Introduction: When we have operate children’s knee in habitual luxation of the patella we noted, that iliotibial band have branch going to patella and to patella tendon. It is important to the etiopathology of the patella luxation, but in valgus of the knee and in hyperpresion of the patella syndrome too. Material and Method: In years 2000–2007 we have performed surgical iliotibial band release In 70 children, 28 boys and 42 girls. In 19 children contracture of the iliotibial band were one-sided, in 51 children contracture were both-sided. Patients were divided in to groups with various pre-operative symptoms:. valgus of the knee – 40 patients (74 legs),. valgus of the knee with subluxation of the patella in extension of the knee – 18 (31 legs),. valgus of the knee with hyperpression of patella syndrome – 11 (15 legs),. pathological knee valgity 1 (1 leg). In all cases we performed surgically release of the iliotibial band. The incision was 5–10 cm over the joint space on the lateral side of the femur. The fasciotomy of the fascia lata and iliotibial band we make in “Z” shape. During operation we flex and extend the knee to be sure all fibres are released. Findings: We have check late result (3 – 36 month postoperatively) in 45 patients (77 legs). We estimate:. 27 patients from group of valgus deformity of the knee. 14 patients from group of valgus of the knee with subluxation of the patella. 3 patients with group of valgus of the knee with hyperpression of patella syndrome. 1 patient with pathological knee valgity. The valgus angle preoperatively reaches 12 to 35 (on average 16 for right leg and 16,5 for left). Postoperatively angle improve in all patients. Knee angle change from 5 to 20 degree (on average 8,4 for Wright leg, 8,3 for left). In group with patella subluxation we have check 23 legs. In 11 patents (18 legs) the angle improve. The 3 patients (5 leg) later has full reconstruction of patello-femoral joint with patella tendon transposition. In patient with post inflammatory deformation the angle improve from 15 to 7 degree, but after next 34 month reaches again 20 degree and patient had osteotomy of the femur. Conclusions:. iliotibial band release show us good result in correction the axis of the knee, first even during operation. After iliotibial band release is possible to move patella passive to medial side of the knee. Late result show us good effect in group of valgus of the knee deformity and in group with hyperpression of the patella syndrome. In group of subluxation of the patella effectivity of this method is 78%. We believe that surgical release of iliotibial band is easy and effective method of knee valgus correction in idiopathic valgity or in patella subluxation and in hyperpression of the patella syndrome

We present the ten- to 15-year follow-up of 31 patients (34 knees), who underwent an Elmslie-Trillat tibial tubercle osteotomy for chronic, severe patellar instability, unresponsive to non-operative treatment. The mean age of the patients at the time of surgery was 31 years (18 to 46) and they were reviewed post-operatively, at four years (2 to 8) and then at 12 years (10 to 15). All patients had pre-operative knee radiographs and Cox and Insall knee scores. Superolateral portal arthroscopy was performed per-operatively to document chondral damage and after the osteotomy to assess the stability of the patellofemoral joint. A total of 28 knees (82%) had a varying degree of damage to the articular surface. At final follow-up 25 patients (28 knees) were available for review and underwent clinical examination, radiographs of the knee, and Cox and Insall scoring. Six patients who had no arthroscopic chondral abnormality showed no or only early signs of osteoarthritis on final radiographs; while 12 patients with lower grade chondral damage (grade 1 to 2) showed early to moderate signs of osteoarthritis and six out of ten knees with higher grade chondral damage (grade 3 to 4) showed marked evidence of osteoarthritis; four of these had undergone a knee replacement. In the 22 patients (24 knees) with complete follow-up, 19 knees (79.2%) were reported to have a good or excellent outcome at four years, while 15 knees (62.5%) were reported to have the same at long-term follow-up. The functional and radiological results show that the extent of pre-operatively sustained chondral damage is directly related to the subsequent development of patellofemoral osteoarthritis.

Cite this article: Bone Joint J 2013;95-B:478–85.

