Patellectomy for osteoarthritis: a new tension preserving surgical technique to reconstruct the extensor mechanism with retrospective review of long-term follow-up

Journal of Orthopaedic Surgery and Research

Greg Keene¹  Charles Willis-Owen¹  Vipin Asopa¹ 

[1] SPORTSMED.SA, 32 Payneham Road, Stepney, Adelaide 5069, SA, Australia

关键词: Extensor;    Pain;    Knee;    Anterior;    Patellectomy;    Osteoarthritis;    Patella;   

Others  :  1219205
DOI  :  10.1186/s13018-015-0237-1

 received in 2014-11-25, accepted in 2015-06-13,  发布年份 2015

【 摘 要 】

Background

The management of severe patellofemoral arthritis in young patients remains a significant problem. For many, patellofemoral replacement is not a desirable option. Current surgical techniques for patellectomy disrupt the extensor lever arm causing weakness. We describe a new technique that maintains the extensor mechanism tension and a case series showing good results for patella-only arthritis at a mean follow-up of 11 years.

Methods

Eight patellectomies were performed using a new surgical technique in patients with a mean age of 38 years, and an average follow-up of 11 years (range 8–16 years). Patients were followed up using a pain visual analogue scale, Lysholm knee score and patient-reported outcome measures.

Results

All patients experienced pain relief following surgery. Those with patella-only arthritis had better outcomes than patients who had patella and trochlea disease. All patients had either full or near full extension. Lysholm scores were better in patients who had disease confined to the patella.

Conclusion

We believe patellectomy with this tension-preserving technique has a role for the management of anterior knee pain secondary to severe patella-only arthritis in young patients where arthroplasty is not desirable.

【 授权许可】

   
2015 Asopa et al.

【 图 表 】

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【 参考文献 】

• [1]Kim YM, Joo YB. Patellofemoral osteoarthritis. Knee Surg Relat Res. 2012; 24(4):193-200.
• [2]11th Annual Report 2014. National Joint Registry for England, Wales and Northern Ireland. Available at: http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2011th%20Annual%20Report%202014.pdf. Accessed 24 January 2015.
• [3]Kaufer H. Patellar biomechanics. Clin Orthop Relat Res. 1979; 144:51-4.
• [4]Compere CL, Hill JA, Lewinnek GE, Thompson RG. A new method of patellectomy for patellofemoral arthritis. J Bone Joint Surg. 1979; 61(5):714-8.
• [5]Duthie HL, Hutchinson JR. The results of partial and total excision of the patella. JBJS. 1958; 40B:75.
• [6]Maquet P. Mechanics and osteoarthritis of the patellofemoral joint. CORR. 1979; 70:144.
• [7]Outerbridge RE. The etiology of chondromalacia patellae. JBJS. 1961; 43B:752.
• [8]Heineck AP. Patellectomy. Surg Gynaecol Obstetrics. 1909; 9:177.
• [9]Grelsamer RP, Stein DA. Patellofemoral arthritis. J Bone Joint Surg. 2006; 88(8):1849-60.
• [10]Annual Report 2013. National Joint Registry of England, Wales and Northern Ireland. Available at: http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%2010th%20Annual%20Report%202013%20B.pdf Accessed 27 December 2013.
• [11]Annual Report 2013. Australian Orthopaedic Association National Joint Replacement Registry. Available at: https://aoanjrr.dmac.adelaide.edu.au/annual-reports-2013. Accessed 27 December 2013.
• [12]Kaufer H. Mechanical function of the patella. J Bone Joint Surg Am. 1971; 53(8):1551-60.
• [13]Jackson R. Technique of purse-string patellectomy. Techniques in Orthopaedics. 1997;12(3).
• [14]Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982; 10:150-4.
• [15]Castaing J, Castellani L, Plisson JL, Delplace J. Total patellectomy. Technics and results. Rev Chir Orthop Reparatrice Appar Mot. 1969; 55(3):259-78.
• [16]Steurer PA, Gradisar IA, Hoyt WA, Chu M. Patellectomy: a clinical study and biomechanical evaluation. Clin Orthop Relat Res. 1979; 144:84-90.
• [17]Ziran BH, Goodfellow DB, Deluca LS, Heiple KG. Knee function after patellectomy and cruciform repair of the extensor mechanism. Clin Orthop Relat Res. 1994; 302:138-46.
• [18]Baker CL, Hughston JC. Miyakawa patellectomy. J Bone Joint Surg Am. 1988; 70(10):1489-94.
• [19]Bentley G. The surgical treatment of chondromalacia patellae. JBJS Br. 1978; 60-B(1):74-81.
• [20]Lennox I, Cobb A, Knowles J, Bentley G. Knee function after patellectomy. JBJS Br. 1994; 76-B(3):485-7.