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Kim YD, Lim D, Kwak DS, Cho N, Koh IJ. Kinematical alignment better restores native patellar tracking pattern than mechanical alignment. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38932596 DOI: 10.1002/ksa.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/10/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The purpose of this study was to assess whether kinematic alignment (KA) outperforms mechanical alignment (MA) in restoring patellar tracking to native patterns by using a clustering algorithm. METHODS Twenty cadavers (40 knees) were evaluated. For each cadaver, one knee was randomly assigned to KA and the other to MA. KA total knee arthroplasty (TKA) procedures were performed using a caliper-verified technique, while MA TKA procedures utilized a measured resection technique. Subsequently, all specimens were mounted on a customized knee-testing system, and patellar tracking was measured using a motion analysis system. All patellar tracking data were clustered using the density-based spatial clustering of applications with noise algorithm. Differences in patellar tracking patterns and the restoration of native patellar tracking were compared between the two alignment strategies. RESULTS Patellar tracking patterns following KA were considerably different from MA. Pre- and post-TKA patellar tracking patterns following MA were grouped into separate clusters, whereas a substantial proportion of patellar tracking patterns following KA were grouped into the pre-TKA dominant cluster. Compared to MA, a greater proportion of patellar tracking patterns following KA showed similar patterns to native knees (p < 0.05) and more patellar tracking patterns following KA paired with preoperative patterns (p < 0.01). CONCLUSION KA restored native patellar tracking patterns more closely compared to MA. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Yong Deok Kim
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Department of Anatomy, College of Medicine, Catholic Institute for Applied Anatomy, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nicole Cho
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Rezaei A, Moon J, Lichtig A, Mera B, Drake B, Choubey AS, Kim S, Tueni N, Piponov H, Koh J, Karam J, Amirouche F. Precision soft tissue balancing: grid-assisted pie-crusting in total knee arthroplasty. Front Surg 2024; 11:1331902. [PMID: 38645507 PMCID: PMC11026714 DOI: 10.3389/fsurg.2024.1331902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The varus and valgus knee deformities result from imbalance in tension between medial and lateral soft tissue compartments. These conditions need to be addressed during total knee arthroplasty (TKA). However, there is no consensus on optimal soft-tissue release techniques for correcting varus and valgus deformities during TKA. We assessed the efficacy of a novel grid-based pie-crusting technique on soft-tissue release. Methods Cadaver knees were dissected, leaving only the femur and tibia connected by an isolated MCL or the femur and fibula connected by an isolated LCL. Bone cuts were made as performed during primary TKA. Mechanical testing was performed using an MTS machine. A 3D-printed 12-hole grid was placed directly over the MCL and LCL. Using an 18-gauge needle, horizontal in-out perforations were made 3 mm apart. Deformation and stiffness of the ligaments were collected after every 2 perforations. Means were calculated, and regression analyses were performed. Results A total of 7 MCL and 6 LCL knees were included in our analysis. The mean medial femorotibial (MFT) space increased from 6.018 ± 1.4 mm-7.078 ± 1.414 mm (R2 = 0.937) following 12 perforations. The mean MCL stiffness decreased from 32.15 N/mm-26.57 N/mm (R2 = 0.965). For the LCL group, the mean gap between the femur and fibula increased from 4.287 mm-4.550 mm following 8 perforations. The mean LCL stiffness decreased from 29.955 N/mm-25.851 N/mm. LCL stiffness displayed a strong inverse relationship with the number of holes performed (R2 = 0.988). Discussion Our results suggest that using this novel grid for pie-crusting of the MCL and LCL allows for gradual lengthening of the ligaments without sacrificing their structural integrity. Our proposed technique may serve as a valuable piece in the soft-tissue release toolkit for orthopaedic surgeons performing TKA in varus and valgus deformed knees.
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Affiliation(s)
- Arash Rezaei
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - John Moon
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Asher Lichtig
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Barbara Mera
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Brett Drake
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Apurva S. Choubey
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Sunjung Kim
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Nicole Tueni
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Hristo Piponov
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Jason Koh
- Department of Orthopaedic Surgery, Northshore University Health System, Skokie, IL, United States
| | - Joseph Karam
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Farid Amirouche
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
- Department of Orthopaedic Surgery, Northshore University Health System, Skokie, IL, United States
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Matsuda S, Hirakawa M, Nagashima Y, Akase H, Kaku N, Tsumura H. Exploring the extension quantities of a medial collateral ligament pie-crusting model using a finite element method. Comput Methods Biomech Biomed Engin 2024:1-8. [PMID: 38317625 DOI: 10.1080/10255842.2024.2310725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
Medial collateral ligament (MCL) pie-crusting can balance the soft tissue during total knee arthroplasty but requires more studies with the finite element method (FEM). We have developed three models of MCL pie-crusting utilizing FEM, treating the MCL in the following ways: (1) as a singular elastic body with both ends attached to the bone (model A), (2) as 19 bundled elastic bodies, each attached to both ends of the bone (model B), and (3) as 19 bundled elastic bodies with an adhesive component in the gap, attached to both ends of the bone (model C). The pie-crusting model was created by adding a cut around the center of each model. The left side of the model was fixed and forces of 80 and 120 N in the positive direction of the x-axis were applied. Model A was extended by 0.0068 and 0.010 mm for approximately 10 punctures. Model B-2 was extended by 1.34 and 2.01 mm, approximately twice as much as model B-1. Model C was extended by 0.34 and 0.50 mm for every 10 punctures added. These findings clarify that the model composed of aggregates of fibers with adhesive parts (model C) is suitable for MCL pie-crusting analysis.
