Abstract
Soft tissue balancing of the “flexion gap” has a direct affect on patello-femoral tracking. Both of which are necessary for a well functioning Total Knee Arthroplasty (TKA). Traditionally, successful restoration of soft tissue balance and patellar tracking depend heavily on surgeon experience, empirical judgment and technical skill.
Orthopaedic residents often are confronted with the challenge of learning to perform TKA without objective measures with which to assess the accuracy of their surgical technique. Also, the vast majority of TKA’s are performed by surgeons who do less than 25 TKA’s per year. Both populations often rely upon surgical release of the lateral patellar retinacular tissues in order to restore “optimal” patellar tracking. This surgical technique is often associated with division of the lateral geniculate vessels and increased potential for avascular necrosis of the patella and lateral subcutaneous hematoma. Both groups of surgeons would be well served if there were available a means with which they could objectively measure whether or not they have in fact achieved the soft tissue balance they intended and optimal patello-femoral tracking, without the need for a lateral release.
Historically, the incidence of lateral release, as a means of improving patellofemoral tracking, has been reported performed in more than 10% of TKA. A prospective group of 200 consecutive TKA’s, performed by two surgeons, in which an electronic means of assessing “flexion gap” balance was retrospectively reviewed for the incidence of intra-operative lateral release. It was found that use of electronic measurement to assure “flexion gap” balance was associated with a significant reduction in the incidence of lateral release required to achieve optimal patello-femoral tracking.
Correspondence should be addressed to Diane Przepiorski at ISTA, PO Box 6564, Auburn, CA 95604, USA. Phone: +1 916-454-9884; Fax: +1 916-454-9882; E-mail: ista@pacbell.net
