- Discussion:
- the patella should evert with minimal tension on the patella tendon;
- methods to facilitate patellar eversion:
- patellar resurfacing:
- patellar resurfacing can be performed early in the exposure inorder to thin the patella and facilitate the eversion;
- proximally ensure that there is an adequate quadriceps incision;
- in revision TKR, a quadriceps snip may be required;
- transect any adhesions in the in the suprapatella pouch;
- distally ensure that the entire patellar tendon has been exposed;
- it is permissible to sharply elevate a small amount (10-20%) of the patellar tendon off its insertion (rather than
have it partially avulse under tension);
- incise the anterior attachements of the lateral mensicus of the tibia;
- ensure that an adequate lateral capsular exposure has been performed;
- excise patello-femoral ligaments:
- attach a Kocher clamp to cuff of retinaculum attached to medial side of patella;
- retract the Kocher to partially evert the patella so that the patellofemoral ligaments are placed under tension;
- use curved Mayo's to spread under the patellofemoral ligament and then incise it;
- lateral retinacular release
Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?
Patellar Eversion During Total Knee Replacement: A Prospective, Randomized Trial