Control-matched computational evaluation of tendo-femoral contact in patients with posterior-stabilized total knee arthroplasty

Painful patellar crepitus is a potential complication in up to 14% of patients following posterior-stabilized (PS) total knee arthroplasty (TKA). A recent clinical study identified influential patient and surgical variables by comparing a group of crepitus patients with controls matched for age, sex, and body mass index. The purpose of our study was to evaluate effects of variables identified as significant in the clinical study, including patellar ligament length, femoral component flexion, patellar button size, and position of the joint line, on contact between the quadriceps tendon and the PS femoral component. A previously verified finite element model was utilized to estimate tendo-femoral contact during deep flexion activity. Using discrete perturbations, the computational model confirmed the clinical findings in that an increased patellar ligament length, flexed femoral component, lowered joint line, and larger patellar component all reduced potentially deleterious contact near the intercondylar notch. With the selected level of anatomic and component alignment perturbations, the most influential factor affecting tendo-femoral contact was patellar ligament length. Three crepitus patients with matched controls were subsequently modeled, and contact with the anterior border of the notch was present in each crepitus patient, but none of the controls. Alternative surgical alignments for these patients were evaluated to improve the potential long-term outcomes. By characterizing conditions that may lead to painful crepitus, the modeling approach supports clinicians by identifying pre-surgical indicators and important alignment parameters to control intraoperatively.