title: No difference in clinical outcome between patella eversion and lateral retraction in total knee arthroplasty: a systemic review and meta-analysis.
abstract: OBJECTIVE
  Surgical exposure during total knee arthroplasty (TKA) requires mobilization technique of the patella. Proponents of minimally invasive TKA claim that lateral retraction, rather than eversion, of the patella may be beneficial. Many randomized controlled studies attempt to identify this issue; however, no final conclusion arrives. With this systemic review and meta-analysis, we intended to test whether patella eversion during TKA had deleterious effects.
  
  
  METHODS
  A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE and other internet database. We retrieved all the relevant studies designed to interpret this issue. The searching time frame was from the establishing of these databases until July 2014.
  
  
  RESULTS
  Six randomized controlled trials assessing a total of 414 patients and 451 knees were included. The duration of surgery was much shorter (p = 0.003), and the length of skin incision was much longer (p < 0.00001). No significant difference was found on other measurements, including length of hospital stay, quadriceps strength, complications, straight leg raise, Visual Analogue Scale score and functional scores.
  
  
  CONCLUSIONS
  Patella eversion could decrease the duration of the surgery; nevertheless, the length of skin incision was longer; no significant difference was found on other measurements, especially the quadriceps strength and complications which were concerned. Patella eversion and patella lateral retraction could achieve similar clinical outcomes.
  
  
  METHODS
  Systematic review and meta-analysis, Level I.
authors.affiliation: Department of Orthopedics, Tongji University, Shanghai Tenth People's Hospital, 301 Yanchang Rd, Shanghai, 200072, People's Republic of China, zpf-dragon@163.com.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Zan
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.forename: Xinyu
authors.initials: X
authors.lastname: Cai
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Ma
authors.forename: Guodong
authors.initials: G
authors.lastname: Li
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D053580:Muscle Strength; D061646:Operative Time; D010329:Patella / Q000601:surgery*; D064232:Visual Analog Scale