Significantly Lower Incidence of Patellar Clunk Syndrome Using a Highly Congruent Tibial Insert

Patellar crepitus and patellar clunk syndrome are potential complications seen in patients undergoing total knee arthroplasty (TKA). The etiology of this phenomenon is incompletely understood. A retrospective chart review was performed to identify a consecutive series of patients who underwent primary TKA with either a traditional posterior-stabilized implant (group 1, 728 TKAs) or a cruciate substituting implant (group 2, 393 TKAs). All surgical procedures were performed by a single surgeon at the same institution using the same surgical technique, including selective patellar resurfacing and release of the posterior cruciate ligament. The incidence of patellar clunk requiring arthroscopic debridement was recorded. Statistical analysis was performed. The incidence of patellar clunk requiring arthroscopic debridement was significantly higher in group 1 versus group 2 (6.6% vs. 0% respectively, p < 0.001) with standardization of surgeon and technique factors, suggesting implant design is a critical variable in the development of this complication. (Journal of Surgical Orthopaedic Advances 34(1):046-049, 2025).