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Affiliation(s)
- Shogo Matsuda
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Masashi Hirakawa
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Yu Nagashima
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Hiroya Akase
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University, Yuhu City, Oita, Japan
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Kanna R, Kumar VS, Karthikeyan V, Anand S, Ravichandran C, Murali SM. Influence of Preoperative Deformity on Flexion Gap Asymmetry in Measured Resection Technique: A Theoretical Study in Navigated Gap Balancing Total Knee Arthroplasties, Done for Varus Knee Osteoarthritis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00007. [PMID: 38354198 PMCID: PMC11136515 DOI: 10.5435/jaaosglobal-d-23-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Disagreement exists on (a) achieving a symmetrical flexion gap and (b) the influence of varus deformity on the flexion gap asymmetry (FGA) in measured resection (MR) total knee arthroplasty (TKA). We aimed to determine the FGA and influence of preoperative deformity on the FGA, based on the MR technique, in varus knee osteoarthritis. METHODS In 321 navigated TKAs, we released the soft tissues in extension. In 90° flexion, with the tensioner in situ, we calculated the FGA, the angle between the posterior femoral cut (planned 3° external rotation to the posterior condylar line, parallel to the surgical transepicondylar axis, or perpendicular to the Whiteside line) and the proximal tibial resection plane. RESULTS The FGA values varied widely, and the risk of >2° and >3° FGA was present in at least 60% and 40% knees, respectively. These risks were high in knees with moderate and severe varus deformity. CONCLUSIONS In varus knee osteoarthritis, the risk of FGA (based on the MR technique) was high, especially when the deformity was moderate to severe. Caution is required in MR TKA, and surgeons must consider safer alternatives (gap balancing or hybrid technique) to achieve a symmetrical flexion gap in these knees.
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Affiliation(s)
- Raj Kanna
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - V. Senthil Kumar
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - Vijaya Karthikeyan
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - Sumit Anand
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - Chandramohan Ravichandran
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - S. M. Murali
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
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Anil U, Lin C, Bieganowski T, Hennessy D, Schwarzkopf R, Walker PS. Design and evaluation of a 3D printed mechanical balancer for soft tissue balancing in total knee replacement. Knee 2023; 44:118-129. [PMID: 37597474 DOI: 10.1016/j.knee.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/18/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Soft tissue balancing is an important step in a total knee procedure, carried out manually, or using an indicator. The purpose of this study was to evaluate our design of 3D printed Balancer, and demonstrate how it could be used at surgery. PROCEDURES When inserted between the femur and tibia, the Balancer displayed the forces acting across the lateral and medial compartments, indicated by pointers at the end of the handle. A loading rig was used to measure the pointer deflections for different forces applied at different locations on the condyle surfaces. Repeatability and reproducibilty were evaluated. The Balancer was tested in six fresh knee specimens using a surgical simulation rig. MAIN FINDINGS Pointer deflections of up to 12 millimeters occurred for less than 1 mm displacements at the condyle surfaces. Reproducibility tests showed a standard deviation of 14% at lower loads, reducing to only 4% at higher loads. Mean pointer deflections were within 8% for forces applied at ±10 mm AP, and +5/-3 mm in an ML direction, relative to the neutral contact point. In specimens, most lateral to medial force differences could be corrected by a 2° change in frontal plane angle of the tibial resection. Effects of ligament releases were also demonstrated. PRINCIPAL CONCLUSIONS The 3D printed Balancer was easy to use, and provided the surgeon with lateral and medial force data over a full range of flexion, enabling possible corrective procedures to be specified.
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Affiliation(s)
- Utkarsh Anil
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, USA
| | - Charles Lin
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, USA
| | - Thomas Bieganowski
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, USA
| | - Daniel Hennessy
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, USA
| | - Ran Schwarzkopf
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, USA
| | - Peter S Walker
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, USA.
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Engseth LHW, Grønsund J, Aunan E, Brattgjerd JE, Schulz A, Moatshe G, Röhrl SM. A novel instrument for ligament balancing: a biomechanical study in human cadaveric knees. J Exp Orthop 2023; 10:83. [PMID: 37584812 PMCID: PMC10429480 DOI: 10.1186/s40634-023-00643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Ligament balancing is a prerequisite for good function and survival in total knee arthroplasty (TKA). Various balancing techniques exist, but none have shown superior results. The pie-crusting technique by Bellemans of the medial collateral ligament is commonly utilized; however, it can be difficult to achieve repeatable ligament lengthening with this technique. Therefore, we invented a novel instrument to standardize the pie-crusting technique of the superficial and deep medial collateral ligament (hereafter MCL). The purpose was to examine if pie-crusting with the instrument could produce repeatable ligament lengthening. METHODS The MCL was isolated in 16 human cadaveric knees, and subjected to axial tension. The instrument was composed of a specific grid of holes in rows, used to guide sequential pie-crusting puncturing of the MCL with a Ø1.6 mm end-cutting cannula. Ligament lengthening was measured after each row of punctures. Regression analysis was performed on the results. RESULTS Mean lengthening ± SD in human cadaveric MCL for puncturing of row 1 in the instrument was 0.06 ± 0.09 mm, 0.06 ± 0.04 mm for row 2, 0.09 ± 0.08 mm for row 3, 0.06 ± 0.05 mm for row 4 and 0.06 ± 0.04 mm for row 5, giving a mean total lengthening of 0.33 ± 0.20 mm. Linear regression revealed that MCLs were repeatably lengthened by 0.07 mm per row when punctured using the instrument. CONCLUSIONS MCLs showed linear lengthening in human cadavers for subsequent use of the instrument. Our instrument shows promising results for repeatable ligament lengthening.
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Affiliation(s)
- Lars H W Engseth
- Department of Orthopaedics, Oslo University Hospital Ullevål (OUH), P.O Box 4956, Nydalen, Oslo, 0424, Norway.
- Department of Surgery, Innlandet Hospital Trust, Lillehammer, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Center for Implant and Related Research Oslo (CIRRO), Oslo, Norway.
