Original Articles
The effect of surgical approaches and tourniquet application on patellofemoral tracking in total knee arthroplasty*,**,*

https://doi.org/10.1054/arth.2003.50057Get rights and content

Abstract

The purpose of this study was to assess the influences of surgical approaches and tourniquet application on the lateral retinacular tension (LRT). Single-setting bilateral total knee arthroplasty was performed in 10 patients, and the medial parapatellar and midvastus approaches were randomly performed on each knee using tourniquet application. The LRT was measured using the buckle transducer before and after each approach. Next, the tourniquet was deflated and the measurement was repeated. After the parapatellar approach, LRT was significantly decreased. Conversely, no significant change was seen after the midvastus approach with the tourniquet inflated. However, in the midvastus approach, LRT was significantly decreased after tourniquet deflation. We concluded that both the parapatellar and midvastus approaches influence patellar tracking and LRT. © 2003 Elsevier Inc. All rights reserved.

Section snippets

Materials and methods

From January to December 1999, 95 TKAs were performed in our department. Of these, single-setting bilateral TKAs were performed in 12 patients by the senior author (H.O.). Selection criteria for this study included patients single-setting bilateral TKA, almost the same grade arthrosis in both knees, and ability to flex the knee more than 120° and extend the knee less than −15°. Exclusion criteria were previous knee surgery and severe varus or valgus knee deformity. Ten patients met the

Results

After tourniquet inflation and before beginning each surgical approach, LPFL stress increased with knee flexion, with the maximum at 120° flexion. In the parapatellar approach group, the average values from the transducer at each knee flexion angle before surgery were 0 ± 0 MPa at full extension, 0.49 ± 0.13 MPa at 30°, 1.07 ± 0.22 MPa at 60°, 1.65 ± 0.31 MPa at 90°, and 1.98 ± 0.4 MPa at 120° of knee flexion. In the midvastus approach group, the average values were 0 ± 0 MPa at full extension,

Discussion

The etiology of patellar maltracking after TKA is multifactorial and commonly results from imbalance in the extensor mechanism characterized by excessive tightness of the lateral retinaculum and associated weakness of the vastus medialis muscle [6, 21, 22]. Placement of prosthetic components in an excessively valgus position results in an increased lateral force vector on the patella and may also result in the maltracking of the patella [21]. Asymmetrical patellar resection and malpositioning

Acknowledgements

The authors gratefully thank Seiko Harata, MD, for his helpful comments and suggestions. The authors also acknowledge Kan-ichiro Wada, MD, for data analysis.

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    *

    No benefits or funds were received in support of this study.

    **

    Reprint requests: Yasuyuki Ishibashi, MD, Department of Orthopaedic Surgery, Hirosaki University, School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.

    *

    0883-5403/03/1803-0010$30.00/0

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