Skip to main content
SpringerLink
Log in

No difference in clinical outcome between patella eversion and lateral retraction in total knee arthroplasty: a systemic review and meta-analysis

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

Abstract

Purpose

Surgical exposure during total knee arthroplasty (TKA) requires mobilization technique of the patella. Proponents of minimally invasive TKA claim that lateral retraction, rather than eversion, of the patella may be beneficial. Many randomized controlled studies attempt to identify this issue; however, no final conclusion arrives. With this systemic review and meta-analysis, we intended to test whether patella eversion during TKA had deleterious effects.

Methods

A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE and other internet database. We retrieved all the relevant studies designed to interpret this issue. The searching time frame was from the establishing of these databases until July 2014.

Results

Six randomized controlled trials assessing a total of 414 patients and 451 knees were included. The duration of surgery was much shorter (p = 0.003), and the length of skin incision was much longer (p < 0.00001). No significant difference was found on other measurements, including length of hospital stay, quadriceps strength, complications, straight leg raise, Visual Analogue Scale score and functional scores.

Conclusions

Patella eversion could decrease the duration of the surgery; nevertheless, the length of skin incision was longer; no significant difference was found on other measurements, especially the quadriceps strength and complications which were concerned. Patella eversion and patella lateral retraction could achieve similar clinical outcomes.

Level of evidence

Systematic review and meta-analysis, Level I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Alcelik I, Sukeik M, Pollock R, Misra A, Shah P, Armstrong P, Dhebar M (2012) Comparison of the minimally invasive and standard medial parapatellar approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:2502–2512

    Article  CAS  PubMed  Google Scholar 

  2. Arnout N, Victor J, Cleppe H, Soenen M, Van Damme G, Bellemans J (2009) Avoidance of patellar eversion improves range of motion after total knee replacement: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 17:1206–1210

    Article  PubMed  Google Scholar 

  3. Bonutti PM, Mont MA, McMahon M, Ragland PS, Kester M (2004) Minimally invasive total knee arthroplasty. J Bone Joint Surg Am 86:26–32

    PubMed  Google Scholar 

  4. Bonutti PM, Neal DJ, Kester MA (2003) Minimal incision total knee arthroplasty using the suspended leg technique. Orthopedics 26:899–903

    PubMed  Google Scholar 

  5. David Rosin R (2008) Perspectives on this issue of the IJS. Int J Surg 6:425

    Article  Google Scholar 

  6. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  7. Dalury DF, Mulliken BD, Adams MJ, Lewis C, Sauder RR, Bushey JA (2009) Early recovery after total knee arthroplasty performed with and without patellar eversion and tibial translationA prospective randomized study. J Bone Joint Surg Am 91:1339–1343

    Article  PubMed  Google Scholar 

  8. Flören M, Davis J, Peterson MG, Laskin RS (2007) A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja. J Arthroplasty 22:51–57

    Article  PubMed  Google Scholar 

  9. Haas SB, Cook S, Beksac B (2004) Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop Relat Res 428:68–73

    Article  PubMed  Google Scholar 

  10. Higgins JP, Green S (2008) Cochrane handbook for systematic reviews of interventions. Wiley Online Library, Hoboken

    Book  Google Scholar 

  11. Insall J (1971) A midline approach to the knee. J Bone Joint Surg Am 53:1584–1586

    CAS  PubMed  Google Scholar 

  12. Jenkins D, Rodriguez J, Ranawat A, Alexiades M, Deshmukh A, Fukunaga T, Greiz M, Rathod P, McHugh M (2014) A randomized, controlled, prospective study evaluating the effect of patellar eversion on functional outcomes in primary total knee arthroplasty. J Bone Joint Surg Am 96:851–858

    Article  PubMed  Google Scholar 

  13. Keating EM, Faris PM, Meding JB, Ritter MA (1999) Comparison of the midvastus muscle-splitting approach with the median parapatellar approach in total knee arthroplasty. J Arthroplasty 14:29–32