Purpose. In vivo comparative gap measurements were performed in 3 different patella positions (reduced, subluxated and everted) using offset-type-force-controlled-spreader-system. Methods. Prospectively, 50 knees were operated by TKA using a navigation-assisted gap balancing technique. The offset-type-force-controlled-spreader-system was used for gap measurements. This commercially-available instrument allows controllable tension in patella reduced position. The mediolateral gaps of knee extension (0°) and flexion (90°) angle were recorded in 3 different patella positions; reduced, subluxated and everted. Any gap differences of more than 3 mm were considered as a meaningful difference. Correlation between the difference with the demographic data, preoperative radiologic alignment and intraoperative data was analyzed. For statistical analysis, ANOVA and Pearson correlation test were used. Results. The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Statistically significant difference were observed for the lateral gap of patella eversion compared to gap of patella reduction in knee flexion position (p<0.05). There were notable cases of variability in knee flexion position. Significant portion 12 (24%) knees of patella subluxation and 33 (66%) knees of patella evertion demonstrated either increased or decreased gaps in knee flexion position compared from the gaps of patella reduction position. Conclusion. The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Therefore, the intraoperative patellar positioning has influence on the measurement of the joint gap. Keeping the patella in reduced position is important during gap balancing

Arthroscopic intervention for early symptoms of arthrosis of the knee was a well-established procedure until Moseley cited his study showing no difference in outcomes when compared to “sham” surgery. Now there is no opportunity for reimbursement with arthroscopic debridement unless mechanical internal derangement can be documented. There are, however, several specific lesions of arthrosis which respond well to arthroscopic intervention and are reimbursed by third party payers. Arthroscopic three compartment microfracture with non-weight bearing and passive motion for eight weeks post- op has significantly relieved symptoms. Second look biopsies have confirmed type II hyaline cartilage and increased joint interval. Proper patient selection is paramount and guidelines will be discussed. Isolated severe patellofemoral arthrosis with patella subluxation responds to arthroscopic patella lateral facetectomy. Jones has reported significant pain relief up to two years with this excellent option for a difficult patient problem. The technique and results will be presented in detail. Loss of terminal extension in the arthritic knee can accelerate deterioration and force earlier decision for TKA. Parson's third tubercle is an osteophyte that forms just anterior to the ACL insertion on the tibia and is the frequent cause of extension loss. Arthroscopic resection of the tubercle results in increased extension and diminishes the stress concentration assuring better longevity for the native knee. The diagnostic characteristics, resection techniques and results of the Dallas series will be presented

Patella subluxation assessed on dynamic MRI has previously been shown to be associated with anterior knee pain. In this MRI study of 60 patients we investigated the relationship between subluxation and multiple bony, cartilaginous and soft-tissue factors that might predispose to subluxation using discriminant function analysis. Patella engagement (% of patella cartilage overlapping with trochlea cartilage) had the strongest relationship with subluxation. Patellae with > 30% engagement tended not to sublux; those with < 30% tended to sublux. Other factors that were associated with subluxation included the tibial tubercle-trochlea notch distance, vastus medialis obliquus distance from patella, patella alta, and the bony and cartilaginous sulcus angles in the superior part of the trochlea. No relationship was found between subluxation and sulcus angles for cartilage and bone in the middle and lower part of the trochlea, cartilage thicknesses and Wiberg classification of the patella. This study indicates that patella engagement is a key factor associated with patellar subluxation. This suggests that in patients with anterior knee pain with subluxation, resistant to conservative management, surgery directed towards improving patella engagement should be considered. A clinical trial is necessary to test this hypothesis

Purpose of Study:. Various techniques have been described and are still used for treating recurrent dislocation of the patella when conservative measures fail. Among them are distal, proximal and combined realignment techniques and lateral releases. Since being shown proof of the biomechanical importance of the medial patellofemoral ligament (MPFL) in patellofemoral instability, the reconstruction of the MPFL has gained in popularity. The objective of this paper is to present a case series with preliminary clinical results using the gracilis tendon to reconstruct the MPFL. Method:. Between 01/07 and 03/11 23 knees in 21 patients underwent reconstruction of the MPFL.4 of these patients had had previous surgery. Preoperatively the Caton Deschamps ratio using plain x-rays was worked out and the TT/TG distance was measured using CT scanning. Using these measurements as a guideline, 7 cases underwent a tibial tubercle transfer as an additional procedure. In 6 of the cases an additional cartilage procedure was required. The technique was simplified using intra-operative x-rays to achieve anatomical tunnel placement. Results:. The Tegner Activity Score was used to evaluate the patients preoperatively and at a minimum of 6 months postoperatively. The scores improved on average from 3,6 to 7,4. One patient had an extensor lag of 10 degrees at 3 months. This had normalised by 6 months. One patient had recurrence of her instability and required a revision MPFL reconstruction using an allograft. One patient had recurrent episodes of patella subluxation but no overt dislocation. Conclusion:. This case series gave good functional results using the Tegner Activity score. The procedure of MPFL reconstruction was effective in stabilising the patellae and in improving the symptoms of patellofemoral instability

