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Patellar crepitation in the P.F.C. sigma total knee system
Amar S Ranawat1, Chitranjan S Ranawat, John E Slamin
1Ranawat Orthopaedic Center LLC, New York, USA.
Orthopedics
|September 28, 2006
Summary
Peripatellar scar formation, causing knee crepitation or clunk syndrome, affects 1-5% of patients after knee replacement. Most cases resolve within a year, but severe symptoms may require surgical scar removal.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Knee Biomechanics
Background:
- Painless and painful patellar crepitation and patellar clunk syndrome are recognized clinical entities associated with knee arthroplasty.
- These conditions are linked to peripatellar scar formation, particularly with posterior-stabilized knee components, but can also occur with cruciate-retaining designs.
- The underlying pathology involves inflammatory fibrous hyperplasia of peripatellar tissues, influenced by implant design and surgical technique.
Purpose of the Study:
- To describe the spectrum of peripatellar scar formation, including painless and painful crepitation and patellar clunk syndrome.
- To investigate the relationship between implant design, surgical technique, and the development of inflammatory peripatellar scar tissue.
- To outline the incidence, natural history, and management strategies for these conditions following knee replacement surgery.
Main Methods:
- Review of clinical entities: patellar crepitation and patellar clunk syndrome.
- Analysis of microscopic and gross pathological findings related to peripatellar scar tissue.
- Evaluation of incidence rates and patient outcomes from existing literature.
Main Results:
- The incidence of these conditions ranges from 1% to 5% across different studies.
- Inflammatory fibrous hyperplasia is the key pathological finding, related to implant design and surgical factors.
- Most patients with mild symptoms experience improvement within 6 months to 1 year.
Conclusions:
- Peripatellar scar formation is a spectrum of conditions affecting knee arthroplasty patients.
- While many cases resolve spontaneously, significant symptoms like catching warrant consideration for early surgical intervention.
- Open scar excision is a recommended treatment for disabling symptoms associated with peripatellar scar tissue.
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