J Korean Orthop Assoc.  2010 Apr;45(2):133-138. 10.4055/jkoa.2010.45.2.133.

Clinical Value of "The Single Stitch Method" in Intraoperative Assessment of Patellar Tracking in Total Knee Arthroplasty

Affiliations
  • 1Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea. sdcho@uuh.ulsan.kr

Abstract

PURPOSE
We evaluated the lateral release rate and the clinical results according to the intraoperative assessment of patellar tracking in total knee arthroplasty (TKA).
MATERIALS AND METHODS
We analyzed 365 primary total knee arthroplasties in 278 patients. The knees showing good patellar tracking without tourniquet deflation were classified into group 1, those showing improved patellar tracking after tourniquet deflation were classified into group 2, those showing improved patellar tracking after the single stitch method were classified into group 3 and those showing persistent patellar maltracking, that resulted in lateral retinacular release, were classified into group 4. The postoperative patellar tilting angle was measured and the clinical results were evaluated for all the groups.
RESULTS
We classified 176, 127, 57 and 5 knees into groups 1, 2, 3 and 4 respectively. Only 5 knees (1.4%) showed poor patellar tracking with the single stitch method after tourniquet deflation and this resulted in lateral retinacular release. The postoperative mean patellar tilting angle was 4.1degrees, 3.4degrees, 5.1degrees and 4.3degrees in each group, respectively, and no statistical differences were shown between the groups (p>0.05). Nine knees complained of anterior knee pain and there was no difference between groups.
CONCLUSION
Lateral retinacular release in TKA may not be necessary if the patellar tracking is improved with the single stitch method after tourniquet deflation.

Keyword

knee; total knee arthroplasty; patellar tracking

MeSH Terms

Arthroplasty
Humans
Knee
Tourniquets
Track and Field

Figure

  • Figure 1 Measurement of the patellar tilting angle with the Merchant view of the knee joint.


Reference

1. Clayton ML, Thirupathi R. Patellar complications after condylar arthroplasty. Clin Orthop Relat Res. 1982. 170:152–155.
2. Briard JL, Hungerford DS. Patellofemoral instability in total knee arthroplasty. J Arthroplasty. 1989. 4:Suppl. 87–97.
Article
3. Ranawat CS. The patellofemoral joint in total condylar knee arthroplasty. Pros and cons based on five- to ten-year follow-up observations. Clin Orthop Relat Res. 1986. 205:93–99.
4. Reider B, Marshall JL, Ring B. Patellar tracking. Clin Orthop Relat Res. 1981. 157:143–148.
Article
5. Engh GA, Parks NL, Ammeen DJ. Influence of surgical approach on lateral retinacular releases in total knee arthroplasty. Clin Orthop Relat Res. 1996. 331:56–63.
Article
6. Grace JN, Rand JA. Patellar instability after total knee arthroplasty. Clin Orthop Relat Res. 1988. 237:184–189.
Article
7. Kawano T, Miura H, Nagamine R, et al. Factors affecting patellar tracking after total knee arthroplasty. J Arthroplasty. 2002. 17:942–947.
Article
8. McPherson EJ. Patellar tracking in primary total knee arthroplasty. Instr Course Lect. 2006. 55:439–448.
9. Johnson DP, Eastwood DM. Lateral patellar release in knee arthroplasty. Effect on wound healing. J Arthroplasty. 1992. 7:Suppl. 427–431.
10. Laskin RS. Lateral release rates after total knee arthroplasty. Clin Orthop Relat Res. 2001. 392:88–93.
Article
11. Archibeck MJ, Camarata D, Trauger J, Allman J, White RE Jr. Indication for lateral retinacular release in total knee replacement. Clin Orthop Relat Res. 2003. 414:157–161.
12. Choi CH, Kim JH, Sung IH. A study of the decision status for the lateral retinacular release based on lateral patellar tilt angle in total knee arthroplasty: related with tourniquet effect. J Korean Knee Soc. 2007. 19:26–31.
13. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br. 1996. 78:226–228.
Article
14. Gomes LS, Bechtold JE, Gustilo RB. Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop Relat Res. 1988. 236:72–81.
15. Brick GW, Scott RD. The patellofemoral component of total knee arthroplasty. Clin Orthop Relat Res. 1988. 231:163–178.
Article
16. Komatsu T, Ishibashi Y, Otsuka H, Nagao A, Toh S. The effect of surgical approaches and tourniquet application on patellofemoral tracking in total knee arthroplasty. J Arthroplasty. 2003. 18:308–312.
Article
17. Ritter MA, Campbell ED. Postoperative patellar complications with or without lateral release during total knee arthroplasty. Clin Orthop Relat Res. 1987. 219:163–168.
Article
18. Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL, Adams JB. The relationship of lateral release and tourniquet deflation in total knee arthroplasty. J Knee Surg. 2003. 16:209–214.
Article
19. Marson BM, Tokish JT. The effect of a tourniquet on intraoperative patellofemoral tracking during total knee arthroplasty. J Arthroplasty. 1999. 14:197–199.
Article
20. Choi CH, Sung IH, Jung WS, Kim DW. Incidence of lateral retinacular release in total knee arthroplasty. J Korean Knee Soc. 2005. 17:29–33.
21. Husted H, Toftgaard Jensen T. Influence of the pneumatic tourniquet on patella tracking in total knee arthroplasty: a prospective randomized study in 100 patients. J Arthroplasty. 2005. 20:694–697.
22. Kim JH, Choi CH, Koo MH, Choi WS. A study on the criteria for lateral retinacular release in total knee arthroplasty: the no thumb technique with one stitch method. J Korean Knee Soc. 2008. 20:123–128.
23. McMahon MS, Scuderi GR, Glashow JL, Scharf SC, Meltzer LP, Scott WN. Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/or lateral retinacular release in total knee arthroplasty. Clin Orthop Relat Res. 1990. 260:10–16.
Article
24. Scuderi G, Scharf SC, Meltzer LP, Scott WN. The relationship of lateral releases to patellar viability in total knee arthroplasty. J Arthoplasty. 1987. 2:209–214.
25. Windsor RE, Scuderi GR, Insall JN. Patellar fractures in total knee arthroplasty. J Arthroplasty. 1989. 4:Suppl. 63–67.
Article
26. Bindelglass DF, Cohen JL, Dorr LD. Patellar tilt and subluxation in total knee arthroplasty. Relationship to pain, fixation, and design. Clin Orthop Relat Res. 1993. 286:103–109.
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