Management of Painful Patellar Clunk and Crepitance: Results at a Mean Follow-Up of Five Years.

Introduction: Painful patellar clunk and crepitance (PCC) is a known complication of total knee arthroplasty (TKA) with posterior-stabilized designs. Arthroscopic management of PCC has been proposed as a treatment option for PCC.

Methods: We reviewed all cases of PCC from a consecutive single-surgeon series using a specific posterior stabilized (PS) design treated with arthroscopy for PCC. In a series of 1,488 TKA cases, forty-six patients (3.1%) were identified to have clinical signs and symptoms of PCC during post-operative clinic follow-up.

Results: Patients elected for arthroscopic excision of the supra-patellar lesion in eighteen of the forty-six cases (39%), after failing conservative management, for a 1.2% incidence of arthroscopic excision for PCC in the TKA cohort. All cases were followed for a minimum of two years. Three of the cases had recurrence of PCC after arthroscopy (16.7%), and each of these patients was successfully treated with a second arthroscopic excision procedure. Patient satisfaction after arthroscopic excision was rated extremely satisfied or very satisfied in 79% of patients and moderately satisfied in 21% of patients. Several radiographic measurements were considered in the PCC cohort, and only increased posterior tibial slope was associated with the need for arthroscopic excision. At final followup, the mean knee society score was 92.4, the mean WOMAC score was 82.9, and mean range of motion was 0-119.7 degrees.

Discussion: The incidence of PCC requiring arthroscopic excision with the Sigma PS design was relatively low, at 1.2% of patient. Patients who underwent arthroscopic excision for PCC had high patient satisfaction and low recurrence rates. In recurrent cases, repeat excision also resolved symptoms. Thus, arthroscopic excision is an effective treatment option for PCC in symptomatic patients.