| | | | - Eirik Aunan
- Department of Surgery, Innlandet Hospital Trust, Lillehammer, Norway
| | - Jan Egil Brattgjerd
- Department of Orthopaedics, Oslo University Hospital Ullevål (OUH), P.O Box 4956, Nydalen, Oslo, 0424, Norway
- Faculty of Health Sciences, OsloMet, Oslo, Norway
| | - Anselm Schulz
- Center for Implant and Related Research Oslo (CIRRO), Oslo, Norway
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Gilbert Moatshe
- Department of Orthopaedics, Oslo University Hospital Ullevål (OUH), P.O Box 4956, Nydalen, Oslo, 0424, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Department of Orthopaedics, Oslo University Hospital Ullevål (OUH), P.O Box 4956, Nydalen, Oslo, 0424, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for Implant and Related Research Oslo (CIRRO), Oslo, Norway
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Blomquist MB, Blank JL, Schmitz DG, Thelen DG, Roth JD. Shear wave tensiometry tracks reductions in collateral ligament tension due to incremental releases. J Orthop Res 2023; 41:524-533. [PMID: 35716160 PMCID: PMC9759618 DOI: 10.1002/jor.25400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Surgeons routinely perform incremental releases on overly tight ligaments during total knee arthroplasty (TKA) to reduce ligament tension and achieve their desired implant alignment. However, current methods to assess whether the surgeon achieved their desired reduction in the tension of a released ligament are subjective and/or do not provide a quantitative metric of tension in an individual ligament. Accordingly, the purpose of this study was to determine whether shear wave tensiometry, a novel method to assess tension in individual ligaments based on the speed of shear wave propagation, can detect changes in ligament tension following incremental releases. In seven medial and eight lateral collateral porcine ligaments (MCL and LCL, respectively), we measured shear wave speeds and ligament tensions before and after incremental releases consisting of punctures with an 18-gauge needle. We found that shear wave speed squared decreased linearly with decreasing tension in both the MCL (average coefficient of determination (R2 avg ) = 0.76) and LCL (R2 avg = 0.94). We determined that errors in predicting tension following incremental releases were 26.2 and 14.2 N in the MCL and LCL, respectively, using ligament-specific calibrations. These results suggest shear wave tensiometry is a promising method to objectively measure the tension reduction in released structures. Clinical Significance: Direct, objective measurements of the tension changes in individual ligaments following release could enhance surgical precision during soft tissue balancing in total knee arthroplasty. Thus, shear wave tensiometry could help surgeons reduce the risk of poor outcomes associated with overly tight ligaments, including residual knee pain and stiffness.
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Affiliation(s)
- Matthew B. Blomquist
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jonathon L. Blank
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Dylan G. Schmitz
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Darryl G. Thelen
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Joshua D. Roth
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
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Kang KH, Kim MS, Kim JJ, In Y. Risk Factors and Preventive Strategies for Perioperative Distal Femoral Fracture in Patients Undergoing Total Knee Arthroplasty. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020369. [PMID: 36837570 PMCID: PMC9965432 DOI: 10.3390/medicina59020369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
Background and Objectives Perioperative distal femoral fracture is rare in patients undergoing total knee arthroplasty (TKA). In such rare cases, additional fixation might be required, and recovery can be delayed. Several studies have focused on perioperative distal femoral fractures in TKA, but there remains a lack of information on risk factors. The purpose of this study was to investigate risk factors for perioperative distal femoral fractures in patients undergoing TKA and suggest preventive strategies. Materials and Methods: This retrospective study included a total of 5364 TKA cases in a single institution from 2011 to 2022. Twenty-four distal femoral fractures occurred during TKA or within one month postoperatively (0.45%). Patient demographics, intraoperative findings, and postoperative progress were obtained from patient medical records and radiographs. Risk factors for fractures were analyzed using multivariate Firth logistic regression analysis. Results: Although all 24 distal femoral fractures occurred in female patients (24 of 4819 patients, 0.50%), the incidence rate of fracture between male and female patients was not significantly different (p = 0.165). The presence of osteoporosis and insertion of a polyethylene (PE) insert with knee dislocation were statistically significant risk factors (p = 0.009 and p = 0.046, respectively). However, multivariate logistic regression analysis showed that only osteoporosis with bone mineral density (BMD) < -2.8 (odds ratio (2.30), 95% CI (1.03-5.54), p = 0.043) was an independent risk factor for perioperative distal femoral fracture in TKA patients. Conclusions: Our results suggest that osteoporosis with BMD < -2.8 is a risk factor for distal femoral fractures in patients undergoing TKA. In these patients, careful bone cutting, adequate gap balancing, and especially the use of the sliding method for insertion of a PE insert are recommended as preventive strategies.
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Sohn S, Koh IJ, Kim MS, Choi KY, Lim DS, In Y. Mobile-Bearing has no Benefit Over Fixed-Bearing Total Knee Arthroplasty in Joint Awareness and Crepitus: A Randomized Controlled Trial. J Arthroplasty 2023; 38:78-84. [PMID: 35934188 DOI: 10.1016/j.arth.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Given higher component conformity, rotational availability of polyethylene insert, and more physiologic patellofemoral tracking, mobile-bearing (MB) total knee arthroplasty (TKA) is supposed to offer advantages in joint perception and crepitus. The purpose of this study was to investigate whether MB TKA offers superior outcomes over fixed-bearing (FB) TKA in terms of joint awareness and crepitus. METHODS This prospective, randomized, controlled trial included 49 FB and 49 MB TKAs that shared the same posterior-stabilized femoral component. Primary outcomes included joint awareness assessed with the Forgotten Joint Score and crepitus graded according to severity and sound at 3 years postoperatively. Secondary outcomes were the range of motion, the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, component position, and joint line level on radiographs. RESULTS The Forgotten Joint Score showed no significant difference between the FB (67 points; range, 0-100) and MB groups (63 points; range, 13-100) (P = .440). For crepitus, no significant differences were found in the overall incidence rate (FB group, 18%; MB group, 12%; P = .386) and grade (grade 1, 6 versus 5; grade 2, 2 versus 1; grade 3, 1 versus 0, respectively). There were no significant differences in range of motion, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index, as well as radiographic outcomes between the two groups (all, P > .05). CONCLUSION MB TKA offers no benefits in terms of joint awareness and crepitus compared with FB TKA at mean 3 years postoperatively. The theoretical advantages of MB TKA have yet to be demonstrated in practice, leaving the selection of bearing type to the surgeon's judgment. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Da Sol Lim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kwak DS, Kim YD, Cho N, Cho HJ, Ko J, Kim M, Choi JH, Lim D, Koh IJ. Guided-Motion Bicruciate-Stabilized Total Knee Arthroplasty Reproduces Native Medial Collateral Ligament Strain. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121751. [PMID: 36556953 PMCID: PMC9788414 DOI: 10.3390/medicina58121751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/11/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Guided-motion bicruciate-stabilized (BCS) total knee arthroplasty (TKA) includes a dual cam-post mechanism with an asymmetric bearing geometry that promotes normal knee kinematics and enhances anterior-posterior stability. However, it is unclear whether the improved biomechanics after guided-motion BCS TKA reproduce soft tissue strain similar to the strain generated by native knees. The purpose of this cadaveric study was to compare medial collateral ligament (MCL) strain between native and guided-motion BCS TKA knees using a video extensometer. Materials and Methods: Eight cadaver knees were mounted onto a customized knee squatting simulator to measure MCL strain during flexion in both native and guided-motion BCS TKA knees (Journey II-BCS; Smith & Nephew, Memphis, TN, USA). MCL strain was measured using a video extensometer (Mercury® RT RealTime tracking system, Sobriety s.r.o, Kuřim, Czech Republic). MCL strain level and strain distribution during knee flexion were compared between the native and guided-motion BCS TKA conditions. Results: The mean and peak MCL strain were similar between native and guided-motion BCS TKA knees at all flexion angles (p > 0.1). MCL strain distribution was similar between native and BCS TKA knees at 8 of 9 regions of interest (ROIs), while higher MCL strain was observed after BCS TKA than in the native knee at 1 ROI in the mid portion of the MCL at early flexion angles (p < 0.05 at ≤30° of flexion). Conclusions: Guided-motion BCS TKA restored the amount and distribution of MCL strain to the values observed on native knees.
