Arthroscopic Debridement for Patellar Crepitations and Clunk Syndrome Post Total Knee Arthroplasty

Abstract

Background: Patellar crepitus and clunk syndrome (PCC) are infrequent but troublesome complications following total knee replacement (TKR) surgeries in patients with end-stage arthritis, often impairing function, and patient satisfaction. Arthroscopic debridement offers a minimally invasive treatment. This study aims to evaluate arthroscopic debridement's significance in managing post-TKR symptoms such as PCC in end-stage arthritis patients.

Methods: A retrospective cohort design was conducted over 10 years at a single center, assessing 825 TKR patients. Of these, 9 (1.1%) with symptomatic PCC requiring arthroscopic knee debridement. Pre- and post-operative outcomes were assessed using the Insall-Salvati Score, Blackburne-Peel Ratio, Knee Society Score (KSS), Oxford Knee Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) index. Statistical analysis was performed using paired t-tests with significance set at p<0.05.

Results: Trends indicated an increase in knee TKR surgeries, with significant improvements in patient-reported outcomes and surgical measures postoperatively. Post-debridement, symptomatic PCC prevalence declined from 100% to 33.3%. Significant improvements were observed in surgical parameters (Insall-Salvati Score: 1.3 to 1.16, p=0.022; Blackburne-Peel Ratio: 0.79 to 0.61, p=0.010; TKR joint line level: 20.16 to 20.6, p<0.001) and patient-reported outcomes (KSS Part 1: 71.0 to 89.7, p<0.001; KSS Part 2: 52.2 to 70.6, p=0.031; Oxford Knee Score: 26.0 to 38.3, p<0.001; WOMAC: 72.7 to 32.4, p<0.001). Three patients reported persistent symptoms.

Conclusion: Arthroscopic debridement offers a minimally invasive and effective solution for managing PCC post-TKR, with significant improvements in both surgical alignment metrics and patient-reported outcomes. Although PCC is uncommon, it can substantially affect postoperative satisfaction, and its successful management requires individualized consideration of biomechanical and patient-specific factors. Further prospective studies are warranted to validate long-term outcomes and identify predictors of recurrence.