Patellar Tracking in Total Knee Replacement

Ahmadzadeh, Hossein; Rastegar, Mohammad; Karami, Mohammad Mehdi; Razzaghi, Abdoleslam; Mortazavi, Seyed Mohammad Javad

doi:10.22034/ijos.2025.492612.1119

Patellar Tracking in Total Knee Replacement

Document Type : Review

Authors

Hossein Ahmadzadeh

Mohammad Rastegar

Mohammad Mehdi Karami

Abdoleslam Razzaghi

Seyed Mohammad Javad Mortazavi

Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

https://doi.org/10.22034/ijos.2025.492612.1119

Abstract

One of the common complications after total knee replacement surgery is pain and instability in the patellofemoral joint, which significantly impacts patients' quality of life. Statistics show that 8–12% of revision knee replacement surgeries are due to issues related to the patellofemoral joint. A critical concern during surgery is patellar maltracking, which is frequently observed. This condition occurs when the patella does not move along its proper path, leading to functional problems and pain. Various methods have been introduced to evaluate and correct patellar maltracking. This review article addresses different aspects of this issue, including: Definition of patellofemoral maltracking, factors affecting patellar tracking, intraoperative evaluation of patellar tracking, the concept of Perfect Patellar Tracking, Surgical methods to correct patellar maltracking. This article aims to provide a comprehensive perspective on the importance of proper correction of patellar tracking to improve surgical outcomes and patients’ satisfaction.

Keywords

Patella

Knee replacement arthroplasty

Patellofemoral

Subjects

Knee

1 Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001(392):315-8. doi: 10.1097/00003086-200111000-00041.

2 Sharkey P.F, Lichstein P.M, Shen C, Tokarski A.T, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years? J Arthroplasty. 2014;29(9):1774-8. doi: 10.1016/j.arth.2013.07.024.

3 Furnes O, Espehaug B, Lie S.A, Vollset S.E, Engesaeter L.B, Havelin L.I. Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994-2000. Acta Orthop Scand. 2002;73(2):117-29. doi: 10.1080/000164702753671678.

4 Berger R.A, Crossett L.S, Jacobs J.J, Rubash H.E. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res. 1998(356):144-53. doi: 10.1097/00003086-199811000-00021.

5 Lakstein D, Zarrabian M, Kosashvili Y, Safir O, Gross AE, Backstein D. Revision total knee arthroplasty for component malrotation is highly beneficial: a case control study. J Arthroplasty. 2010;25(7):1047-52. doi: 10.1016/j.arth.2009.07.004.

6 Strachan R.K, Merican A.M, Devadasan B, Maheshwari R, Amis A.A. A technique of staged lateral release to correct patellar tracking in total knee arthroplasty. J Arthroplasty. 2009;24(5):735-42. doi: 10.1016/j.arth.2008.02.005.

7 Maniar R, Singhi T, Rathi S, Baviskar J, Nayak R. Surgical Technique: Lateral Retinaculum Release in Knee Arthroplasty Using a Stepwise, Outside-in Technique. Clinical orthopaedics and related research. 2012;470:2854-63. doi: 10.1007/s11999-012-2420-6.

8 Smith A.J, Lloyd D.G, Wood D.J. A kinematic and kinetic analysis of walking after total knee arthroplasty with and without patellar resurfacing. Clin Biomech (Bristol). 2006;21(4):379-86. doi: 10.1016/j.clinbiomech.2005.11.007.

9 Briard J.L, Hungerford D.S. Patellofemoral instability in total knee arthroplasty. J Arthroplasty. 1989;4 Suppl:S87-97. doi: 10.1016/s0883-5403(89)80013-0.

10 Mochizuki R.M, Schurman D.J. Patellar complications following total knee arthroplasty. J Bone Joint Surg Am. 1979;61(6a):879-83.

11 Husted H, Toftgaard Jensen T. Influence of the pneumatic tourniquet on patella tracking in total knee arthroplasty: a prospective randomized study in 100 patients. J Arthroplasty. 2005;20(6):694-7. doi: 10.1016/j.arth.2004.11.016.

12 Laskin R.S. Lateral release rates after total knee arthroplasty. Clin Orthop Relat Res. 2001(392):88-93. doi: 10.1097/00003086-200111000-00011.

13 Archibeck M.J, Camarata D, Trauger J, Allman J. White Jr R.E. Indications for lateral retinacular release in total knee replacement. Clin Orthop Relat Res. 2003(414):157-61. doi: 10.1097/01.blo.0000079260.91782.96.

14 Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y. Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg. 2001;14(3):152-6.

15 Cho W.S, Woo J.H, Park H.Y, Youm Y.S, Kim B.K. Should the 'no thumb technique' be the golden standard for evaluating patellar tracking in total knee arthroplasty? Knee. 2011;18(3):177-9. doi: 10.1016/j.knee.2010.04.009.

16 Bindelglass D.F, Vince K.G. Patellar tilt and subluxation following subvastus and parapatellar approach in total knee arthroplasty. Implication for surgical technique. J Arthroplasty. 1996;11(5):507-11. doi: 10.1016/s0883-5403(96)80101-x.

17 Ogata K, Ishinishi T, Hara M. Evaluation of patellar retinacular tension during total knee arthroplasty. Special emphasis on lateral retinacular release. J Arthroplasty. 1997;12(6):651-6. doi: 10.1016/s0883-5403(97)90138-8.

18 Molyneux S, Brenkel I. Predictors and outcomes of lateral release in total knee arthroplasty: a cohort study of 1859 knees. Knee. 2012;19(5):688-91. doi: 10.1016/j.knee.2011.10.004.

19 Ritter M.A, Pierce M.J, Zhou H, Meding J.B, Faris P.M, Keating E.M. Patellar complications (total knee arthroplasty). Effect of lateral release and thickness. Clin Orthop Relat Res. 1999(367):149-57.

20 Wachtl S, Jakob R. Patella osteotomy for lateral retinaculum decompression in total knee arthroplasty. Acta orthopaedica Scandinavica. 2000;71:522-4. doi: 10.1080/000164700317381252.

21 Lakstein D, Naser M, Adar E, Atoun E, Edelman A, Hendel D. Partial lateral patellar facetectomy as an alternative to lateral release in Total Knee Arthroplasty (TKA). J Arthroplasty. 2014;29(11):2146-9. doi: 10.1016/j.arth.2014.06.013.

22 Ritter M.A, Campbell E.D. Postoperative patellar complications with or without lateral release during total knee arthroplasty. Clin Orthop Relat Res. 1987(219):163-8.

23 Ritter M.A, Herbst S.A, Keating E.M, Faris P.M, Meding J.B. Patellofemoral complications following total knee arthroplasty. Effect of a lateral release and sacrifice of the superior lateral geniculate artery. J Arthroplasty. 1996;11(4):368-72. doi: 10.1016/s0883-5403(96)80024-6.