The effects of over‐ and under‐stuffing the anterior knee compartment in primary TKA: A systematic review
Bibliographic record
Abstract
PURPOSE: Up to 20% of patients remain dissatisfied following total knee arthroplasty (TKA), often due to anterior knee pain (AKP) and other patellofemoral complications. Several studies highlighted risks of over- or under-stuffing within the patellofemoral compartment, yet there are no standardised methods for their assessment, and their effects on patient-reported outcome measures (PROMs) remain unclear. The aim of this review was to synthesise and critically appraise all published studies that investigated effects of over- and under-stuffing the anterior compartment on PROMs following primary TKA. METHODS: The protocol for this systematic review followed PRISMA guidelines was registered on PROSPERO (July 2024), before electronic searches by two readers (C.K. and V.G.) using Medline and Scopus. The authors included clinical studies published in English, reporting a quantifiable method to assess the anterior compartment in TKA, with clinical and/or radiographic outcomes. The authors excluded in vitro or ex vivo studies, reviews or editorials, studies on revision TKA and studies with follow-up <1 year. RESULTS: Searches returned 160 records, of which 14 met the eligibility criteria (10 retrospective and 4 prospective), representing 4404 knees in 3718 patients. The primary outcome was over-stuffing in five studies, which investigated its correlation with PROMs and/or AKP, while the primary outcome was under-stuffing in two studies. The PROMs reported were Western Ontario and McMaster Universities Osteoarthritis Index (eight studies), knee society score (six studies), knee injury and osteoarthritis outcome score (two studies), as well as Oxford knee score, forgotten joint score and Kujala scores (each one study). Only two studies used dynamic assessments, while 12 used static assessments. Only 3 of the 14 studies found significant effects of over-stuffing (by >5 mm) on PROMs. CONCLUSIONS: Changes in anterior offset, particularly over-stuffing, may cause patellofemoral complications. Although it would be ideal to restore the anterior compartment, small deviations do not affect clinical outcomes. A threshold of 5 mm could represent the 'safe zone' for change in anterior offset in patients undergoing TKA. LEVEL OF EVIDENCE: Level III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.049 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.008 |
| Bibliometrics | 0.010 | 0.010 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".