title: The Effect of Patellar Thickness on Intraoperative Knee Flexion and Patellar Tracking in Patients With Arthrofibrosis Undergoing Total Knee Arthroplasty.
abstract: We evaluated the intraoperative effect of patellar thickness on intraoperative passive knee flexion and patellar tracking during total knee arthroplasty (TKA) in patients with preoperative arthrofibrosis and compared them to patients with normal preoperative range of motion (ROM) documented in a prior study.
  
  
  
  Routine posterior cruciate ligament-retaining TKA was performed in a total of 34 knees, 23 with normal ROM and 11 with arthrofibrosis, defined as ≤100° of passive knee flexion against gravity under anesthesia. Once clinical balance and congruent patellar tracking were established, custom trial patellar components thicker than the standard trial by 2-mm increments (2-8 mm) were sequentially placed and trialed. Passive flexion against gravity was recorded using digital photograph goniometry. Gross mechanics of patellofemoral tracking were visually assessed.
  
  
  
  On average, passive knee flexion decreased 2° for every 2-mm increment of patellar thickness (P < .0001), which was similar to patients with normal preoperative ROM. In addition, increased patellar thickness had no gross effect on patellar subluxation and tilt in patients with arthrofibrosis as well as those with normal ROM.
  
  
  
  Patellar thickness had a modest effect on intraoperative passive flexion and no effect on patellar tracking in patients with arthrofibrosis undergoing TKA. There was no marked difference in intraoperative flexion and patellar tracking between patients with arthrofibrosis and patients with normal preoperative ROM.
authors.affiliation: Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts.
authors.forename: Abraham D
authors.initials: AD
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts.
authors.forename: Vivek M
authors.initials: VM
authors.lastname: Shah
authors.affiliation: Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Scott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D053587:Arthrometry, Articular; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000033:anatomy & histology / Q000601:surgery*; D010781:Photography; D016059:Range of Motion, Articular
keywords: arthrofibrosis; patellar thickness; patellar tracking; range of motion; total knee arthroplasty