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Affiliation(s)
- Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yong Deok Kim
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Nicole Cho
- Boston College, Morrissey College of Arts and Sciences, Chestnut Hill, MA 02467, USA
| | - Ho-Jung Cho
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jaeryong Ko
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Minji Kim
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - Jae Hyuk Choi
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: ; Tel.: +82-2-2030-2655; Fax: +82-2-2030-4629
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Clinical Outcomes of Repair of Complete Detachment of Medial Collateral Ligament at the Tibial Insertion in Bilateral Total Knee Arthroplasty. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7266233. [PMID: 35911142 PMCID: PMC9334065 DOI: 10.1155/2022/7266233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
Purpose Complete detachment of the medial collateral ligament (MCL) may occur during medial release of total knee arthroplasty (TKA) in patients with severe varus knee osteoarthritis. This study was to determine functional and stability outcomes of repaired knee with complete detachment of MCL compared to those of contralateral nondetached MCL in patients with bilateral TKA. Methods Records of 1052 consecutive knees undergoing bilateral TKA from 2003 to 2015 were retrospectively reviewed. Of which, 45 patients were repaired for complete MCL detachment injury (2.1%) at tibial insertion in one side (repaired group). MCL was not detached in the contralateral side (control group). Clinical evaluation was performed preoperatively and at the final follow-up using KS and WOMAC scores between two groups. Similarly, stability was compared on a valgus stress radiograph between two groups. Results Two patients had insufficient data. Hence, 43 patients were included after a minimum of 5 years follow-up. There were no significant differences in terms of alignment and clinical outcomes between the two groups either preoperatively or at the final follow-up (p > 0.05). Radiographic stability also showed no differences between repaired and control groups in extension and 30° of flexion (p=0.208 and p=0.125). Conclusions For tibial detachment of the MCL during TKA, repair with suture anchor provided good clinical and stability results, similar to TKA without MCL injury. Therefore, repair with a suture anchor is a reliable method that provides good clinical and stability outcomes in patients with MCL injury during TKA.
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Lim D, Kwak DS, Kim M, Kim S, Cho HJ, Choi JH, Koh IJ. Kinematically aligned total knee arthroplasty restores more native medial collateral ligament strain than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:2815-2823. [PMID: 34312712 DOI: 10.1007/s00167-021-06680-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Kinematically aligned total knee arthroplasty (KA TKA) targets restoration of patient-specific alignment and soft tissue laxity. However, whether KA TKA reproduces native soft tissue strain remains unclear. This cadaveric study tested the hypothesis that KA TKA would better restore the quantitative strain and strain distribution of medial collateral ligament (MCL) to the native healthy knee compared to mechanically aligned (MA) TKA. METHODS Twenty-four fresh-frozen cadaver knees (12 pairs) were mounted on a customized knee squatting simulator to measure MCL strain during flexion. For each pair, one knee was assigned to KA TKA and the other to MA TKA. During KA TKA, the amount of femur and tibia resected was equivalent to implant thickness without MCL release using the calipered measuring technique. MA TKA was performed using conventional measured resection techniques. MCL strain was measured using a video extensometer (Mercury® RT RealTime tracking system, Sobriety s.r.o, Czech Republic). MCL strain and strain distribution during knee flexion were measured, and the measurements compared between native and post-TKA conditions. RESULTS Mean and peak MCL strain were similar between KA TKA and native knees at all flexion angles (p > 0.1 at all flexion angles) while mean strain at all flexion angles and peak strain at ≥ 60º of MA TKA were approximately twice those of the native knees (p < 0.05 at ≥ 60º of flexion). In addition, greater MCL strain was observed in 4 of 12 regions of interest (ROI) after MA TKA (M1, M2, P1 and P2) compared to the native knee, whereas after KA TKA, MCL strain measurements were similar at all but 1 ROI (P2). CONCLUSIONS KA TKA restored a more native amount and distribution of MCL strain compared to MA TKA. These findings provide clues for understanding why patients may experience better performance and more normal knee sensations after KA TKA compared to MA TKA. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Minji Kim
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Seoyeong Kim
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - Ho-Jung Cho
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jae Hyuk Choi
- Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, Seoul, 03312, Republic of Korea. .,Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
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Motififard M, Sheikhbahaei E, Piri Ardakani M, Cheraghsahar H, Shahzamani A. Intraoperative repair for iatrogenic MCL tear due to medial pie-crusting in TKA yields satisfactory mid-term outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29:3246-3253. [PMID: 32613338 DOI: 10.1007/s00167-020-06126-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE This study aimed to assess the rate of iatrogenic mid-substance superficial medial collateral ligament (sMCL) tear due to the medial pie-crusting technique during varus deformity total knee arthroplasty and compare the knee society score (KSS), range of motion (ROM), and instability rate of the repaired group to the control group with intact sMCL. METHODS For this retrospective series of prospectively collected data, the multiple needle puncturing technique was performed for 653 out of the 1768 knees during algorithmic medial soft-tissue release. Iatrogenic tear was observed in 35 knees (5%); hence, repair with running locking nonabsorbable braided suture was performed. Patients were visited and reviewed both clinically and radiographically at 6 weeks, 3 months, 6 months, 12 months, and annually thereafter. Chi-square, ANOVA, Mann-Whitney, independent and paired t test were used to analyze the variables. P value < 0.05 was considered statistically significant. RESULTS 85% of the repaired sMCL had stable joints with a mean KSS of 88 ± 3 and a mean ROM of 103 ± 11 degrees (°). The other five patients (15%) with mean KSS of 40 ± 8 and mean ROM of 81° ± 5° had an instability and needed to undergo a revision surgery. The control group had a mean KSS of 86 ± 15 and mean ROM of 107° ± 8°; however, 7 knees had an instability and needed a revision surgery. No significant difference was observed in terms of KSS (P = 0.86) and ROM (P = 0.64) between the control and repaired groups. CONCLUSION The mid-substance sMCL tear is an important intraoperative complication of medial pie-crusting. Repairing this iatrogenic tear with nonabsorbable suture had satisfying clinical outcomes regarding the postoperative knee ROM and KSS in comparison to the control group. However, there is a chance of failure, which should be perceived by the surgeons. LEVEL OF EVIDENCE Therapeutic studies, investigating the results of treatment, Level III.
