Download PDF
J Knee Surg 2022; 35(14): 1544-1548
DOI: 10.1055/s-0041-1727114
Original Article

Total Infrapatellar Fat Pad Excision Leads to Worse Isokinetic Performance in Total Knee Arthroplasty: A Randomized Controlled Trial

Deniz Cankaya 
1   Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Aksaray, Turkey
,
Sefa Akti
1   Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Aksaray, Turkey
,
Niyazi Erdem Yasar
2   Department of Orthopaedic and Traumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
,
Dilek Karakus
3   Department of Physical Medicine and Rehabilition, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
,
Kazim Onur Unal
2   Department of Orthopaedic and Traumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
,
Taha Esref Karhan
2   Department of Orthopaedic and Traumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
,
Erdem Aras Sezgin
1   Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Aksaray, Turkey
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

There are concerns that total infrapatellar fat pad (IPFP) excision in total knee arthroplasty (TKA) results in patellar tendon shortening due to ischemic contracture, but individual preference of the surgeon is still the main determinant between total or partial excision. The aim of this randomized controlled study was to compare isokinetic performance and clinical outcome of TKAs with total and partial excision of the IPFP. Seventy-two patients scheduled to undergo TKA for primary knee osteoarthritis by a single surgeon were randomly assigned to either total or partial excision group. Patients were evaluated preoperatively and at postoperative 1 year, with Knee Society Score (KSS) and isokinetic measurements. The physiatrist performing isokinetic tests and patients were blinded to the study. There were no significant differences between the groups in respect of age, body mass index, gender, and preoperative KSS and isokinetic performance. Postoperatively, both groups had improved KSS knee and KSS function scores, with no difference determined. Knee extension peak torque was significantly higher postoperatively in the partial excision group at postoperative 1 year (p = 0.036). However, there were no significant differences in knee flexion peak torque following TKA (p = 0.649). The results of this study demonstrated that total excision of the IPFP during TKA is associated with worse isokinetic performance, which is most likely due to changes in the knee biomechanics with the development of patella baja. Partial excision of the IPFP appears to be a valid alternative to overcome this potential detrimental effect without impeding exposure to the lateral compartment. This is a Level I, therapeutic study.

Keywords

infrapatellar fat pad - patellar tendon - total knee arthroplasty - isokinetic test


Publication History

Received: 30 October 2020

Accepted: 12 February 2021

Article published online:
31 March 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 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
    CrossrefPubMedGoogle Scholar
  • 2 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
    CrossrefPubMedGoogle Scholar
  • 3 Gwyn R, Kotwal RS, Holt MD, Davies AP. Complete excision of the infrapatellar fat pad is associated with patellar tendon shortening after primary total knee arthroplasty. Eur J Orthop Surg Traumatol 2016; 26 (05) 545-549
    CrossrefPubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 Pawar U, Rao KN, Sundaram PS, Thilak J, Varghese J. Scintigraphic assessment of patellar viability in total knee arthroplasty after lateral release. J Arthroplasty 2009; 24 (04) 636-640
    CrossrefPubMedGoogle Scholar
  • 6 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
    CrossrefPubMedGoogle Scholar
  • 7 Chonko DJ, Lombardi Jr AV, Berend KR. Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 2004; 12: 231-238
    PubMedGoogle Scholar
  • 8 D'Lima DD, Poole C, Chadha H, Hermida JC, Mahar A, Colwell Jr CW. Quadriceps moment arm and quadriceps forces after total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 213-220
    PubMedGoogle Scholar
  • 9 Papp M, Zsákai Z, Gömöri A. Comparison of total knee arthroplasty after combined high tibial osteotomy with a matched group of primary total knee arthroplasty. Eklem Hastalik Cerrahisi 2019; 30 (02) 79-84
    CrossrefPubMedGoogle Scholar
  • 10 Lizaur-Utrilla A, Gonzalez-Parreño S, Martinez-Mendez D, Miralles-Muñoz FA, Lopez-Prats FA. Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surg Sports Traumatol Arthrosc 2020; 28 (05) 1473-1478
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 Liu YP, Li SZ, Yuan F. et al. Infrapatellar fat pad may be with tendon repairing ability and closely related with the developing process of patella Baja. Med Hypotheses 2011; 77 (04) 620-623
    CrossrefPubMedGoogle Scholar
  • 13 Wickham MQ, Erickson GR, Gimble JM, Vail TP, Guilak F. Multipotent stromal cells derived from the infrapatellar fat pad of the knee. Clin Orthop Relat Res 2003; (412) 196-212
    CrossrefPubMedGoogle Scholar
  • 14 Colombel M, Mariz Y, Dahhan P, Kénési C. Arterial and lymphatic supply of the knee integuments. Surg Radiol Anat 1998; 20 (01) 35-40
    CrossrefPubMedGoogle Scholar
  • 15 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
    CrossrefPubMedGoogle Scholar
  • 16 Maffiuletti NA, Bizzini M, Widler K, Munzinger U. Asymmetry in quadriceps rate of force development as a functional outcome measure in TKA. Clin Orthop Relat Res 2010; 468 (01) 191-198
    CrossrefPubMedGoogle Scholar
  • 17 Lienhard K, Lauermann SP, Schneider D, Item-Glatthorn JF, Casartelli NC, Maffiuletti NA. Validity and reliability of isometric, isokinetic and isoinertial modalities for the assessment of quadriceps muscle strength in patients with total knee arthroplasty. J Electromyogr Kinesiol 2013; 23 (06) 1283-1288
    CrossrefPubMedGoogle Scholar
  • 18 Kellis E, Baltzopoulos V. In vivo determination of the patella tendon and hamstrings moment arms in adult males using videofluoroscopy during submaximal knee extension and flexion. Clin Biomech (Bristol, Avon) 1999; 14 (02) 118-124
    CrossrefPubMedGoogle Scholar
  • 19 Krevolin JL, Pandy MG, Pearce JC. Moment arm of the patellar tendon in the human knee. J Biomech 2004; 37 (05) 785-788
    CrossrefPubMedGoogle Scholar
  • 20 Bittmann MF, Lenhart RL, Schwartz MH, Novacheck TF, Hetzel S, Thelen DG. How does patellar tendon advancement alter the knee extensor mechanism in children treated for crouch gait?. Gait Posture 2018; 64: 248-254
    CrossrefPubMedGoogle Scholar