Non-anatomical capsular closure of a standard parapatellar knee arthrotomy leads to patellar maltracking and decreased range of motion: a cadaver study.


Journal Article

PURPOSE: A parapatellar approach disrupts the medial soft tissue stabilizers of the patella. We hypothesized that soft tissue realignment during arthrotomy closure of native cadaveric knees influences patellar kinematics leading to decreased range of motion. METHODS: Parapatellar arthrotomy was performed in seven native human cadaveric knees that did not contain arthroplasty components. Capsular closure was performed with figure-of-eight sutures in five different positions for each specimen. The capsule was closed anatomically, and then shifted 1.5 or 3 cm distal, or 1.5 or 3 cm proximal relative to surgical markings of the patellar poles. In each closure position, real-time patellar kinematics and range of motion were recorded using a navigation system with patellar tracking function. RESULTS: Maximum knee flexion was significantly reduced with closure shifted 3 cm proximal (133° ± 8.2°, p < 0.001) or distal (139° ± 6.4°, p < 0.05) compared to anatomical closure (147° ± 4.1°). All closure positions significantly influenced patellar rotation at 45°, 90°, and 120° of flexion (p < 0.001). Closure 1.5 or 3 cm distal increased lateral patellar shift relative to the mechanical axis (p < 0.01). Patellar tilt was significantly decreased at 90° and 120° by closure 3 cm distal (p < 0.01) and at 120° when closed 1.5 cm distal (p < 0.05). CONCLUSIONS: Imprecise arthrotomy closure significantly impacted patellar kinematics and passive range of motion. Therefore, every effort should be made to provide anatomical closure of the extensor mechanism to preserve native patellar movement kinematics. LEVEL OF EVIDENCE: V.

Full Text

Duke Authors

Cited Authors

  • Plate, JF; Seyler, TM; Halvorson, JJ; Santago, AC; Lang, JE

Published Date

  • March 2014

Published In

Volume / Issue

  • 22 / 3

Start / End Page

  • 543 - 549

PubMed ID

  • 23334622

Pubmed Central ID

  • 23334622

Electronic International Standard Serial Number (EISSN)

  • 1433-7347

Digital Object Identifier (DOI)

  • 10.1007/s00167-013-2369-3


  • eng

Conference Location

  • Germany