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
- 1Sichuan Mianyang 404 Hospital, Mianyang, Sichuan, China
- 2The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 3Army Medical University Xinqiao Hospital Department of Orthopeadics, Chongqing, China
Abstract
BackgroundTo 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.MethodsA 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.ResultsThe 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.ConclusionResidual 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.
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BibTeX
@article{wang2026reconstruction,
title = {{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}},
author = {Zhibing Wang and Xingwang Cheng and Xia Zhang},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1953154},
url = {https://doi.org/10.3389/fsurg.2026.1953154},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Zhibing Wang
AU - Xingwang Cheng
AU - Xia Zhang
PY - 2026
DA - 2026/10/23
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1953154
UR - https://doi.org/10.3389/fsurg.2026.1953154
AB - BackgroundTo 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.MethodsA 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.ResultsThe 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.ConclusionResidual 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.
SN - 2296-875X
ER -