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. 2023 Aug 1;8(8):597-605.
doi: 10.1530/EOR-22-0107.

Overstuffing the patellofemoral compartment in total knee arthroplasty: a systematic review

Marco Gupton  1 , Jordan E Johnson  1 , G Robert Cummings  1 , Chenthuran Deivaraju  2
Affiliations

Overstuffing the patellofemoral compartment in total knee arthroplasty: a systematic review

Marco Gupton et al. EFORT Open Rev. .

Abstract

Purpose: To systematically review and analyze the data available in the literature to evaluate the role of patellofemoral overstuffing in affecting clinical outcomes following primary total knee arthroplasty.

Methods: A systematic literature review was conducted following the PRISMA guidelines. Only studies including primary total knee arthroplasty in the setting of osteoarthritis with a quantifiable method of measuring patellofemoral overstuffing using pre- and post-operative x-rays or advanced imaging, as well as reported subjective and/or objective patient outcomes in relation to patellofemoral overstuffing were included. Extracted data included patellofemoral overstuffing quantitative measurement method, outcome measurements, follow-up, patient demographics, author, and publication details. Descriptive analysis was provided for the available literature.

Results: There were six included articles with a total of 2325 TKAs assessed. All papers found no significant effect on clinical outcomes when the amount of PFJ overstuffing was within reason.

Conclusion: The amount of overstuffing that routinely takes place seems to be within tolerable limits and does not create a significant difference in clinical outcomes. Nevertheless, it is recommended to recreate the anatomic dimensions of the PFJ in order to best obtain a joint that is within this safe margin of error.

Keywords: anterior knee stuffing; patellofemoral compartment overstuffing; patellofemoral joint stuffing; patellofemoral overstuffing.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1
Figure 1
Methods of quantifying PFJ overstuffing produced by Pierson et al. (18) (A) Anterior patellar displacement (APD), (B) Anterior posterior femoral diameter (APFD), (C) Anterior femoral offset (AFO), (D) Posterior femoral offset (PFO).
Figure 2
Figure 2
Methods of quantifying PFJ overstuffing produced by Kemp et al. (34) The teardrop distance (A) is measured from the most posterior aspect of teardrop (B) to the anterior surface of the patella. The teardrop distance ratio (TDR) is composed of the teardrop distance divided by the shaft diameter (A). The medial patellofemoral ligament (MPFL) distance (D) is measured from the MPFL origin to the anterior surface of the patella. The MPFL distance ratio (MPFLDR) is composed of MPFL distance divided by shaft diameter (A). The anterior trochlear offset ratio (ATOR) is composed of the anterior offset distance (E) divided by the shaft diameter ().
Figure 3
Figure 3
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of study selection.
See this image and copyright information in PMC

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