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Affiliation(s)
- Mehdi Motififard
- Orthopedic Surgery Department, School of Medicine, Kashani University Hospital, Isfahan University of Medical Sciences, Kashani St. Felezi Br., Isfahan, Iran
| | - Erfan Sheikhbahaei
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Piri Ardakani
- Orthopedic Surgery Department, School of Medicine, Kashani University Hospital, Isfahan University of Medical Sciences, Kashani St. Felezi Br., Isfahan, Iran.
| | - Hojat Cheraghsahar
- Orthopedic Surgery Department, School of Medicine, Kashani University Hospital, Isfahan University of Medical Sciences, Kashani St. Felezi Br., Isfahan, Iran
| | - Arvin Shahzamani
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Yuenyongviwat V, Iamthanaporn K, Tuntarattanapong P, Dissaneewate K, Tangjatsakow P, Liawrungrueang W, Hongnaparak T. Multiple needle puncture combined with repetitive knee manipulation in total knee arthroplasty for correcting varus deformity. J Orthop Surg (Hong Kong) 2021; 28:2309499020924600. [PMID: 32431216 DOI: 10.1177/2309499020924600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Multiple needle punctures (MNPs), for gap balancing in total knee replacement, have less variability in gap widening compared to the conventional released technique. This study aimed to evaluate the outcome of gap-balancing techniques in varus osteoarthritis (OA) knees, by serial MNP, after a total knee prosthesis trial component was placed, combined with repetitive knee manipulation. METHODS This study was a retrospective, case-matched study of 161 patients. The data were collected from varus OA knee patients, who had total knee arthroplasty by a single surgeon. Sixty-eight patients required MNP, combined with repetitive knee manipulation for gap balancing, and 93 patients did not. Both groups of MNP patients underwent the same surgical technique and postoperative care protocols. RESULTS Knee society scores, in terms of knee score and functional score, were not different in both groups when we started the study, at 6-month and 1-year follow-ups (p > 0.05). The femorotibial angle was not significantly different between groups at the start of the study, initial postoperative, 6 months, and 1 year (p = 0.74, 0.45, 0.99, and 0.82, respectively). Medial joint opening in knee radiographic was found in 3% of the patients in the MNP group and in 4% of patients in the control group at 1-year follow-up (p = 0.65). CONCLUSION This study found MNP combined with repetitive knee manipulation was effective, reproductive, and a safe method for varus OA knee. We believe that the cycle of performed needle punctures, knee manipulation, and reevaluation could gradually lengthen the medial soft tissue without risk of over lengthening or medial collateral ligament rupture.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kantapon Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Preyanun Tangjatsakow
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Posterior stabilized total knee arthroplasty reproduces natural joint laxity compared to normal in kinematically aligned total knee arthroplasty: a matched pair cadaveric study. Arch Orthop Trauma Surg 2021; 141:119-127. [PMID: 33040208 DOI: 10.1007/s00402-020-03624-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE As the goal of kinematic aligned (KA) total knee arthroplasty (TKA) is to preserve soft tissue tension to the native knee, many KA surgeons recommend cruciate-retaining (CR) prosthesis. However, how a posterior-stabilizing (PS) prosthesis affects the biomechanics of a KA TKA remains unclear. This cadaveric study tested the hypothesis that a PS prosthesis in KA TKA would produce biomechanics similar to CR prosthesis and KA TKA with a PS prosthesis would produce more native knee biomechanics than mechanical aligned (MA) TKA with PA prosthesis. METHODS Fourteen cadaver knees (7 pairs) were mounted on a knee-testing system to measure knee motion during flexion. For each pair, 1 knee was assigned to KA TKA and the other to MA TKA. In the KA TKA group, the native knee, CR TKA, and PS TKA were tested sequentially. MA TKA was performed using conventional measured resection techniques with a PS prosthesis. All kinematics were measured and compared with the native knee before and after surgery. RESULTS A PS prosthesis restored femoral rollback similar to a CR prosthesis. CR TKA showed less lateral rollback at knee flexion ≤ 60° than the native knee. There were no differences in soft tissue tensions among the native knee, CR, and PS prosthesis, except in varus tension at 30° of flexion. Varus tension of CR TKA was larger than those of PS TKA and the native knee after KA TKA with < 1 degree difference. Meanwhile, KA TKA achieved knee motion that was closer to the native knee than did MA TKA at ≥ 60° of flexion when using a PS prosthesis. There were no differences in soft tissue tension between KA-PS and MA-PS TKA. CONCLUSIONS After KA TKA, a PS prosthesis affords similar femoral rollback and soft tissue tension when compared with a CR prosthesis. A PS TKA may be a feasible strategy for patients requiring a PS prosthesis when performing KA TKA. LEVEL OF EVIDENCE Therapeutic Laboratory study, I.
