Research On The Long-term Knee Function Compensation After Patellectomy

Objective:This thesis is to discuss the long-term compensation issues of the knee function after patellectomy for comminuted fracture patella, to provide a theoretical basis for selection of clinical surgical methods.Methods:With the result of the measurement of BIODEX isokinetic dynamometer and rehabilitation system and the analysis of knee extensor/flexor strength test, in combination of the follow-up examination, knee function assessment according to the American Knee Society (AKS) system, X-ray and MRI results, the thesis has made a comprehensive evaluation for the 20 patients who have received complete resection for unilateral comminuted fracture patella over 11 years ago. Among these, there are 18 males and 2 females, with an average age of 50.1 years (from 41 to 83 years old), and there are 13 cases with left knee totally resected and 7 with right one.Results:There is no significant difference (P>0.05) in the case of knee joint flexion/extension with isokinetic concentric contraction at 60°/s, the Knee joint flexor/extensor ratio of health and the different surgical side. That is to say, in comparison of the diseased side flexor/extensor ratio of health and the reference value,0.90, there is also no significant difference (P>0.05). However, in terms of the torque of the knee extensor both at the non-surgical side and the surgical one, the latter is significantly lower than the former at the last 10° in knee extension(P<0.05) for all cases. The non-surgical side of the knee joint scores 146-179, while the surgical side is 129-175 given by the ASK, not significantly different (P>0.05) from each other. The osteoarthritis is graded by Kellgren-Lawrence, and there is no significant difference (P>0.05) regarding the degeneration severity for both sides. What’s more, graded by Recht, the cartilage lesion severity at the non-surgical side is significantly worse than at the surgical side (P<0.05).Conclusion:1 The knee joint flexing/extending strength and function can recover to a similar level of the non-surgical side after a long time.2 There is no significant difference for the two-side knee joint osteoarthritis degeneration degree, but the articular cartilage degeneration at the non-surgical side is more obvious than the other side.3 Patellectomy is a valuable method for the patients with severe comminuted fracture patella and damaged articular surface. But it should be taken the rehabilitation and protection plan to the the non-surgical side after patellectomy.