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Does patella position influence ligament balancing in total knee arthroplasty?

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

Abstract

Purpose

In vivo comparative gap measurements were performed in three different patella positions (reduced, subluxated and everted) using offset-type-force-controlled-spreader-system.

Methods

Prospectively, 50 knees were operated by total knee arthroplasty using a navigation-assisted gap-balancing technique. The offset-type-force-controlled-spreader-system was used for gap measurements. This commercially available instrument allows controllable tension in patella-reduced position. The mediolateral gaps of knee extension (0°) and flexion (90°) angle were recorded in three different patella positions; reduced, subluxated and everted. Any gap differences of more than 3 mm were considered as a meaningful difference. Correlation between the difference with the demographic data, preoperative radiologic alignment and intraoperative data was analysed. For statistical analysis, ANOVA and Pearson’s correlation test were used.

Results

The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Statistically significant difference was observed for the lateral gap of patella eversion compared to gap of patella reduction in knee flexion position (p < 0.05). There were notable cases of variability in knee flexion position. Significant portion of 12 (24 %) knees of patella subluxation and 33 (66 %) knees of patella evertion demonstrated either increased or decreased gaps in knee flexion position compared to the gaps of patella reduction position.

Conclusion

The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Therefore, the intraoperative patellar positioning has influence on the measurement of the joint gap. Keeping the patella in reduced position is important during gap balancing.

Level of evidence

I.

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Acknowledgments

The authors would like to thank Ms. Min-Jung Lee for statistical analysis of this manuscript, and Mr. Ho-Woo Kim for data collection.

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Republic of Korea

    Jung-Ro Yoon & Jae-Hyuk Yang

  2. Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea

    Kwang-Jun Oh

  3. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Joon Ho Wang

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  1. Jung-Ro Yoon
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Correspondence to Jae-Hyuk Yang.

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Yoon, JR., Oh, KJ., Wang, J.H. et al. Does patella position influence ligament balancing in total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 23, 2012–2018 (2015). https://doi.org/10.1007/s00167-014-2879-7

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  • DOI: https://doi.org/10.1007/s00167-014-2879-7

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