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买买提克里木· 吐, 贾 勇, 许 刚, 何 春, 张 飞, 刘 剑, 王 鹏, 吾木尔 别. [Clinical observation of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1238-1242. [PMID: 33063486 PMCID: PMC8171879 DOI: 10.7507/1002-1892.202003132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear (BHT). METHODS Between August 2016 and May 2019, 44 case of meniscus BHT were treated with arthroscopic all-inside combined outside-in "suture loop". There were 29 males and 15 females with an average age of 26.6 years (range, 18-42 years). The causes of injury included sports injury in 31 cases, falling injury in 7 cases, and sprain in 6 cases. There were 32 cases of medial meniscus posterior horn tears and 12 cases of lateral meniscus posterior horn tears. The disease duration ranged from 6 weeks to 3 months. Thirty-three cases were complicated with anterior cruciate ligament rupture. All patients had normal lower limb alignment. The preoperative Lysholm score was 42.1±9.1. According to the evaluation criteria of MRI and Barrett et al., the healing of meniscus was evaluated, and the effectiveness was evaluated by Lysholm score. RESULTS All the 44 patients were followed up 8-36 months with an average of 16.8 months. At last follow-up, according to the evaluation criteria of Barrett et al., 39 cases were clinically healed, 5 cases were not healed, the clinical healing rate was 88.6%; according to MRI evaluation, 32 cases were completely healed, 7 cases were partially healed, and 5 cases were not healed, the total healing rate was 88.6%, and the complete healing rate was 72.7%. Lysholm score was 87.8±4.8, which was significantly different from that before operation ( t=31.060, P=0.000). CONCLUSION Arthroscopic all-inside combined with outside-in "suture loop" repair is a reliable and effective method for the meniscus BHT, which can obtain good joint function.
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Affiliation(s)
- 吐松江 买买提克里木·
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 勇 贾
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 刚 许
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 春青 何
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 飞 张
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 剑 刘
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 鹏波 王
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 别克 吾木尔
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
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Lee HJ, Kim SH, Park YB. Selective medial release using multiple needle puncturing with a spacer block in situ for correcting severe varus deformity during total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140:1523-1531. [PMID: 32519075 DOI: 10.1007/s00402-020-03510-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We aimed to establish a selective and sequential medial release technique using multiple needle puncturing (MNP) with a spacer block in situ in severe varus deformity during total knee arthroplasty (TKA) and to investigate its efficacy and safety. MATERIALS AND METHODS A total of 128 patients with a varus angle >15° were included. Patients were classified according to the tightness of extension and flexion (group 1, no tightness; group 2, extension; group 3, flexion; group 4, extension and flexion). When medial tightness was found on extension, the posterior clearing procedure, including release of the posterior capsule, posterior oblique ligament, and semimembranosus, was performed sequentially. When medial tightness was found on flexion, MNP using an 18-gauge needle with a spacer block in situ was performed at the anterior portion of the superficial MCL (aMCL). Clinical and radiological evaluations including stress radiographs were performed. RESULTS Among 128 knees, 110 required medial release (posterior clearing procedure only in 44 [34.3%], MNP with a spacer block in situ at aMCL only in 38 [29.7%], posterior clearing procedure and MNP in 28 [21.9%]). The mediolateral gap imbalances on extension and/or flexion were significantly improved (p < 0.001 in all). There were no significant differences in clinical radiological outcomes among groups. Over-release, iatrogenic transection, and postoperative laxity on the stress radiographs were not observed. CONCLUSION The selective and sequential technique using posterior clearing and/or MNP with a spacer block in situ can be a reliable option for managing medial tightness in severe varus deformity during primary TKA.
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Affiliation(s)
- Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, 21 Bonghyeon-ro, Jinjeop-eup, Namyangju-si, 12013, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
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Efficacy and Safety of Functional Medial Ligament Balancing With Stepwise Multiple Needle Puncturing in Varus Total Knee Arthroplasty. J Arthroplasty 2020; 35:380-387. [PMID: 31587980 DOI: 10.1016/j.arth.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aims of this study were to (1) describe our functional stepwise multiple needle puncturing (MNP) technique as the final step in medial ligament balancing during total knee arthroplasty (TKA) and (2) evaluate whether this technique can provide sufficient medial release with safety. METHODS A total of 137 patients with 212 consecutive knees who underwent TKAs with or without functional stepwise MNP of superficial medial collateral ligament was recruited in this prospective cohort. Eighty-one patients with 129 knees who performed serial stress radiographs were enrolled in the final assessment. Superficial medial collateral ligament was punctured selectively (anteriorly or posteriorly or both) and sequentially depending on the site and degree of tightness. Mediolateral stability was assessed using serial stress radiographs and comparison was performed between the MNP and the non-MNP groups at postoperative 6 months and 1 year. Clinical outcomes were also evaluated between 2 groups. RESULTS Fifty-five TKAs required additional stepwise MNP (anterior needling 19, posterior needling 3, both anterior and posterior needling 33). Preoperative hip-knee-ankle angle and the difference in varus-valgus stress angle showed significant difference between the MNP and the non-MNP groups, respectively (P = .009, P = .037). However, there was no significant difference when comparing the varus-valgus stress angle between the MNP and the non-MNP groups during serial assessment. Clinical outcomes including range of motion also showed no significant differences between the 2 groups. CONCLUSION Functional medial ligament balancing with stepwise MNP can provide sufficient medial release with safety in TKA with varus aligned knee without clinical deterioration or complication such as instability. LEVEL OF EVIDENCE Level II, Prospective cohort study.
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Koh IJ, Lin CC, Patel NA, Chalmers CE, Maniglio M, Han SB, McGarry MH, Lee TQ. Kinematically aligned total knee arthroplasty reproduces more native rollback and laxity than mechanically aligned total knee arthroplasty: A matched pair cadaveric study. Orthop Traumatol Surg Res 2019; 105:605-611. [PMID: 31006644 DOI: 10.1016/j.otsr.2019.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A growing body of evidence supports that kinematically aligned (KA) total knee arthroplasty (TKA) provides superior clinical outcomes and satisfaction than mechanically aligned (MA) TKA. In theory, KA TKA would restore knee kinematics closer to the native condition than MA TKA, but the current biomechanical evidence is lacking. HYPOTHESIS KA TKA would restore knee biomechanics to the native condition better than MA TKA. METHODS Seven pairs of cadavers were tested. For each pair, one knee was randomly assigned to KA TKA and the other to MA TKA. During KA TKA, the sizes of femur and tibia resections were equivalent to implant thickness to align with the patient-specific joint line. MA TKA was performed using conventional measured resection techniques. All specimens were mounted on a customized knee-testing system and digitized. Knee motions measured during flexion included rollback, axial tibiofemoral rotation, and laxities, specifically varus-valgus laxity, anterior-posterior translation, and internal-external rotation. RESULTS The pattern of knee motion following KA TKA was similar to the native knee. However, following MA TKA, both medial and lateral rollback and tibiofemoral axial rotation were decreased relative to those of the native knee. Valgus laxity was restored only after KA TKA, whereas varus laxity was restored only after MA TKA. Anterior translation was increased regardless of the alignment strategy. In addition, rotational laxities were restored after KA TKA, but external rotation laxity increased after MA TKA. CONCLUSION KA TKA restores femoral rollback and laxity to the native condition better than MA TKA. KA TKA may enhance functional performance and provide a more normal knee sensation. LEVEL OF EVIDENCE II, Controlled laboratory study.