Purpose of the study. To determine the outcome after the Semi-tendinosis tendon was used in reconstruction of the Medial Patella-femoral ligament using a fixed dynamic stabilising structure. Method. The Adductor Magnus tendon insertion at the Adductor tubercle of the medial femoral condyle was used as a dynamic and fixed stabilising point preventing patella subluxation. This is a constant landmark in most patients and eliminates the need to find the isometric stabilisation point of the Medial Patella-femoral ligament. The Semi-tendinosus tendon was routed from its distal tibia attachment through a drill hole in the patella from distal to proximal. It was then transferred sub-vastus around the Adductor Magnus femoral attachment and sutured back onto itself at the inferior patella pole. It was tensioned at 30 degrees of knee flexion. Between 2004 and 2011 forty knees were reconstructed using the Semi-tendinosus tendon combined with an extra-synovial lateral release. All had failed conservative therapy for repeated patella instability. Post-operatively the patients followed a strict rehabilitation protocol. At follow-up the patients were questioned for any symptoms of patella instability or dislocation. Any complications of the surgery were documented. Patients were examined for any signs of patella apprehension or abnormal patella tracking. Results. The male to female ratio was 2:3. The mean age was 26 (range13 to 33). The mean follow- up was 44 months. To date no recurrence of instability was noted. Within as early as 4 weeks post-surgery a reduction of patella apprehension was noted in all patients. 90% of patients were able to return to an active life-style. No serious complications were documented. Conclusion. Transferring Semi-tendinosus around the fixed, dynamic distal insertion point of Adductor Magnus provides good results in the medium term and is a technique that may be combined with distal patella tendon realignment procedures. NO DISCLOSURES

Patella management in total knee arthroplasty remains controversial. Minimizing patella related problems is the main goal in any type of knee arthroplasty. This can be achieved with and without resurfacing. However, patella resurfacing resulted in, at times, catastrophic failures, which increased the popularity of patella non resurfacing, particularly with anatomical femoral groove designs. If patella non resurfacing is to be recommended, clinical outcomes must be equal or better than those of routine patella resurfacing in the specific prosthesis utilized. From a large cohort of over 6000 TKA five studies were conducted to analyze isokinetic strength, subjective, clinical, and radiographic outcomes as well as histopathological data. Isokinetic strength, subjective, clinical, and radiographic outcomes favor nonresurfacing in TKA with proper femoral component rotation and conforming patellar groove. Our data indicate that patella subluxation and femoral component malrotation is significantly associated with development of arthrofibrosis. On the base of our studies we propose specific surgical techniques for optimal patella treatment (patelloplasty) in TKA

Twenty four operations were reviewed in 23 patients to show a modified Roux-Goldthwait operation would improve the symptoms of chronic patella instability. This retrospective study used a questionnaire to record symptoms before and after surgery. The examination assessed joint hypermobility, patella tracking and stability, the Q and valgus angles of the knee. Apprehension test and assessment of patella tilt was also assessed. All patients underwent radiographic assessment. Twenty of 23 patients were improved by this procedure. Patella subluxation was reduced by 22%. Patella dislocation was reduced by 86%. The 3 unsuccessful cases had generalised joint laxity and may have been improved by the addition of a medial reefing procedure. There were no cases of tibial tuberosity numbness post operatively, patella tilt or failure of the transposed tendon. We showed that this procedure is effective, regardless of x-ray signs. We did observe a subjective increase in patellofemoral pain post operatively

