J Knee Surg 2017; 30(05): 479-483
DOI: 10.1055/s-0036-1593360
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Infrapatellar Fat Pad Excision during Total Knee Arthroplasty Did Not Alter the Patellar Tendon Length: A 5-Year Follow-Up Study

Yunus İmren
1   Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
,
Süleyman Semih Dedeoğlu
1   Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
,
Murat Çakar
1   Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
,
Haluk Çabuk
1   Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
,
Tahsin Olgun Bayraktar
1   Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
,
Hakan Gürbüz
1   Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
› Author Affiliations
Further Information

Publication History

30 May 2016

07 August 2016

Publication Date:
29 September 2016 (online)

Abstract

Partial or total resection of the infrapatellar fat pad (IPFP) helps surgeon improve access to lateral tibial plateau for better placement of the knee prosthesis. We aimed to investigate the effect of IPFP excision on clinical and radiologic outcomes including patellar tendon length (PTL), range of motion, and functional scores after total knee arthroplasty (TKA) at 5-year follow-up. We retrospectively evaluated postoperative first X-rays (day 0) and postoperative final 5-year control views of 228 knees in patients with primary osteoarthritis who underwent TKA between September 2006 and December 2009 in our hospital. Exclusion criteria were patients who had lateral release, patellar resurfacing, septic or aseptic loosening, fracture around the replaced knee, any other prior knee surgery, or any systemic inflammatory disease. IPFP was completely resected in all knees to enhance surgical exposure and patellar mobilization. Radiologic evaluation of PTL was performed in early postoperative and 5-year control X-rays comparatively. The mean early postoperative PTL was 47.4 ± 6 (range: 35–72), the mean final postoperative PTL was 47 ± 6.3 (range: 33–68) (p = 0.1). The average preoperative flexion was 115 ± 11 degrees, whereas it was 111 ± 4 degrees, postoperatively (p = 0.73). Both the clinical and functional outcome scores improved in all patients. IPFP excision during TKA did not alter PTL at 5-year follow-up. A focus on other surgical and/or host-related factors may help clarify contradictory patellar tendon shortening reported in the literature.