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Affiliation(s)
- In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, 03312 Seoul, Republic of Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea.
| | - Charles C Lin
- University of California, Irvine, School of Medicine, 92697 Irvine, CA, United States
| | - Nilay A Patel
- Department of Orthopaedic Surgery, University of California, Irvine, UCI Medical Center, route 81, 101 City Drive South, 92868 Orange, CA, United States
| | - Christen E Chalmers
- University of California, Irvine, School of Medicine, 92697 Irvine, CA, United States
| | - Mauro Maniglio
- Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland
| | - Sung Bin Han
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, 03312 Seoul, Republic of Korea
| | - Michelle H McGarry
- Congress Medical Foundation, 800 South Raymond Pasadena, 91105 CA, United States
| | - Thay Q Lee
- Congress Medical Foundation, 800 South Raymond Pasadena, 91105 CA, United States
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Kinematically aligned total knee arthroplasty reproduces native patellofemoral biomechanics during deep knee flexion. Knee Surg Sports Traumatol Arthrosc 2019; 27:1520-1528. [PMID: 30370439 DOI: 10.1007/s00167-018-5270-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE The implant positioning for kinematically aligned total knee arthroplasty (TKA) differs fundamentally from conventional mechanically aligned TKA. This difference may affect patellofemoral (PF) biomechanics after TKA. This cadaveric study tested the hypothesis that kinematically aligned TKA would restore PF biomechanics to the native condition better than mechanically aligned TKA. METHODS Seven pairs (14 knees) of fresh-frozen cadavers were tested. All specimens were mounted on a customized knee-testing system and digitized using a Microscribe 3DLX instrument (Revware Inc., Raleigh, NC, USA) to measure patellar kinematics in terms of patellar varus/valgus rotation, medial/lateral position, flexion/extension rotation and proximal/distal position at knee flexion angles of 0°, 30°, 60°, 90°, and 120°. The medial and lateral PF joint contact pressure distributions at 120° of knee flexion were measured using a K-scan system (Tekscan Inc., Boston, MA, USA). All patellae remained unresurfaced. For each pair, one knee was randomly assigned to kinematically aligned TKA and the other to mechanically aligned TKA performed using the conventional measured resection technique. During kinematically aligned TKA, the amount of femur and tibia resected was equivalent to implant thickness to maintain the patient-specific joint line. All patellar kinematics were measured and compared between the native condition and after surgery. RESULTS The patellae of mechanically aligned TKA rotated more valgus and was positioned more laterally compared with those of kinematically aligned TKA at knee flexion angles ≥ 90°. Neither the patellar flexion/extension rotation nor the proximal/distal position differed between either prosthetic knee design and the native knee at all flexion angles. The contact pressure distribution between the medial and lateral PF joint after kinematically aligned TKA were similar to those of the native knee, while the lateral PF joint contact pressure after mechanically aligned TKA was higher than that of the native knee (p = 0.038). CONCLUSIONS Kinematically aligned TKA better restores patellar kinematics and PF contact pressure distribution to the native condition than mechanically aligned TKA during deep knee flexion. These findings provide clues to understand why kinematically aligned TKA is associated with less anterior knee pain and better PF functional performance compared to mechanically aligned TKA. Patients undergoing kinematically aligned TKA may experience a more normal feeling during deep knee flexion activities.
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Iamthanaporn K, Geater A, Yuenyongviwat V. Predictability of open superficial medial collateral ligament lengthening technique in total knee arthroplasty. Comparison of multiple needle puncturing and subperiosteal elevation: A cadaver study. Orthop Traumatol Surg Res 2018; 104:977-982. [PMID: 30243679 DOI: 10.1016/j.otsr.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Lengthening of superficial medial collateral ligament (sMCL) is often needed in total knee replacement for varus osteoarthritis knee. This study aimed to compare the relationship of multiple needle puncturing (MNP) and subperiosteal elevation (SE) for sMCL lengthening on the gap increment and sequential lengthening in cadaveric knees. HYPOTHESIS MNP produces more reliable gap increment than SE technique for sMCL lengthening performed in knee flexion. METHODS From 8 pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo MNP and the others to SE. In the MNP group, an 18gauge needle was used to puncture through the sMCL, performing five punctures each time of release. For the SE group, a periosteal elevator was used to sequentially deepen distally beneath the sMCL insertion with an increment depth of 5mm each time of release. The primary outcome was the medial gap increment at knee extension and 90° knee flexion after every attempt in each group. RESULTS At each level of lengthening, the widening of flexion and extension gap were not significantly different between the two techniques except for lengthening after 4 and 6 attempts of SE that gave greater widening in extension gap. Variability (width of mid 95% of values) was significantly greater for any given number of attempts using SE than MNP (0.5 vs. 0.24mm per attempt for extension and 2.28 vs. 0.95mm per attempt for flexion; both p<0.001). CONCLUSION The MNP technique is a reproducible technique for lengthening the sMCL in knee flexion. It has less variability in gap widening compared to the SE technique. LEVEL OF EVIDENCE II, controlled randomized laboratory study.
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Affiliation(s)
- Khanin Iamthanaporn
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Songkhla, Hat Yai, Thailand.
