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The effect of overstuffing the patellofemoral joint on the extensor retinaculum of the knee

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

Abstract

Overstuffing the patellofemoral compartment during TKR leads to complications such as maltracking and wear, predisposing to early failure. However, there is no data describing how the patellar construct thickness affects the retinacula. This study instrumented cadaveric knees that had a Genesis II (Smith & Nephew, Memphis, TN, USA) TKR in situ. Sutures were passed along the medial patellofemoral ligament (MPFL) and the deep transverse fibre band of the lateral retinaculum, from the ilio-tibial band (ITB) to the patella. These sutures were attached to displacement transducers. Length changes in the retinacula were measured during knee flexion-extension against the actions of 175 N quadriceps and 30 N ITB tensions. This was done with the natural patellar thickness, then repeated with the patella 2 mm thinner, 2 mm thicker and 4 mm thicker (overstuffed). Each thickness change caused a significant overall slackening or stretching of the MPFL (P < 0.0001 by ANOVA), with 2.3 mm mean stretching (P < 0.001 all angles of knee flexion by post-testing) at 4 mm thicker. The ITB-patellar band was not slackened (P = 0.491) or stretched (P = 0.346) significantly by 2 mm thickness changes. 4 mm thickening stretched the lateral retinaculum 1.1 mm (P = 0.0108). Patellar thickness affected the MPFL more than the lateral retinaculum. This difference reflected the mobile attachment of the lateral retinaculum to the ITB, whereas the MPFL was stretched directly between bony attachments. 2 mm overstuffing did not stretch the retinacula sufficiently to cause mechanical effects.

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Acknowledgments

During this study, KM Ghosh was supported by a grant from Smith & Nephew (UK) Ltd; AM Merican was supported by the University of Malaya Medical Centre and the Arthritis Research Campaign (ARC), and F Iranpour by a grant from the Furlong Charitable Foundation for Research. The tissue specimens were supplied by the International Institute for the Advancement of Medicine, Jessup, PA, USA.

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Authors and Affiliations

  1. Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, SW7-2AZ, UK

    K. M. Ghosh & Andrew A. Amis

  2. Orthopaedic Surgery Department, Newcastle University Hospital, Newcastle upon Tyne, NE2-4HH, UK

    K. M. Ghosh & D. J. Deehan

  3. Musculoskeletal Surgery Department, Imperial College London, Charing Cross Hospital, London, W6-8RF, UK

    A. M. Merican, F. Iranpour & Andrew A. Amis

  4. University of Malaya Medical Centre, Kuala Lumpur, Malaysia

    A. M. Merican

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  1. K. M. Ghosh
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  2. A. M. Merican
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  3. F. Iranpour
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  4. D. J. Deehan
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  5. Andrew A. Amis
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Correspondence to Andrew A. Amis.

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Ghosh, K.M., Merican, A.M., Iranpour, F. et al. The effect of overstuffing the patellofemoral joint on the extensor retinaculum of the knee. Knee Surg Sports Traumatol Arthrosc 17, 1211–1216 (2009). https://doi.org/10.1007/s00167-009-0830-0

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