 
  • References

  • 1 Dragoo JL, Johnson C, McConnell J. Evaluation and treatment of disorders of the infrapatellar fat pad. Sports Med 2012; 42 (01) 51-67
  • 2 Bohnsack M, Hurschler C, Demirtas T, Rühmann O, Stukenborg-Colsman C, Wirth CJ. Infrapatellar fat pad pressure and volume changes of the anterior compartment during knee motion: possible clinical consequences to the anterior knee pain syndrome. Knee Surg Sports Traumatol Arthrosc 2005; 13 (02) 135-141
  • 3 Chougule SS, Stefanakis G, Stefan SC, Rudra S, Tselentakis G. Effects of fat pad excision on length of the patellar tendon after total knee replacement. J Orthop 2015; 12 (04) 197-204
  • 4 Van Beeck A, Clockaerts S, Somville J. , et al. Does infrapatellar fat pad resection in total knee arthroplasty impair clinical outcome? A systematic review. Knee 2013; 20 (04) 226-231
  • 5 Gallagher J, Tierney P, Murray P, O'Brien M. The infrapatellar fat pad: anatomy and clinical correlations. Knee Surg Sports Traumatol Arthrosc 2005; 13 (04) 268-272
  • 6 Clockaerts S, Bastiaansen-Jenniskens YM, Runhaar J. , et al. The infrapatellar fat pad should be considered as an active osteoarthritic joint tissue: a narrative review. Osteoarthritis Cartilage 2010; 18 (07) 876-882
  • 7 Distel E, Cadoudal T, Durant S, Poignard A, Chevalier X, Benelli C. The infrapatellar fat pad in knee osteoarthritis: an important source of interleukin-6 and its soluble receptor. Arthritis Rheum 2009; 60 (11) 3374-3377
  • 8 Clements KM, Ball AD, Jones HB, Brinckmann S, Read SJ, Murray F. Cellular and histopathological changes in the infrapatellar fat pad in the monoiodoacetate model of osteoarthritis pain. Osteoarthritis Cartilage 2009; 17 (06) 805-812
  • 9 Pinsornsak P, Naratrikun K, Chumchuen S. The effect of infrapatellar fat pad excision on complications after minimally invasive TKA: a randomized controlled trial. Clin Orthop Relat Res 2014; 472 (02) 695-701
  • 10 Moverley R, Williams D, Bardakos N, Field R. Removal of the infrapatella fat pad during total knee arthroplasty: does it affect patient outcomes?. Int Orthop 2014; 38 (12) 2483-2487
  • 11 Maculé F, Sastre S, Lasurt S, Sala P, Segur JM, Mallofré C. Hoffa's fat pad resection in total knee arthroplasty. Acta Orthop Belg 2005; 71 (06) 714-717
  • 12 Lemon M, Packham I, Narang K, Craig DM. Patellar tendon length after knee arthroplasty with and without preservation of the infrapatellar fat pad. J Arthroplasty 2007; 22 (04) 574-580
  • 13 Meneghini RM, Pierson JL, Bagsby D, Berend ME, Ritter MA, Meding JB. The effect of retropatellar fat pad excision on patellar tendon contracture and functional outcomes after total knee arthroplasty. J Arthroplasty 2007; 22 (06) (Suppl. 02) 47-50
  • 14 Weale AE, Murray DW, Newman JH, Ackroyd CE. The length of the patellar tendon after unicompartmental and total knee replacement. J Bone Joint Surg Br 1999; 81 (05) 790-795
  • 15 Tanaka N, Sakahashi H, Sato E, Hirose K, Isima T. Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty 2003; 18 (07) 897-902
  • 16 Miller MD. ed. Review of Orthopaedics, 5th ed. Chap. 5. Philadelphia, PA: Saunders Elsevier; 2008: 323
  • 17 Sharma V, Tsailas PG, Maheshwari AV, Ranawat AS, Ranawat CS. Does patellar eversion in total knee arthroplasty cause patella baja?. Clin Orthop Relat Res 2008; 466 (11) 2763-2768
  • 18 Zan P, Wu Z, Yu X, Fan L, Xu T, Li G. The effect of patella eversion on clinical outcome measures in simultaneous bilateral total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2016; 31 (03) 637-640
  • 19 Ryan JA, Meyers KN, Dibenedetto P, Wright TM, Haas SB. Failure of the patellar tendon with the patella everted versus noneverted in a matched-pair cadaver model. HSS J 2010; 6 (02) 134-137
  • 20 Hasegawa M, Kawamura G, Wakabayashi H, Sudo A, Uchida A. Changes to patellar blood flow after minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2009; 17 (10) 1195-1198
  • 21 Flören M, Davis J, Peterson MG, Laskin RS. A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja. J Arthroplasty 2007; 22 (06) (Suppl. 02) 51-57
  • 22 Nemschak G, Pretterklieber ML. The patellar arterial supply via the infrapatellar fat pad (of Hoffa): a combined anatomical and angiographical analysis. Anat Res Int 2012; 2012: 713838
  • 23 Kayler DE, Lyttle D. Surgical interruption of patellar blood supply by total knee arthroplasty. Clin Orthop Relat Res 1988; (229) 221-227
  • 24 McMahon MS, Scuderi GR, Glashow JL, Scharf SC, Meltzer LP, Scott WN. Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/or lateral retinacular release in total knee arthroplasty. Clin Orthop Relat Res 1990; (260) 10-16
  • 25 Subramanyam P, Sundaram PS, Rao N. Scintigraphic assessment of patellar vascularity in total knee replacement surgeries following lateral release. Avicenna J Med 2012; 2 (03) 54-59
  • 26 Lehner B, Koeck FX, Capellino S, Schubert TE, Hofbauer R, Straub RH. Preponderance of sensory versus sympathetic nerve fibers and increased cellularity in the infrapatellar fat pad in anterior knee pain patients after primary arthroplasty. J Orthop Res 2008; 26 (03) 342-350