Stability of capsule closure and postoperative anterior knee pain after medial parapatellar approach in TKA.

Purpose: Anterior knee pain after total knee arthroplasty (TKA) remains a widely discussed postoperative complication. In contrast to sports traumatology, the role of the dissected medial patellofemoral ligament (MPFL) using a medial parapatellar approach in TKA has not been discussed so far. In the present study, it was hypothesized that the attempted repair of the MPFL in TKA by simple closure of the joint capsule may not be successful in some cases, causing anterior knee pain. Furthermore, it was hypothesized, that the success of repair might be influenced by femoral component rotation.

Methods: Forty patients received their TKA in a ligament-balanced and forty patients in a conventional measured-resection technique. After implantation of the TKA using a medial parapatellar approach, two titan clips were attached on both sides of the capsule incision. 3 days and 3 months after surgery, the dehiscence of the two clips was measured on skyline patella radiographs; additionally patellar tilt, shift, the Knee Society Score and the Feller Score were obtained.

Results: 48 patients showed an increase of capsule dehiscence. Patients with a capsule dehiscence of more than 4 mm showed significantly less improvement in the Feller score 3 months postoperatively than patients with a capsule dehiscence ≤4 mm. Regarding the radiological measurements and the clinical outcome, no significant difference between the ligament-balanced and the measured-resection group was found.

Conclusions: The present results suggest that the successful repair of the MPFL after using a medial parapatellar approach in TKA could reduce the high rate of postoperative anterior knee pain. Furthermore, the appearance of capsule dehiscence and anterior knee pain does not seem to be dependent on the used operative technique.