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Effects of patellofemoral overstuffing on knee flexion and patellar kinematics following total knee arthroplasty: a cadaveric study

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Abstract

Purpose

The purpose of this study was to test the hypothesis that overstuffing the patellofemoral joint during total knee arthroplasty (TKA) would decrease passive knee flexion and alter patellar kinematics during knee flexion.

Methods

Ten cadaveric knees were implanted with cruciate-retaining TKAs, and the patellofemoral joint was overstuffed in 2-mm increments with custom-augmented patellar prostheses (+2 mm through +8 mm). Changes to knee flexion, patellar shift, tilt and rotation were measured with an imageless optical-tracking computer navigation system.

Results

Knee flexion decreased an average 1.2° with each additional 2 mm of patellar thickness. Compared with control TKA (+0 mm), no significant decrease in knee flexion was detected until the patellofemoral joint was overstuffed with the +8-mm patellar prosthesis. Kinematic tracking data showed significantly greater lateral shift of patella with the +6- and +8-mm prostheses and significantly greater lateral tilt with the +8-mm prosthesis. Overstuffing had no appreciable effect on patellar rotation.

Conclusions

Passive knee flexion after TKA is significantly reduced when overstuffing the patellofemoral joint by +8 mm, and patellofemoral kinematics are altered when overstuffing the joint by +6 mm. These results demonstrate the relatively modest effects of patellofemoral overstuffing on knee flexion and patellar tracking kinematics after TKA.

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Acknowledgments

We recognise the following parties for their valuable contribution towards completion of this work: Depuy Orthopaedics provided prosthetic components and financial support, Brainlab provided the software required to run our navigation system, and Richard D. Scott, MD, provided the custom augmented patellar buttons and guidance during study design.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Daniel N. Bracey, Matthew L. Brown, Hoyt R. Beard, Sandeep Mannava, Omar F. Nazir, Thorsten M. Seyler & Jason E. Lang

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  1. Daniel N. Bracey
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  2. Matthew L. Brown
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  3. Hoyt R. Beard
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  4. Sandeep Mannava
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  5. Omar F. Nazir
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  6. Thorsten M. Seyler
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  7. Jason E. Lang
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Corresponding author

Correspondence to Jason E. Lang.

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Bracey, D.N., Brown, M.L., Beard, H.R. et al. Effects of patellofemoral overstuffing on knee flexion and patellar kinematics following total knee arthroplasty: a cadaveric study. International Orthopaedics (SICOT) 39, 1715–1722 (2015). https://doi.org/10.1007/s00264-015-2715-9

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  • DOI: https://doi.org/10.1007/s00264-015-2715-9

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