Background. We would like to analyze the risk factors of no thumb test among knee alignment tests during total knee arthroplasty surgery. Methods. The 156 cases of total knee arthroplasty by an operator from October 2009 to April 2010 were analyzed according to preoperative indicators including body weight, height, degree of varus deformity, and patella subluxation and surgical indicators such as pre-osteotomy patella thickness, degree of patella degeneration, no thumb test which was evaluated after medial prepatella incision and before bone resection (1st test), no thumb test which was evaluated with corrective valgus stress (2nd test, J test), and the kind of prosthesis. We comparatively analyzed indicators affecting no thumb test (3rd test). Results. There was no relation between age, sex, and body weight and no thumb test (3rd test). Patellar sulcus angle (p = 0.795), patellar congruence angle (p = 0.276) and preoperative mechanical axis showed no relationship. The 1st no thumb test (p = 0.007) and 2nd test (p = 0.002) showed signifi cant relation with the 3rd no thumb test. Among surgical indicators, pre-osteotomy patella thickness (p = 0.275) and degeneration of patella (p = 0.320) were not relevant but post-osteotomy patellar thickness (p = 0.002) was relevant to no thumb test (3rd test). According to prosthesis, there was no signifi cance with Nexgen (p = 0.575). However, there was signifi cant correlation between Scorpio (p = 0.011), Vanguard (p = 0.049) and no thumb test (3rd test). Especially, Scorpio had a tendency to dislocate the patella, but Vanguard to stabilize the patella. Conclusions. No thumb test (3rd test) is correlated positively with 1st test, 2nd test, and post-osteotomy patella thickness. Therefore, the more patella osteotomy and the prosthesis with high affi nity to patellofemoral alignment would be required for correct patella alignment

Recurrent patellar dislocation is a relatively common disorder in young patients. Historically, treatment options have been based on the underlying disorder predisposing the patient to the dislocation. This has resulted in various soft tissue reefing procedures, patella tendon realignment procedures and boney realignment procedures. Further research has shown that the medial patellofemoral ligament (MPFL) is the primary restraint to lateral patella subluxation and dislocation. Many authors have published their successful treatment of recurrent patella dislocation by reconstruction of the medial patellofemoral ligament. The most widely used is autologous semitendinosis tendon grafts, as well as synthetic materials, and MPFL reconstructions may be combined with boney procedures. Varieties of fixation techniques have been described involving both the patella and femoral sides. We present a technique of MPFL reconstruction using the autologous ipsilateral quadriceps tendon. Our technique avoids the morbidity associated with semitendinosis graft harvesting and the drill holes in, and potential resulting fracture of, the patella. The technique is also simple and is associated with decreased procedure costs. We present the technique and a series of 6 patients (7 knees) with follow up ranging from 8 months to 9 years. The average age of patients at the time of surgery 16–28 years (mean = 20years). There have been no redis-locations. The median Kujala patellofemoral knee score at follow up was 97 out of 100 (Range 69–100). The results compare very favourably to published results using other techniques. Our technique of reconstructing the MPFL is reliable, produces good results using an objective knee score, and is cost effective

1346 Primary TKR’s were evaluated. In keeping with the principle of Insall all patellas were resurfaced with the only exclusion being a previous patellectomy or excessive patella erosion. Most TKR were of posterior cruciate substituting devices (IB11 (56.9%) or Nexgen LPS (42.3%)). The reason for operation was OA (94.5%), RA (2.9%), and others 2.6%. Most knees were in varus (68.5%), 17% were in valgus, and 14.5% were in neutral alignment. The method of preparing the patella and extensor mechanism was as follows: A total fat pad excision was performed, debulking the patella thickness of 1mm. The patella component was placed medially and superiorly, a peri-patella synovectomy was performed, and a release of the lateral patella femoral ligaments was done. A lateral release was performed in 17.5% of patients. Follow up ranges from 9 months to 15 years. Reoperation for patella problems was necessary in only 5 patients (0.37%). There was 1 case of patella subluxation, 1 case of persistent anterior knee pain, and 3 patients with a patella clunk (in IB 11 knees only). In our hands this approach has led to excellent long term results without some of the potential complications described in the literature and warrants continued use of routine patella resurfacing when doing TKR

Purpose of the study: To develop a new treatment algorithm for patients with chronic anterior knee pain based on kinematic patella tracking MR imaging. Methods and Results: Patients with anterior knee pain of more than one year duration and not responding to non-operative treatment, underwent kinematic MRI study. The provocative test was performed with the conventional MRI scanner and the patient extending the knee against resistance, the resistance provided by inflated beach ball. A retrospective analysis was done of first seventy patients, who had undergone this scanning technique. On the imaging films, four measurements were made. They were patella subluxation, tilt, cartilage thickness and the Tibial Tubercle Trochlear distance (TTD). Patellar subluxation was classified as mild, moderate and severe. We found that a Tibial Tubercle Trochlea distance of 18mm had a specifity of 100% and a sensitivity of 89% for severe maltracking. Conclusion: Kinematic MR Imaging is a useful investigation before considering operative treatment for patients with chronic anterior knee pain. Based on our study, we conclude that those patients with moderate lateral maltracking with a TTD< 18 mm should be offered lateral release and those with severe maltracking and TTD> 18mm should have a tibial tubercle transfer, in addition to lateral release

Purpose of the study: To develop a new treatment algorithm for patients with chronic anterior knee pain based on kinematic patella tracking MR imaging. Methods and Results: Patients with anterior knee pain of more than one year duration and not responding to non-operative treatment, underwent kinematic MRI study. The provocative test was performed with the conventional MRI scanner and the patient extending the knee against resistance, the resistance provided by inflated beach ball. A retrospective analysis was done of first seventy patients, who had undergone this scanning technique. On the imaging films, four measurements were made. They were patella subluxation, tilt, cartilage thickness and the Tibial Tubercle Trochlear distance (TTD). Patellar subluxation was classified as mild, moderate and severe. We found that a Tibial Tubercle Trochlea distance of 18mm had a specifity of 100% and a sensitivity of 89% for severe maltracking. Conclusion: Kinematic MR Imaging is a useful investigation before considering operative treatment for patients with chronic anterior knee pain. Based on our study, we conclude that those patients with moderate lateral maltracking with a TTD< 18 mm should be offered lateral release and those with severe maltracking and TTD> 18mm should have a tibial tubercle transfer, in addition to lateral release

Aims

The aim of this study was to evaluate medium- to long-term outcomes and complications of the Stanmore Modular Individualised Lower Extremity System (SMILES) rotating hinge implant in revision total knee arthroplasty (rTKA) at a tertiary unit. It is hypothesized that this fully cemented construct leads to satisfactory clinical outcomes.

When managing malignant long bone tumours in skeletally immature patients it is desirable, after resection, to reconstruct with a prosthesis that can be lengthened at appropriate intervals to keep pace with growth of the contralateral side. In an attempt to avoid multiple surgical procedures to achieve such lengthening we have recently developed a prosthesis that can be lengthened non-invasively. Purpose of study: To look at our early experience with the use of non-invasive growing femoral prostheses. Methods: Between November 2002 and February 2004 the prosthesis was implanted in 6 patients (3 males and 3 females) with a diagnosis of osteosarcoma. The patients were aged between 9 and 14 years (mean 11.5 years) at the time of surgery. Patients were lengthened at appropriate intervals and the process was monitored with scanograms. The prosthesis contains a magnet that is connected to gears that drive the extending mechanism. The patients’ limb is placed into a coil and the principle of electromagnetic induction coupling is used to achieve lengthening. Total degree of lengthening to date was recorded for each patient together with the range of knee movement and any complications that occurred. Patients were functionally evaluated at their last follow-up visit using the Musculoskeletal Tumour Society (MSTS) Scoring System. Results: To date patients have been lengthened by an average of 18mm (8–48mm). The mean amount of knee flexion is 125 degrees. The mean MSTS score is 18 (16–21). There have been two complications; one patient developed patella subluxation during the lengthening programme and one patient has required serial casting to treat a flexion deformity of 25 degrees. Conclusions: We have been encouraged by our early results with this prosthesis and have been able to demonstrate that the technology works reliably in vivo. We are continuing to use this prosthesis in skeletally immature patients

Recurrent patellar dislocation is a relatively common disorder in young patients. Historically, treatment options have been based on the underlying disorder predisposing the patient to the dislocation. This has resulted in various soft tissue reefing procedures, patella tendon realignment procedures and boney realignment procedures. Further research has shown that the medial patello-femoral ligament (MPFL) is the primary restraint to lateral patella subluxation and dislocation. Many authors have published their successful treatment of recurrent patella dislocation by reconstruction of the medial patellofemoral ligament. The most widely used is autologous semitendinosis tendon grafts, as well as synthetic materials, and MPFL reconstructions may be combined with boney procedures. Varieties of fixation techniques have been described involving both the patella and femoral sides. We present a technique of MPFL reconstruction using the autologous ipsilateral quadriceps tendon. Our technique avoids the morbidity associated with semitendinosis graft harvesting and the drill holes in, and potential resulting fracture of, the patella. The technique is also simple and is associated with decreased procedure costs. We present the technique and a series of six patients (seven knees) with follow up ranging from eight months to nine years. The average age of patients at the time of surgery 16 to 28 years (mean = 20 years). There have been no redislocations. The median Kujala patellofemoral knee score at follow up was 97 out of 100 (Range 69–100). The results compare very favorably to published results using other techniques. Our technique of reconstructing the MPFL is reliable, produces good results using an objective knee score, and is cost effective. Seventy staff members participated from a potential pool of approximately one hundred staff on duty at the time. Of the seventy staff who participated in this research project a total of three staff members were within 50 mls of the correct amount for each of the three samples. Overall staff were very poor at estimating blood loss. Staff working in the operating theatre, no matter what their affiliation or years of experience, are not accurate when estimating blood loss spilt into a patients bed. A tool that aids in blood loss estimation is a valuable addition to the theatre resource manual

