title: Trans-patella tendon approach for domed lateral unicompartmental knee arthroplasty does not increase the risk of patella tendon shortening.
abstract: OBJECTIVE
  Shortening of the patella tendon has been noted after total knee arthroplasty and has been associated with diminished functional outcomes. Traumatic and/or ischaemic injury peri-operatively are suggested causes. The Oxford domed lateral unicompartmental knee arthroplasty (UKA) requires a vertical incision through the patella tendon to facilitate orientation of the proximal tibial saw cut; this may induce scarring or impair vascularity of the tendon and can cause shortening. This study investigated the hypothesis that the trans-patella tendon incision increases the incidence of patella tendon shortening after domed lateral UKA when compared to flat lateral UKA performed without the trans-patella tendon incision.
  
  
  METHODS
  The radiographs of 50 patients who underwent domed lateral UKA, using the trans-patella tendon approach, and a cohort of 30 patients who underwent flat lateral UKA, in which an incision through the patella tendon was not employed, were reviewed retrospectively. The patella tendon length (PTL) and the Insall-Salvati ratio were measured. In addition, pre-operative and post-operative clinical scores were recorded using both the OKS and AKSS. A change in PTL of greater than or equal to 10 % was considered to be significant.
  
  
  RESULTS
  In the domed lateral UKA group, 13 patients demonstrated a >10 % change in the PTL at 1-year post-surgery (2 shortened and 11 lengthened). In the flat lateral UKA group, nine patients demonstrated a significant change in the PTL at 1-year post-surgery (2 shortened and 7 lengthened).
  
  
  CONCLUSIONS
  This study demonstrated that using a trans-patella approach during lateral domed UKA surgery did not significantly increase patella tendon shortening and did not result in reduced clinical outcomes.
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK, b.h.vanduren@gmail.com.
authors.forename: B H
authors.initials: BH
authors.lastname: van Duren
authors.forename: H
authors.initials: H
authors.lastname: Pandit
authors.forename: T W
authors.initials: TW
authors.lastname: Hamilton
authors.forename: E
authors.initials: E
authors.lastname: Fievez
authors.forename: A P
authors.initials: AP
authors.lastname: Monk
authors.forename: C A F
authors.initials: CA
authors.lastname: Dodd
authors.forename: D W
authors.initials: DW
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors