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Deep-dished highly congruent tibial insert in CR-TKA does not prevent patellar tendon angle increase and patellar anterior translation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Starting from the hypothesis that a deep-dished highly congruent tibial insert in cruciate-retaining total knee arthroplasty would prevent the increase in patellar tendon angle and anterior patellar translation by reducing the paradoxical anterior femoral translation, the main purpose of the present study was to investigate the effect of this prosthesis design, and secondary to assess the clinical outcomes at 6-month follow-up.

Methods

Twenty patients treated with cruciate-retaining total knee arthroplasty with navigation technique were enrolled and prospectively followed up at 6 months. The median value of age was 71 years (57–83). Before and after surgery, the following parameters were calculated: patellar tendon angle, anterior–posterior and medio-lateral patellar translation, patellar height and range of motion. All patients were assessed with the SF-36 Physical Functioning and the Knee injury and Osteoarthritis Outcome Score ADL scores.

Results

Patellar tendon angle and anterior patellar translation significantly increased in post-operative conditions (p < 0.0001); a statistically significant medial patellar translation was found (p < 0.0001), while patellar height did not show any difference between pre- and post-operative conditions (n.s). A significant correlation was found between patellar tendon angle and anterior patellar translation and the clinical scores (p < 0.0417). There was a significant post-operative decrease (p < 0.0033) in the range of motion.

Conclusions

The present study failed to demonstrate that deep-dished highly congruent tibial insert prevents the anterior translation of the patella in cruciate-retaining total knee arthroplasty, thus causing inferior clinical scores. It provided useful information about the biomechanical role of the patella in total knee arthroplasty, allowing to choose the most appropriate surgical approach.

Level of evidence

Case series, Level IV.

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Acknowledgments

The authors would like to particularly thank Silvia Bassini for her remarkable contribution to improve the graphics of this paper.

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Authors and Affiliations

  1. Biomechanics and Technological Innovation Laboratory, Codivilla-Putti Research Center, Bologna University, Via Di Barbiano 1-10, 40136, Bologna, Italy

    Ibrahim Akkawi, Francesca Colle, Danilo Bruni, Giovanni Francesco Raspugli, Simone Bignozzi, Stefano Zaffagnini, Francesco Iacono & Maurilio Marcacci

  2. Laboratorio di NanoBiotecnologie-NaBi, Istituto Ortopedico Rizzoli, Bologna, Italy

    Francesca Colle

  3. The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127, Pisa, Italy

    Francesca Colle

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  1. Ibrahim Akkawi
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Correspondence to Ibrahim Akkawi.

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Akkawi, I., Colle, F., Bruni, D. et al. Deep-dished highly congruent tibial insert in CR-TKA does not prevent patellar tendon angle increase and patellar anterior translation. Knee Surg Sports Traumatol Arthrosc 23, 1622–1630 (2015). https://doi.org/10.1007/s00167-014-2889-5

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