When and How Is Patella Tracking Best Assessed in Total Knee Arthroplasty Surgery?
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Much emphasis has been placed on the role of patella resurfacing in total knee arthroplasty (TKA), yet the impact of soft tissue balancing has frequently been understated. The authors used a novel system to precisely assess patellofemoral joint (PFJ) tracking intraoperatively, to determine the impact of both retinacular reconstruction and tourniquet use on PFJ kinematics. PFJ kinematics assessed intraoperatively for 20 consecutive TKA patients. Measurements were recorded using both the "no thumb technique" and following reconstruction of the retinaculum with two positional sutures. The tourniquet was deflated and both measurements were repeated. Tourniquet inflation was not found to have a significant impact on the patella tracking (mean translation 0.9 mm, p = 0.15). Patella retinacular reconstruction generated a significant medialization of the patella by a mean of 5.5 mm (p < 0.0001) when compared with the traditional retinacular open "no thumb technique." The use of a tourniquet has been shown to have no effect on patella tracking. Reconstruction of the patella retinaculum markedly improves patella tracking, generating a mean medialization of 15%. The authors advocate the routine use of two positional sutures to restore the patella retinaculum, before trialing the patella component, as a reproducible means of assessing the PFJ kinematics.Keywords:
Retinaculum
Retinaculum
Vastus medialis
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The purpose of lateral retinaculum release (LRR) is to increase the medial mobility of the patella and reduce its lateral inclination. With this type of surgery, the excessive lateral pulling of the patella by the lateral retinaculum and, to some extent, by the vastus lateralis muscle can be reduced. Thus, the indications for LRR of the patellofemoral joint are various patellofemoral joint disorders characterized by too little patellar medialization or lateral retinacular contracture. Too little medial movement of patella may be related to the following symptoms: anterior knee pain, lateral patellofemoral joint high-pressure syndrome, patella instability, patella dislocation (primary, recurrent, or fixed), stiff knee, etc. Release of the lateral retinaculum helps to relieve symptoms. However, if the above symptoms occur with normal or even excessive medial patellar motion, these symptoms (especially anterior knee pain, patella instability, or patella dislocation) are not associated with contracture of the lateral retinaculum, and release of the lateral retinaculum may not achieve the desired effect.
Retinaculum
Lateral release
Anterior knee pain
Joint Contracture
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Retinaculum
Quadriceps tendon
Patellar ligament
Vastus medialis
Infrapatellar fat pad
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Retinaculum
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A case of lateralisation of the patella, 21 year old female, was reported. The patient complained of pain and weakness in her left knee after sprain. On examination the patella slipped laterally from slight flexion to acute flexion but it returned to the normal position at the maximum flexion angle of the knee joint. Her right knee was revealed to have the same abnormality slight degree without symptoms.The medial retinaculum was surgically sutured to the separated M. vastus medialis and the lateral retinaculum was insiced along the lateral border of the patella. Results of operation was satisfactory and the lateralisation was thought to be congenital in nature and to be exaggerated by sprain.
Retinaculum
Vastus medialis
Knee flexion
Abnormality
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The objective of this study was to evaluate the contribution of the medial retinaculum to the stability of the patella, for several angles of knee flexion. For six cadaveric knees, the patella and patella retinaculum were exposed, and the force required to dislocate the patella laterally by 5 mm was measured, in 0, 45 and 90 degrees of knee flexion, preserving and dissecting the medial retinaculum. Wilcoxon singed rank test (SPSS, version 23, Chicago, USA) was used for data analysis. A p value of < 0.05 was considered as statistically significant. The force required to displace the patella laterally is smaller with the medial retinaculum dissected than intact, in 0, 45 and 90 degrees (p = 0.028, p = 0.046, p = 0.027 respectively). The lateral displacement force is greater as the flexion angle increases, with medial retinaculum intact or dissected (p = 0.028). Thus, an intact medial retinaculum provides more stability against lateral displacement forces to the patella, especially in lower flexion angles. Consequently, surgical methods reinforcing the medial retinaculum combined or not with lateral retinaculum release, are of great importance in the plan of the orthopedic surgeons. The engagement of the bones during flexion of the knee contributes significantly to the stability of the patella.
Retinaculum
Cadaveric spasm
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Objective To explore the more effective operation treatment for patellofemoral pain syndrome.Methods 100 patients with patellofemoral pain syndrome were randomly divided into two groups,the therapy group(n=50) and control group(n=50).All operations were carried out with arthroscope.The patients of therapy group were treated with medial patellofemoral ligament striction plus lateral patella retinaculum lysis,and the patients of control group were just treated with lateral patella retinaculum lysis.Results All patients were followed up with the mean time of 13 months,and were evaluated with kujala scoring system for therapeutic effect,the mean of therapy group was 76.66±5.26 and that of control group was 69.36±3.42(P0.05),which indicated that the clinical therapeutic effect of medial patellofemoral ligament reefing plus lateral patella retinaculum lysis in treatment of patellofemoral pain syndrome was satisfied.Conclusion Compared with lateral patella retinaculum lysis,the surgical approach superior in correcting the patho-movement loci of patellofemoral joint,makes it easier the balance between exterior and interior interspace in patellofemoral joint,relieves the pain of knee more effectively.The postoperative complications,such as the haematoma in joint,the necrosis and dearticulation of whirbone,don't occur.
Medial Patellofemoral Ligament
Retinaculum
Patellofemoral Pain Syndrome
Patellofemoral joint
Therapeutic effect
Clinical efficacy
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Retinaculum
Degeneration (medical)
Anterior knee pain
Patellofemoral Pain Syndrome
Strain (injury)
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Lateral dislocation of the patella is a common injury that can be treated successfully nonoperatively. The authors present a patient with lateral dislocation of the patella in which the patella rotated 90 degrees about its vertical axis. The retinaculum had been avulsed from the anterior aspect of the patella but was otherwise intact. Because the intact retinaculum prohibited closed reduction, open reduction was performed. The patient has returned to full, unrestricted activities.
Retinaculum
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The aim of the present pilot study was to evaluate patterns in the current practice of tourniquet use in Turkey. The results of this study can provide detailed information regarding tourniquet use and evaluate the need for guidelines on tourniquet use in Turkey.The questionnaire was sent to orthopedic residents and surgeons by either giving printed questionnaires directly or by establishing preliminary communication with surgeons and then sending questionnaires by e-mail. Participating staff consisted of 3 groups: Group 1: orthopedic surgeons; Group 2: orthopedic residents; and Group 3: orthopedic academic staff. Statistical differences in tourniquet use were analyzed among the groups.Use of mechanical tourniquet was significantly higher in Group 1. Plain cuffs were used in orthopedic surgical practice more frequently. Assistant and orthopedic theatre personnel were commonly reported by participants as the tourniquet applicant. Periodic educational practice was not routine. The number of reported complications was higher in Group 3. Cuff padding was generally routine practice. Scientifically valid options at lowest inflation pressure were not observed among the results at the expected rates.The results of this pilot study indicate that there is wide variation in some aspects of tourniquet practice in Turkey. The differences are not acceptable because of the potential for significant complications with some practices. There is a need to provide and ensure adequate education to provide the best patient care. Furthermore, protocols should be developed for acceptable standards of tourniquet use.
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