{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:24:57Z","timestamp":1791253497682,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2009,6,13]],"date-time":"2009-06-13T00:00:00Z","timestamp":1244851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2009,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Overstuffing the patellofemoral compartment during TKR leads to complications such as maltracking and wear, predisposing to early failure. However, there is no data describing how the patellar construct thickness affects the retinacula. This study instrumented cadaveric knees that had a Genesis II (Smith &amp; Nephew, Memphis, TN, USA) TKR in situ. Sutures were passed along the medial patellofemoral ligament (MPFL) and the deep transverse fibre band of the lateral retinaculum, from the ilio\u2010tibial band (ITB) to the patella. These sutures were attached to displacement transducers. Length changes in the retinacula were measured during knee flexion\u2010extension against the actions of 175\u00a0N quadriceps and 30\u00a0N ITB tensions. This was done with the natural patellar thickness, then repeated with the patella 2\u00a0mm thinner, 2\u00a0mm thicker and 4\u00a0mm thicker (overstuffed). Each thickness change caused a significant overall slackening or stretching of the MPFL (<jats:italic>P<\/jats:italic> &lt; 0.0001 by ANOVA), with 2.3\u00a0mm mean stretching (<jats:italic>P<\/jats:italic> &lt; 0.001 all angles of knee flexion by post\u2010testing) at 4\u00a0mm thicker. The ITB\u2010patellar band was not slackened (<jats:italic>P<\/jats:italic> = 0.491) or stretched (<jats:italic>P<\/jats:italic> = 0.346) significantly by 2\u00a0mm thickness changes. 4\u00a0mm thickening stretched the lateral retinaculum 1.1\u00a0mm (<jats:italic>P<\/jats:italic> = 0.0108). Patellar thickness affected the MPFL more than the lateral retinaculum. This difference reflected the mobile attachment of the lateral retinaculum to the ITB, whereas the MPFL was stretched directly between bony attachments. 2\u00a0mm overstuffing did not stretch the retinacula sufficiently to cause mechanical effects.<\/jats:p>","DOI":"10.1007\/s00167-009-0830-0","type":"journal-article","created":{"date-parts":[[2009,6,12]],"date-time":"2009-06-12T12:32:09Z","timestamp":1244809929000},"page":"1211-1216","source":"Crossref","is-referenced-by-count":67,"title":["The effect of overstuffing the patellofemoral joint on the extensor retinaculum of the knee"],"prefix":"10.1002","volume":"17","author":[{"given":"K. M.","family":"Ghosh","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering Imperial College London South Kensington Campus SW7\u20102AZ London UK"},{"name":"Orthopaedic Surgery Department Newcastle University Hospital NE2\u20104HH Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. M.","family":"Merican","sequence":"additional","affiliation":[{"name":"Musculoskeletal Surgery Department Imperial College London Charing Cross Hospital W6\u20108RF London UK"},{"name":"University of Malaya Medical Centre Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Iranpour","sequence":"additional","affiliation":[{"name":"Musculoskeletal Surgery Department Imperial College London Charing Cross Hospital W6\u20108RF London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. J.","family":"Deehan","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department Newcastle University Hospital NE2\u20104HH Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"Amis","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering Imperial College London South Kensington Campus SW7\u20102AZ London UK"},{"name":"Musculoskeletal Surgery Department Imperial College London Charing Cross Hospital W6\u20108RF London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,6,13]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200108000-00011"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2005.07.020"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507299237"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199906000\u201000029"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010005\u20100699\u20105"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100160123"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0736\u20100266(01)00087\u20100"},{"key":"e_1_2_6_9_1","doi-asserted-by":"crossref","unstructured":"GhoshKM MericanAM Iranpour\u2010BoroujeniF DeehanDJ AmisAA(2009)Length change patterns of the extensor retinaculum and the effect of total knee replacement.J Orthop Res (Epub ahead of print)","DOI":"10.1002\/jor.20827"},{"key":"e_1_2_6_10_1","first-page":"129","article-title":"Instrumentation of the patellar osteotomy in total knee arthroplasty: the relationship of patellar thickness and lateral retinacular release","volume":"9","author":"Greenfield MA","year":"1996","journal-title":"Am J Knee Surg"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0883\u20105403(96)80163\u2010X"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s007760050079"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2002.29320"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100180115"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2004.02.008"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010004\u20100508\u20106"},{"key":"e_1_2_6_17_1","first-page":"139","article-title":"Tensile stress of the lateral patellofemoral ligament during knee motion","volume":"10","author":"Luo ZP","year":"1997","journal-title":"Am J Knee Surg"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198805000-00017"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.90B4.20085"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.20755"},{"key":"e_1_2_6_21_1","doi-asserted-by":"crossref","unstructured":"MericanAM SanghaviS Iranpour\u2010BoroujeniF AmisAA(2009)The structural properties of the lateral retinaculum of the knee.J Biomech (submitted)","DOI":"10.1016\/j.jbiomech.2009.06.049"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B1.14924"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000218756.89439.06"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199610000\u201000040"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0883\u20105403(06)80172\u20105"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199910000\u201000018"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-199409000-00001"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B4.14768"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199601000\u201000033"},{"key":"e_1_2_6_30_1","first-page":"372","article-title":"The patella thinning osteotomy. 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