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Synovium removal from the articular side of the quadriceps tendon around the superior pole of patella reduces the crepitus after total knee arthroplasty

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Abstract

Purpose

The purpose of this study was to investigate whether synovium removal from the articular side of the quadriceps tendon around the superior pole of the patella after total knee arthroplasty (TKA) reduced the incidence of patellar crepitus (PC) or not.

Methods

We retrospectively reviewed 134 consecutive patients who underwent primary posterior stabilized (PS)-TKA by one surgeon from 2010 to 2013. Sixty-seven patients performed without touching synovium at superior pole of patella and 67 patients performed with removing all synovium from superior pole of patella were compared; none had patellar resurfacing. Patients were followed up two and six weeks, three, six and 12 months and annually thereafter. The primary outcome was the incidence of PC, detected during follow-up, and was graded as absent (0), fine (1), or coarse (2).

Results

At one year of follow-up, the synovial removal (SR) group had a significant lower rate of PC compared to the synovial preserved (SP) group: 15/67 (22%) vs 34/67 (51%), adjusted odds ratio = 0.29, 95% confidence interval (CI) = 0.14 to 0.64, P = 0.002. All PC in SR group were grade 1 while four knees in SP group were grade 2. Mean PC onset was eight months after surgery (range 1.5 to 12, P = 0.78) in both groups.

Conclusion

Removal of the synovium from the articular side of the quadriceps tendon around the superior pole of patellar reduced the incidence of PC after primary PS-TKA without patellar resurfacing. This is a promising technique and might enlighten surgeons to reduce the noise and improve patient satisfaction after total knee replacement.

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Acknowledgements

We thank Bob Taylor, PhD, for reviewing the article and language help. We also thank all participants for providing the data used in this study.

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Authors and Affiliations

  1. Department of Orthopaedics, Faculty of Medicine, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand

    Sukanis Chumchuen, Supakit Kanitnate, Kittipong Wattanasirisombat & Nattapol Tammachote

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  1. Sukanis Chumchuen
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  2. Supakit Kanitnate
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  3. Kittipong Wattanasirisombat
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  4. Nattapol Tammachote
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sukanis Chumchuen, Supakit Kanitnate, Kittipong Wattanasirisombat, and Nattapol Tammachote. The first draft of the manuscript was written by Sukanis Chumchuen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sukanis Chumchuen.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Thammasat University (MTU-EC-OT-0-100/56) prior to any review process.

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The authors declare no competing interests.

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Chumchuen, S., Kanitnate, S., Wattanasirisombat, K. et al. Synovium removal from the articular side of the quadriceps tendon around the superior pole of patella reduces the crepitus after total knee arthroplasty. International Orthopaedics (SICOT) 46, 2561–2567 (2022). https://doi.org/10.1007/s00264-022-05539-2

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  • DOI: https://doi.org/10.1007/s00264-022-05539-2

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