Patella height influences patellofemoral contact and kinematics following cruciate‐retaining total knee replacement

The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate‐retaining (CR) TKA. We implem...

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Published inJournal of orthopaedic research Vol. 41; no. 4; pp. 793 - 802
Main Authors Tischer, Thomas, Geier, Andreas, Lutter, Christoph, Enz, Andreas, Bader, Rainer, Kebbach, Maeruan
Format Journal Article
LanguageEnglish
Published United States 01.04.2023
Subjects
Arthroplasty, Replacement, Knee - methods
Biomechanical Phenomena
Bone Diseases
Humans
Knee Joint - surgery
Knee Prosthesis
Male
musculoskeletal multibody simulation
Patella - surgery
patella height
Patellofemoral Joint
patellofemoral joint dynamics
Range of Motion, Articular - physiology
total knee arthroplasty
total knee arthroplasty
patellofemoral joint dynamics
patella height
musculoskeletal multibody simulation
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Abstract The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate‐retaining (CR) TKA. We implemented a CR bicondylar TKA with a dome patellar button in a validated dynamic musculoskeletal multibody model of a male human knee joint. Retropatellar dynamics (contact force [N], shear force [N], patellar shift [mm], tilt [°], and rotation [°]) were evaluated during dual‐limb squat motion (flexion from 0° to 90°) with simulated active muscle forces and the effects of different patella heights (Blackburne‐Peel [BP] ratio of 0.39, 0.49, 0.65, 0.85, 1.01, and 1.1 were systematically examined). As active knee flexion increased, PF contact force also increased. Patella alta (BP = 1.1) resulted in higher PF contact forces compared to normal patella height (BP = 0.65) by up to 16%. Contrarily, patella baja was associated with decreased PF forces by 7%. Compared to patella baja (BP = 0.39), patella alta (BP = 1.1) considerably increased the contact force by up to 25%. Different patellar heights mainly affected PF shear forces during early knee flexion. Concerning PF kinematics, patella alta (BP = 1.1) yielded a greater lateral tilt of more than 4° and higher patellar rotation by up to 3° during deep knee flexion, compared to normal patella height (BP = 0.65). Our computational study indicates that patella alta is associated with the highest PF contact and shear force after the implantation of a CR bicondylar TKA. This should be considered in PF disorders following TKA.
AbstractList Abstract The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate‐retaining (CR) TKA. We implemented a CR bicondylar TKA with a dome patellar button in a validated dynamic musculoskeletal multibody model of a male human knee joint. Retropatellar dynamics (contact force [N], shear force [N], patellar shift [mm], tilt [°], and rotation [°]) were evaluated during dual‐limb squat motion (flexion from 0° to 90°) with simulated active muscle forces and the effects of different patella heights (Blackburne‐Peel [BP] ratio of 0.39, 0.49, 0.65, 0.85, 1.01, and 1.1 were systematically examined). As active knee flexion increased, PF contact force also increased. Patella alta (BP = 1.1) resulted in higher PF contact forces compared to normal patella height (BP = 0.65) by up to 16%. Contrarily, patella baja was associated with decreased PF forces by 7%. Compared to patella baja (BP = 0.39), patella alta (BP = 1.1) considerably increased the contact force by up to 25%. Different patellar heights mainly affected PF shear forces during early knee flexion. Concerning PF kinematics, patella alta (BP = 1.1) yielded a greater lateral tilt of more than 4° and higher patellar rotation by up to 3° during deep knee flexion, compared to normal patella height (BP = 0.65). Our computational study indicates that patella alta is associated with the highest PF contact and shear force after the implantation of a CR bicondylar TKA. This should be considered in PF disorders following TKA.
The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate‐retaining (CR) TKA. We implemented a CR bicondylar TKA with a dome patellar button in a validated dynamic musculoskeletal multibody model of a male human knee joint. Retropatellar dynamics (contact force [N], shear force [N], patellar shift [mm], tilt [°], and rotation [°]) were evaluated during dual‐limb squat motion (flexion from 0° to 90°) with simulated active muscle forces and the effects of different patella heights (Blackburne‐Peel [BP] ratio of 0.39, 0.49, 0.65, 0.85, 1.01, and 1.1 were systematically examined). As active knee flexion increased, PF contact force also increased. Patella alta (BP = 1.1) resulted in higher PF contact forces compared to normal patella height (BP = 0.65) by up to 16%. Contrarily, patella baja was associated with decreased PF forces by 7%. Compared to patella baja (BP = 0.39), patella alta (BP = 1.1) considerably increased the contact force by up to 25%. Different patellar heights mainly affected PF shear forces during early knee flexion. Concerning PF kinematics, patella alta (BP = 1.1) yielded a greater lateral tilt of more than 4° and higher patellar rotation by up to 3° during deep knee flexion, compared to normal patella height (BP = 0.65). Our computational study indicates that patella alta is associated with the highest PF contact and shear force after the implantation of a CR bicondylar TKA. This should be considered in PF disorders following TKA.
Author Tischer, Thomas
Enz, Andreas
Geier, Andreas
Bader, Rainer
Kebbach, Maeruan
Lutter, Christoph
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  fullname: Geier, Andreas
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  surname: Kebbach
  fullname: Kebbach, Maeruan
  email: maeruan.kebbach@med.uni-rostock.de
  organization: Rostock University Medical Center
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Issue 4
Keywords total knee arthroplasty
patellofemoral joint dynamics
patella height
musculoskeletal multibody simulation
Language English
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  doi: 10.1007/s00167-018-4831-8
SSID ssj0007128
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Snippet The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze...
Abstract The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically...
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SubjectTerms Arthroplasty, Replacement, Knee - methods
Biomechanical Phenomena
Bone Diseases
Humans
Knee Joint - surgery
Knee Prosthesis
Male
musculoskeletal multibody simulation
Patella - surgery
patella height
Patellofemoral Joint
patellofemoral joint dynamics
Range of Motion, Articular - physiology
total knee arthroplasty
Title Patella height influences patellofemoral contact and kinematics following cruciate‐retaining total knee replacement
URI https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fjor.25425
https://www.ncbi.nlm.nih.gov/pubmed/35949157
https://search.proquest.com/docview/2701073990
Volume 41
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