MRI Diagnosis of Patellar Clunk Syndrome Following Total Knee Arthroplasty

Abstract

Background

Patellar Clunk Syndrome is a painful condition associated with a mechanical catching or clunking during active extension following total knee arthroplasty (TKA). The syndrome is caused by growth of interposing soft tissue usually at the superior pole of the patella. This interposed soft tissue cannot be visualized on plain radiographs.

Questions

The aim was to ascertain if magnetic resonance imaging (MRI) would prove helpful in confirming the clinical diagnosis of patellar clunk by visualizing the interposed soft tissues adjacent to the patella and that the recognition of this tissue would be highly reproducible.

Methods

MRI scans of 12 patients with clinical suspicion or related symptoms of a patellar clunk syndrome following primary TKA were retrospectively evaluated. Size of soft tissue masses proximal to the patella were determined in sagittal and axial MRI views. Largest diameters were recorded in two dimensions by two independent observers, and interobserver reliability was determined by intra-class correlation coefficients (ICC).

Results

Nine patients (75%) showed obvious MRI findings consistent with a patellar clunk lesion with high interobserver reliability (ICC values >0.75). In eight patients, this lead to operative treatment with arthroscopic debridement.

Discussion

MRI helps confirm the clinical diagnosis of patellar clunk. The data indicate that MRI is effective in defining the soft tissue lesion that is implicated in clinically evident patellar clunk syndrome after TKA.

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Acknowledgements

This work was initiated and inspired by Dr. Richard S. Laskin who passed away in 2008. The authors dedicate this work to his remembrance.

The authors would like to thank Dr. Nina Timmesfeld from the Institute for Medical Biometry and Epidemiology, Marburg, Germany for her support with statistical analysis. The authors also thank Ed O'Connell and Tina Miller (Office Managers, HSS) for their warm, efficient, and rapid support.

Disclosures

The study was performed at the Hospital for Special Surgery, New York, NY, USA. Steven B. Haas, MD receives royalties from and is a consultant to Smith & Nephew. Thomas J. Heyse, MD is a consultant to Smith & Nephew. Institutional research support is granted by GE Healthcare and NIH. Hollis Potter, MD is a consultant to Biomet.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

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Correspondence to Thomas J. Heyse MD.

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Level of Evidence: Level IV: Retrospective Case Series

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Heyse, T.J., Chong, L.R., Davis, J. et al. MRI Diagnosis of Patellar Clunk Syndrome Following Total Knee Arthroplasty. HSS Jrnl 8, 92–95 (2012). https://doi.org/10.1007/s11420-011-9258-4

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Keywords

  • patellar clunk
  • TKA
  • MRI
  • total knee arthroplasty
  • magnet resonance imaging