Simon Talbot, Rachel Zordan, Francesca Sasanelli, Matthew Sun
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QTA was measured by the quadriceps tendon axial angle (QTAx). The preoperative and postoperative coronal and axial alignment were measured. Femoral component rotation was measured relative to the preoperative posterior condyles.</p><p><strong>Results: </strong>Analysis was conducted on 388 cases and the mean preoperative QTAx was 6.2° externally rotated (standard deviation 12.0°). QTM (QTAx > 14°) was identified in 76 (19.8%) patients. The diagnosis of QTM was associated with reduced patient outcomes including Forgotten Joint Score (60.2 vs. 51.2, p = 0.008), EuroQol Visual Analogue Scale (81.3 vs. 75.7, p = 0.009), KOOS-12 (80.3 vs. 73.3, p = 0.001) and reduced PASS percentages for all KOOS subscales. In patients with preoperative QTM, femoral component external rotation >2° was associated with improved PROMs when compared to patients with <2° of femoral rotation. This included a clinically significant difference in the improvement of KOOS-12 (11.7 points, p = 0.013) and improved PASS percentages in all KOOS subscales. There was no association between coronal alignment or tibial axial alignment and outcomes.</p><p><strong>Conclusions: </strong>Quadriceps malalignment is a common cause for poorer patient outcomes following total knee replacement. This can be avoided by externally rotating the femoral component to accommodate the deformity in the extensor mechanism.</p><p><strong>Level of evidence: </strong>Level III, case-control study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Preoperative quadriceps malalignment is associated with poor outcomes after knee replacement which are avoided by external rotation of the femoral component.\",\"authors\":\"Simon Talbot, Rachel Zordan, Francesca Sasanelli, Matthew Sun\",\"doi\":\"10.1002/ksa.12544\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Lateralisation of the proximal apex of the quadriceps tendon relative to the mechanical axis or external rotation relative to the femoral shaft can be accurately measured and is strongly associated with patella maltracking. The aim of this study was to first assess the association between preoperative quadriceps tendon alignment (QTA) and the patient-reported outcomes (PROMs) of total knee replacement, and second, determine the influence of component position on outcomes in patients with preoperative quadriceps tendon malalignment (QTM).</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data was performed. All patients had preoperative and postoperative CT scans performed. PROMs were collected preoperatively and at 1 year postoperatively. QTA was measured by the quadriceps tendon axial angle (QTAx). The preoperative and postoperative coronal and axial alignment were measured. Femoral component rotation was measured relative to the preoperative posterior condyles.</p><p><strong>Results: </strong>Analysis was conducted on 388 cases and the mean preoperative QTAx was 6.2° externally rotated (standard deviation 12.0°). QTM (QTAx > 14°) was identified in 76 (19.8%) patients. The diagnosis of QTM was associated with reduced patient outcomes including Forgotten Joint Score (60.2 vs. 51.2, p = 0.008), EuroQol Visual Analogue Scale (81.3 vs. 75.7, p = 0.009), KOOS-12 (80.3 vs. 73.3, p = 0.001) and reduced PASS percentages for all KOOS subscales. In patients with preoperative QTM, femoral component external rotation >2° was associated with improved PROMs when compared to patients with <2° of femoral rotation. This included a clinically significant difference in the improvement of KOOS-12 (11.7 points, p = 0.013) and improved PASS percentages in all KOOS subscales. There was no association between coronal alignment or tibial axial alignment and outcomes.</p><p><strong>Conclusions: </strong>Quadriceps malalignment is a common cause for poorer patient outcomes following total knee replacement. 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引用次数: 0
摘要
目的：股四头肌腱近端顶点相对于机械轴或外旋相对于股骨轴的侧移可以精确测量，并且与髌骨追踪不良密切相关。本研究旨在首先评估全膝关节置换术前股四头肌肌腱对位（QTA）与患者报告结果（PROMs）之间的关联，其次确定组件位置对术前股四头肌肌腱对位不良（QTM）患者结果的影响：对前瞻性收集的数据进行了回顾性分析。所有患者都进行了术前和术后 CT 扫描。收集了术前和术后一年的 PROMs。QTA通过股四头肌腱轴角（QTAx）进行测量。测量术前和术后的冠状和轴向对齐情况。测量股骨组件相对于术前后髁的旋转情况：对 388 个病例进行了分析，术前 QTAx 外旋的平均值为 6.2°（标准偏差为 12.0°）。有 76 例（19.8%）患者被确诊为 QTM（QTAx > 14°）。QTM 诊断与患者预后下降有关，包括遗忘关节评分（60.2 vs. 51.2，p = 0.008）、EuroQol 视觉模拟量表（81.3 vs. 75.7，p = 0.009）、KOOS-12（80.3 vs. 73.3，p = 0.001）和所有 KOOS 分量表的 PASS 百分比下降。在术前有 QTM 的患者中，股骨组件外旋 >2° 与结论患者相比，PROMs 有所改善：股四头肌错位是导致全膝关节置换术后患者预后较差的常见原因。通过外旋股骨组件以适应伸肌机制的畸形，可以避免这种情况：证据级别：三级，病例对照研究。
Preoperative quadriceps malalignment is associated with poor outcomes after knee replacement which are avoided by external rotation of the femoral component.
Purpose: Lateralisation of the proximal apex of the quadriceps tendon relative to the mechanical axis or external rotation relative to the femoral shaft can be accurately measured and is strongly associated with patella maltracking. The aim of this study was to first assess the association between preoperative quadriceps tendon alignment (QTA) and the patient-reported outcomes (PROMs) of total knee replacement, and second, determine the influence of component position on outcomes in patients with preoperative quadriceps tendon malalignment (QTM).
Methods: A retrospective analysis of prospectively collected data was performed. All patients had preoperative and postoperative CT scans performed. PROMs were collected preoperatively and at 1 year postoperatively. QTA was measured by the quadriceps tendon axial angle (QTAx). The preoperative and postoperative coronal and axial alignment were measured. Femoral component rotation was measured relative to the preoperative posterior condyles.
Results: Analysis was conducted on 388 cases and the mean preoperative QTAx was 6.2° externally rotated (standard deviation 12.0°). QTM (QTAx > 14°) was identified in 76 (19.8%) patients. The diagnosis of QTM was associated with reduced patient outcomes including Forgotten Joint Score (60.2 vs. 51.2, p = 0.008), EuroQol Visual Analogue Scale (81.3 vs. 75.7, p = 0.009), KOOS-12 (80.3 vs. 73.3, p = 0.001) and reduced PASS percentages for all KOOS subscales. In patients with preoperative QTM, femoral component external rotation >2° was associated with improved PROMs when compared to patients with <2° of femoral rotation. This included a clinically significant difference in the improvement of KOOS-12 (11.7 points, p = 0.013) and improved PASS percentages in all KOOS subscales. There was no association between coronal alignment or tibial axial alignment and outcomes.
Conclusions: Quadriceps malalignment is a common cause for poorer patient outcomes following total knee replacement. This can be avoided by externally rotating the femoral component to accommodate the deformity in the extensor mechanism.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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