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The outerbridge classification predicts the need for patellar resurfacing in TKA.

E Carlos Rodríguez-Merchán1, Primitivo Gómez-Cardero

  • 1Department of Orthopaedics, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain. carlosrodriguezmerchan@gmail.com

Clinical Orthopaedics and Related Research
|October 22, 2009
PubMed
Summary

Patellar resurfacing during total knee arthroplasty is recommended for Outerbridge Grade IV cartilage defects. This approach reduces the need for revision surgery due to patellofemoral pain, unlike lower grades.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering

Background:

  • Patellar resurfacing (PR) in total knee arthroplasty (TKA) remains a debated topic in orthopedic surgery.
  • The Outerbridge classification is widely used to grade patellar cartilage defects.

Purpose of the Study:

  • To evaluate if the Outerbridge classification can predict the necessity of PR during TKA.
  • To assess the long-term outcomes of PR based on preoperative patellar cartilage defect grading.

Main Methods:

  • A prospective, randomized study involving 500 TKAs performed between 1995 and 2000.
  • Patients were divided into Group A (Outerbridge Grades I-III) and Group B (Outerbridge Grade IV).
  • Within each group, patients were randomized to receive either PR or no PR, using identical prosthetic designs.

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Main Results:

  • After an average follow-up of 7.8 years, Group A showed a significantly lower rate of secondary PR for patellofemoral pain (0.6%) compared to Group B (11.6%).
  • Patients with Outerbridge Grade IV defects had a 21.5 times greater risk of requiring subsequent patellar resurfacing compared to those with Grades I-III.
  • No significant difference in outcomes was observed between patients who underwent PR and those who did not within Group A.

Conclusions:

  • Patellar resurfacing is recommended for patients with Outerbridge Grade IV patellar cartilage defects undergoing TKA.
  • PR is not indicated for Outerbridge Grades I, II, or III patellar defects as it does not significantly improve outcomes and may lead to unnecessary procedures.