Aims

The effects of remnant preservation on the anterior cruciate ligament (ACL) and its relationship with the tendon graft remain unclear. We hypothesized that the co-culture of remnant cells and bone marrow stromal cells (BMSCs) decreases apoptosis and enhances the activity of the hamstring tendons and tenocytes, thus aiding ACL reconstruction.

Introduction: Correct prosthesis alignment and joint line reproduction in total knee replacement (TKR) is vital for a successful clinical outcome. It is acknowledged that the ideal coronal alignment of the knee following TKR should be between 4–10 degrees of valgus. A neutral or varus knee is associated with a higher failure rate. Previous studies have shown that ideal alignment is achieved in only around two-thirds of cases. Joint line elevation > 8mm has been associated with inferior clinical outcome, and depression associated with retropatellar pain and increased risk of patella subluxation. Recently, modifications have been made to the Kine-max-Plus Total Knee System instrumentation, theoretically providing better internal fixation to prevent a varus cut and a 12 mm measured resection from the “normal” tibial plateau. This study aims to examine whether these changes result in an improvement in alignment, and a more reliable restoration of joint line. Materials and Methods: Two consecutive series, each of 75 patients who had undergone TKR using either the old (Group A) or the new (Group B) instrumentation were included in the study. Antero-posterior and lateral preoperative and postoperative knee radiographs were assessed using the American knee society radiographic analysis for prosthesis postionoing by 2 independent observers. The Tibial and Femoral Component Angles in the coronal plane (cTCA and cFCA) and in the sagittal plane (sTCA and sFCA) were measured, as was the change in joint line height. Conclusion: Our results suggest that use of the new instrumentation is associated with better restoration of joint line, and is more effective in preventing implantation of the tibial component in varus. These figures relating to a modern instrumentation system provide a yardstick against which computer assisted and robotic surgery can be judged. Long-term follow-up will be required to assess the clinical significance of these results

The purpose was to evaluate clinical and radiographical outcome of 1777 patella non-resurfacing in two major centres. Patella management in total knee arthroplasty (TKA) is of concern when resurfaced (multiple problems) or when non-resurfaced (pain). Reports in the literature are frequently non-specific regarding surgical approach, femoral rotation alignment, and femoral design. 1777 non-resurfaced patella TKAs from two large centres were evaluated with a 2 to 15 year follow-up, using similar selection criterion, operative techniques, and prostheses. Patient demographics included 70% females (mean age 68 years). Diagnoses included 8% rheumatoid. Radiologic skyline view assessment of 200 cases (100 from each centre) with longest (mean 9. 2 years) follow-up, formed a subset group. Clinical success rate was good/excellent in 94. 6%; scores improved from 59 to 87. Patella-related anterior knee pain requiring re-operation was 1. 1% (19 patients), only 9 (0. 55%) of which had unequivocal improvement following re-surfacing. Twenty-one cases (1. 2%) underwent “incidental” patella resurfacing at revision for other reasons. There were no patella subluxations or dislocations. Two hundred cases with longest follow-up revealed perfect congruent contact in 97. 5% with no lateral deviation (mid-sulcus to patella crown) over 6 mm. Asymptomatic remodelling was noted in 8%, with relative sclerosis and height loss of the lateral facet in 2. 5%. No changes correlated with clinical symptoms. These data support a success rate of over 98% with non-resurfaced patella in a mobile-bearing (LCS) TKA system that includes a patella friendly design, proper soft tissue management, and femoral component rotational alignment using the tibial shaft axis and balanced flexion tension gap method