress of the patellofemoral joint increased with the gradual increase in the flexion angle. Genesis II, with a wider and shallower trochlear groove, showed greater patellofemoral stresses and lateral patellar displacement after TKA without patellar resurfacing. The Gemini MK II with a deeper trochlear groove and slightly protruding lateral condyle is more in line with anatomical design, with smaller patellofemoral joint pressure and better patellar tracking. Conclusions In TKA without patellar resurfacing, a prosthesis with a deeper trochlear groove, a slightly higher lateral femoral condyle, and a more anatomically designed knee that better matches the patellar morphology should be a better choice.

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“…These include new alignment philosophies that aim to respect patient phenotypes, as well as patient‐specific instrumentation and computer‐assisted technologies that aim to improve implant positioning. Residual pain after TKA is reported by 8–27% of patients, and remains a major source of dissatisfaction [8, 25], potentially due to soft‐tissue impingements in knees with prosthetic overhang or under‐coverage [3, 4, 7], implant overstuffing [13] or over‐voluming [31], as well as patellar maltracking [1, 9].…”

Section: Introductionmentioning

confidence: 99%

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

Gousopoulos

Dobbelaere

Ratano

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with 'personalised alignment' would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on of-the-shelf (OTS) TKA. Methods Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and ive refused participation, leaving 140 patients for analysis. Patients completed pre-and post-operative PROMs (Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster osteoarthritis index (WOMAC)) as well as overall level of satisfaction. Proportions that attained a patient acceptable symptom state (PASS) were calculated for OKS and FJS. Clinical indings were compared to the average scores reported for PROMs in recent systematic reviews and/or meta-analyses on OTS TKA. Descriptive statistics were used to summarise the clinical indings as means, standard deviations (SD) and ranges, or numbers and percentages. Results At mean follow-up 33.5 ± 4.5 months, 94% (135/143) were either satisied or very satisied. Proportions that achieved PASS were 89% for OKS (120/135), and 85% for FJS (118/139). Median OKS, WOMAC and KOOS Symptoms and Pain scores were all within the 4th quartile of medians reported in systematic reviews and/or meta-analyses. Conclusions At a minimum follow-up of two years following custom TKA combined with 'personalised alignment', 94% of patients were either satisied or very satisied, and the PASS criteria were achieved in 89% for OKS and 85% for FJS, all of which compare favourably to published outcomes of OTS TKA. Direct comparisons to the literature may not be appropriate, however, considering the heterogeneity of patient demographics and alignment techniques. Randomised controlled trials with suicient statistical power are needed to corroborate these indings and generalise them to unselected TKA patients. Level of evidence IV, retrospective cohort study.

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Wiberg Type III patellae and J-sign during extension compromise outcomes of total knee arthroplasty without patellar resurfacing

Cited by 8 publications

References 30 publications

Impact of Wiberg Patellar Type on Outcomes and Survival Following Cell-Based Cartilage Repair for Patellar Chondral Lesions at Midterm Follow-up

Impact of Wiberg Patellar Type on Outcomes and Survival Following Cell-Based Cartilage Repair for Patellar Chondral Lesions at Midterm Follow-up

The effect of femoral prosthesis design on patellofemoral contact stresses in total knee arthroplasty: a case–control study with mid-term follow-up minimum 3-year follow-up

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

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