From the OrthoCarolina Hip & Knee Center, Charlotte, NC (Hood and Fehring), the OrthoCarolina Research Institute, Charlotte, NC (Rowe, Valenzeula, McBride, and Odum), and the Atrium Health-Musculoskeletal Institute, Charlotte, NC (Odum and Fehring).
J Am Acad Orthop Surg. 2023 Mar 15;31(6):300-304. doi: 10.5435/JAAOS-D-22-00539. Epub 2023 Jan 6.
Meticulous arthrotomy closure during total knee arthroplasty (TKA) is essential to preserve quadriceps strength and maintain proper patellar tracking. We recently encountered a subset of patients referred with anterior knee pain, a palpable retinaculum defect, and quadriceps weakness. Each patient was found to have an arthrotomy dehiscence. This study highlights arthrotomy dehiscence as a failure mechanism after TKA.
A retrospective case series of patients who underwent primary TKA followed by subsequent capsular dehiscence was reviewed. We investigated whether the dehiscence was related to trauma, the presence of a palpable arthrotomy defect, patellar tracking, quadriceps strength, and the type of closure technique.
All patients had an atraumatic disruption and presented with anterior knee pain and quadriceps weakness. Fourteen of 18 patients (78%) had a palpable defect along the medial retinaculum. Nine of 18 patients (50%) had patellar subluxation or tilting. Barbed sutures were used in 13 of 18 (72%) patients. A simple arthrotomy repair (44%) or a vastus medialis obliquus advancement (56%) was used successfully in all patients.
Atraumatic arthrotomy dehiscence as a cause of TKA failure historically has been a rare event. Recently, we have noticed a disturbing number of patients presenting with this failure mechanism. With this study, we call attention to this unique atraumatic failure mechanism in patients presenting with anterior knee pain after TKA. Surgeons should be aware of this risk when using barbed sutures alone and should consider routinely reinforcing the arthrotomy with interrupted sutures.
Level IV, Retrospective Case Series.
在全膝关节置换术（TKA）中，精细的关节切开术闭合对于保持股四头肌力量和维持适当的髌骨轨迹至关重要。我们最近遇到了一组因前膝疼痛、可触及的支持带缺陷和股四头肌无力而转诊的患者。每位患者都发现存在关节切开术裂开。本研究强调了关节切开术裂开是 TKA 后的一种失效机制。
回顾性分析了接受初次 TKA 后随后发生囊袋裂开的患者的病例系列。我们调查了裂开是否与创伤、可触及的关节切开缺陷、髌骨轨迹、股四头肌力量以及闭合技术类型有关。
所有患者均发生无创伤性破裂，表现为前膝疼痛和股四头肌无力。18 例患者中有 14 例（78%）在内侧支持带上有可触及的缺陷。18 例患者中有 9 例（50%）有髌骨半脱位或倾斜。18 例患者中有 13 例（72%）使用了带刺缝线。所有患者均成功采用单纯关节切开修复术（44%）或股直肌斜肌前推术（56%）。
作为 TKA 失败原因的无创伤性关节切开术裂开在历史上一直是一种罕见事件。最近，我们注意到越来越多的患者出现这种失败机制。通过本研究，我们提请注意这种在 TKA 后出现前膝疼痛的患者特有的非创伤性失效机制。当单独使用带刺缝线时，外科医生应意识到这种风险，并应考虑常规使用间断缝线加强关节切开术。
IV 级，回顾性病例系列。
