Length change patterns of the extensor retinaculum and the effect of total knee replacement

Patellofemoral dysfunction following total knee replacement (TKR) is a significant clinical problem, but little information exists on the mechanics of the patellofemoral retinacula or the effects of TKR on these structures. We hypothesized that TKR would cause significant elongation of the retinacula. Retinacular length changes were measured by threading sutures along the retinacula, fixing the sutures to the patella and the iliotibial band (ITB), and attaching the femoral ends to displacement transducers. The intact knee was flexed-extended while the quadriceps and ITB were tensed and the retinacular length change patterns were recorded. The measurements were repeated post-TKR. The medial patellofemoral ligament (MPFL) was close to isometric, stretching 2 mm in terminal knee extension, whereas the lateral retinaculum slackened 8 mm from 110 degrees to 0 degrees flexion. TKR did not cause significant elongation of either of the retinacula, the largest change being 3 mm elongation of the MPFL around 40 degrees , which stretched the MPFL by 1.4 mm above its maximum natural length. Thus, this work did not support the hypothesis that TKR causes significant elongation of the retinacula sufficient to affect knee function.