Work

Reconstruction of a fibrous pseudo-patella in total knee arthroplasty after patellectomy: a function-preserving strategy via intraoperative soft tissue balancing and postoperative rehabilitation– a case report

Year: 2026

Type: article

Abstract: Background: To report the clinical outcomes in a case of severe osteoarthritis secondary to patellectomy 40 years earlier and successfully treated with the function-preserving strategy via fibrous scar tissue extension in total knee arthroplasty (TKA) and postoperative rehabilitation program. Methods: A 59-year-old male patient presented with severe osteoarthritis secondary to the left patellectomy due to trauma 40 years earlier. Intraoperative exploration revealed dense fibrous scar tissues measuring approximately 4.0 cm × 3.0 cm × 1.5 cm at the original patellectomy site. The patient was treated with a function-preserving strategy involving preservation and reshaping of residual fibrous scar tissue into a fibrous pseudo-patella prior to TKA and postoperative rehabilitation, instead of traditional bony patella reconstruction. The fibrous scar tissues acted as a natural alternative to the patella (fibrous pseudo-patella) through extensive lateral retinaculum release and medial capsular tightening to balance soft tissues, and allowed the further TKA using a semi-constrained prosthesis. Postoperatively, the patient was managed by a rehabilitation program for strengthening the quadriceps femoris muscle. Follow-up visits were conducted at 6 weeks, 3 months, and 1 year. Results: The patient benefited from an immediate postoperative pain relief of the knee. Quadriceps strength increased markedly at 6 weeks postoperatively, indicating a full restoration of active knee extension. At the 3-month follow-up, the patient regained functional knee range of motion (ROM) of 0°-120°, and was able to independently squat and stand. The 1-year imaging assessment showed an optimal prosthesis positioning and a stable trajectory of the fibrous pseudo-patella. In addition, the patient presented normal gait patterns at 1 year postoperatively. Conclusion: Residual fibrous scar tissues with sufficient volume and biomechanical strength could be shaped into a natural alternative to the patella through soft tissue balancing, and our function-preserving strategy combining semi-constrained TKA with postoperative rehabilitation might realize an effective and safe post-patellectomy recovery.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2026.1953154

Authors: Zhibing Wang, Xingwang Cheng, Xia Zhang

Institutions: Sichuan Mianyang 404 Hospital, Second Affiliated Hospital of Chongqing Medical University, Army Medical University, Xinqiao Hospital

Language: English

Topic: Total Knee Arthroplasty Outcomes

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801