    Article  CAS  PubMed  Google Scholar 

  14. Kamei G, Murakami Y, Kazusa H, Hachisuka S, Inoue H, Nobutou H, Nishida K, Mochizuki Y, Ochi M (2011) Is patella eversion during total knee arthroplasty crucial for gap adjustment and soft-tissue balancing? Orthop Traumatol Surg Res 97:287–291

    Article  CAS  PubMed  Google Scholar 

  15. Laskin RS (2005) Minimally invasive total knee arthroplasty: the results justify its use. Clin Orthop Relat Res 440:54–59

    Article  PubMed  Google Scholar 

  16. Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820–826

    Article  CAS  PubMed  Google Scholar 

  17. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet 354:1896–1900

    Article  CAS  PubMed  Google Scholar 

  18. Muratsu H, Tsumura N, Yamaguchi M, Mizuno K, Kuroda R, Harada T, Yoshiya S, Kurosaka M (2003) Patellar eversion affects soft tissue balance in total knee arthroplasty. Trans Orthop Res Soc 28:242

    Google Scholar 

  19. Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194

    Article  CAS  PubMed  Google Scholar 

  20. Reid MJ, Booth G, Khan RJ, Janes G (2014) Patellar eversion during total knee replacementa prospective, randomized trial. J Bone Joint Surg Am 96:207–213

    Article  PubMed  Google Scholar 

  21. Sastre S, Sanchez M-D, Lozano L, Orient F, Fontg F, Nuñez M (2009) Total knee arthroplasty: better short-term results after subvastus approach. Knee Surg Sports Traumatol Arthrosc 17:1184–1188

    Article  PubMed  Google Scholar 

  22. Stoffel KK, Flivik G, Yates PJ, Nicholls RL (2007) Intraosseous blood flow of the everted or laterally-retracted patella during total knee arthroplasty. Knee 14:434–438

    Article  PubMed  Google Scholar 

  23. Sharma V, Tsailas PG, Maheshwari AV, Ranawat AS, Ranawat CS (2008) Does patellar eversion in total knee arthroplasty cause patella baja? Clin Orthop Relat Res 466:2763–2768

    Article  PubMed Central  PubMed  Google Scholar 

  24. Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamoto Y (2007) Minimally invasive versus standard approach in total knee arthroplasty. Clin Orthop Relat Res 463:144–150

    PubMed  Google Scholar 

  25. Umrani SP, Cho K-Y, Kim K-I (2013) Patellar eversion does not adversely affect quadriceps recovery following total knee arthroplasty. J Arthroplasty 28:591–594

    Article  PubMed  Google Scholar 

  26. Varela-Egocheaga JR, Suárez-Suárez MA, Fernández-Villán M, González-Sastre V, Varela-Gómez JR, Rodríguez-Merchán C (2010) Minimally invasive subvastus approach: improving the results of total knee arthroplasty: a prospective, randomized trial. Clin Orthop Relat Res 468:1200–1208

    Article  PubMed Central  PubMed  Google Scholar 

  27. Walter F, Haynes MB, Markel DC (2007) A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty 22:509–514

    Article  PubMed  Google Scholar 

  28. Yoshino N, Watanabe N, Fukuda Y, Watanabe Y, Takai S (2011) The influence of patellar dislocation on the femoro-tibial loading during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1817–1822

    Article  PubMed  Google Scholar 

  29. Yoon J-R, Oh K-J, Wang JH, Yang J-H (2014) Does patella position influence ligament balancing in total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2879-7

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Tongji University, Shanghai Tenth People’s Hospital, 301 Yanchang Rd, Shanghai, 200072, People’s Republic of China

    Pengfei Zan, Yong Yang, Xinyu Cai & Guodong Li

  2. Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People’s Hospital, Shanghai, People’s Republic of China

    Wei Sun & Xiaojun Ma

Authors
  1. Pengfei Zan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xinyu Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaojun Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guodong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guodong Li.

Additional information

Pengfei Zan and Wei Sun are co-first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zan, P., Sun, W., Yang, Y. et al. No difference in clinical outcome between patella eversion and lateral retraction in total knee arthroplasty: a systemic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 23, 1791–1798 (2015). https://doi.org/10.1007/s00167-014-3477-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3477-4

Keywords

Search

Navigation