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All Journal Jurnal Profesi Medika: Jurnal Kedokteran dan Kesehatan
Ludwig Andre Pontoh
Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Indonesia & Jakarta Knee & Shoulder Orthopaedic Sport Center, Pondok Indah Hospital
Health Professions Medicine & Pharmacology

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Patellofemoral Tracking After Total Knee Arthroplasty: Etiology, Diagnosis, Management, and the Emerging Role of Robotic-Assisted Alignment Ludwig Andre Pontoh
Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan Vol 19 No 2 (2025): Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan (In Press)
Publisher : Fakultas Kedokteran UPN Veteran Jakarta Kerja Sama KNPT

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33533/jpm.v19i2.14095

Abstract

Patellofemoral maltracking remains a major cause of pain, instability, poor function, and dissatisfaction after total knee arthroplasty (TKA). Despite advances in implant design and surgical technique, patellofemoral complications continue to contribute to revision surgery and inferior outcomes. This review summarizes the etiology, diagnosis, prevention, and management of patellofemoral tracking abnormalities after TKA, including a comparison between conventional and robotic-assisted techniques. The most common causes of maltracking include internal rotation of the femoral or tibial component, excessive valgus alignment, soft-tissue imbalance, patella baja, anterior overstuffing, and implant design mismatch. Internal femoral malrotation is consistently identified as the leading factor causing lateral patellar tilt, subluxation, and instability. Clinical evaluation includes anterior knee pain, crepitus, apprehension, and extensor lag, while radiographs and computed tomography are important for assessing patellar tilt, shift, and component rotation. Treatment depends on the underlying cause. Revision of malrotated components, lateral release, tibial tubercle transfer, medial patellofemoral ligament reconstruction, and secondary patellar resurfacing may be required. Robotic-assisted TKA improves component alignment and intra-operative assessment, but current evidence has not shown superior functional outcomes compared with conventional TKA.
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