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, 90110 Songkhla, Hat Yai, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Songkhla, Hat Yai, Thailand
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Amundsen SH, Meyers KN, Wright TM, Westrich GH. Variability in Elongation and Failure of the Medial Collateral Ligament After Pie-Crusting With 16- and 18-Gauge Needles. J Arthroplasty 2018; 33:2636-2639. [PMID: 29661527 DOI: 10.1016/j.arth.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/23/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In knee arthroplasty with preoperative varus deformity, medial collateral ligament (MCL) release may be needed to achieve balance. Pie-crusting allows for controlled release, but questions remain regarding its ability to obtain predictable results. We compared 16- vs18-gauge needle punctures and determined the number of punctures required to (1) lengthen the MCL by 1 mm and (2) cause ligament failure. METHODS Thirteen knees were dissected, leaving the femur and tibia with an isolated MCL, and randomly assigned to 16- or 18-gauge groups. Initial stiffness was assessed by cycling the ligament to 300 N for 5 cycles. The selected needle was used to make 10 punctures centered over the area of greatest tension. Cyclic testing was repeated after each set of punctures. Changes in MCL length and stiffness were measured. This process was repeated until failure. RESULTS No differences occurred between the 16- and 18-gauge groups in cross-sectional area, initial stiffness, number of punctures to lengthen the MCL by 1 mm, or number of punctures to failure. As the number of punctures increased, a linear increase in elongation and decrease in stiffness occurred. CONCLUSION Needle size was not the influencing factor. Variability in number of punctures, regardless of needle size, to elongate or fail the MCL shows the difficulty in developing a reproducible pie-crusting technique. This suggests that a standard number of punctures do not achieve controlled MCL lengthening for all patients, but that the number of punctures needed can be calculated for an individual knee based on the initial elongation after 10 punctures.
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Affiliation(s)
- Spencer H Amundsen
- Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Kathleen N Meyers
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
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Cho KJ, Seon JK, Jang WY, Park CG, Song EK. Objective quantification of ligament balancing using VERASENSE in measured resection and modified gap balance total knee arthroplasty. BMC Musculoskelet Disord 2018; 19:266. [PMID: 30053812 PMCID: PMC6064102 DOI: 10.1186/s12891-018-2190-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/12/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Soft tissue balancing which is above all most important factor of total knee arthroplasty, has been performed by subjective methods. Recently objective orthosensor has been developed for compartment pressure measurement. The purpose of this study was: (1) to quantify the compartment pressure of the joint throughout the range of motion during TKA using orthosensor, (2) to determine the usefulness of orthosensor by analyzing correlation between the pressure in both compartment with initial trial and after final implantation, and (3) to evaluate the types and effectiveness of additional ligament balancing procedures to compartment pressure. METHODS Eighty-four patients underwent total knee arthroplasty (TKA) using VERASENSE Knee System. TKA was performed by measured resection and modified gap balance technique. Compartment pressure was recorded on full extension, 30°, 60°, 90° and full flexion at initial (INI), after each additional procedure, and after final (FIN) implantation. "Balanced" knees were defined as when the compartment pressure difference was less than 15 pounds. RESULTS Thirty patients (35.7%) showed balanced knee initially and 79 patients (94.0%) showed balance after final implantation. The proportion of balanced knee after initial bony resection, modified gap balancing TKAs showed significantly higher proportion than measured resection TKAs (P = 0.004) On both compartment, the pressure was generally decreased throughout the range of motion. Linear correlation on both compartment showed statistically significant throughout the range on motion, with higher correlation value on the lateral compartment. Total 66 additional ligament balancing procedures were performed. CONCLUSION Using orthosensor, we could obtain 94% quantified balance knee, consequently. And between the techniques, measured resection TKA showed less balanced knee and also required more additional procedures compared to modified gap balancing TKA. Furthermore, with the acquired quantified data during appropriate ligament balancing, the surgeon could eventually reduce the complications associated with soft tissue imbalance in the future.
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Affiliation(s)
- Kyu-Jin Cho
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, South Korea
| | - Jong-Keun Seon
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, South Korea
| | - Won-Young Jang
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, South Korea
| | - Chun-Gon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, South Korea
| | - Eun-Kyoo Song
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, South Korea.
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, 160 Ilsim-Ri, Hwasun-gun, Jeonnam, 519-809, South Korea.
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Herschmiller T, Grosso MJ, Cunn GJ, Murtaugh TS, Gardner TR, Geller JA. Step-wise medial collateral ligament needle puncturing in extension leads to a safe and predictable reduction in medial compartment pressure during TKA. Knee Surg Sports Traumatol Arthrosc 2018; 26:1759-1766. [PMID: 29167955 DOI: 10.1007/s00167-017-4777-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/30/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Medial soft tissue release in a varus deformity knee during total knee arthroplasty is essential for accurate balancing of the reconstruction. This study attempts to quantify the effect of sequential needle puncturing of the medial collateral ligament (MCL) using a pressure sensor insert (Verasense by OrthoSensor) and gap measurement under tension. METHODS Cruciate-retaining arthroplasties were placed in 14 cadaveric knees. The MCL was elongated by step-wise perforation, in five sets of five perforations, with the use of an 18-gauge needle, followed by valgus stress. Following the fifth set of needle perforations, blade perforation was performed on the remaining tense fibers of the MCL. Following each step-wise perforation, corresponding medial compartment pressures and gap measurements under tension were recorded. RESULTS Sensor measurements correlated closely with step-wise tissue release (R = 0.73, p < 0.0001), and a significant decrease in pressure was found in early needle puncturing (mean 49 N after 5, 83 N after 15, p values < 0.05), although changes diminished at later stages of needle perforation (90 N after 20). Gap measurement demonstrated small gradual changes with early puncturing, but showed significant opening in the later stages of release. There was minimal variation in pressure or gap measurements in flexion versus extension. This finding suggests that MCL needle puncture will not lead to unequal gaps between flexion and extension. There were no cases of MCL over-release after 15 punctures, one case after 20 punctures, and three after blade perforation. CONCLUSION Needle puncturing of the MCL in extension for up to 15 punctures can be a safe and predictable way to achieve medial opening when balancing a varus knee during TKA as demonstrated in this cadaveric model. Blade perforation should be used with caution to avoid over-release. The needle puncture method can be used by surgeons to achieve reliable reductions in medial compartment pressures, to help achieve a balanced TKA, with minimal risk of over-release.
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Affiliation(s)
- Thomas Herschmiller
- Center for Hip and Knee Replacement, Columbia University Medical Center, 622 West 168th Street, PH 1147, New York, NY, 10032, USA
| | - Matthew J Grosso
- Center for Hip and Knee Replacement, Columbia University Medical Center, 622 West 168th Street, PH 1147, New York, NY, 10032, USA
| | - Gregory J Cunn
- Center for Hip and Knee Replacement, Columbia University Medical Center, 622 West 168th Street, PH 1147, New York, NY, 10032, USA
| | - Taylor S Murtaugh
- Center for Hip and Knee Replacement, Columbia University Medical Center, 622 West 168th Street, PH 1147, New York, NY, 10032, USA
| | - Thomas R Gardner
- Center for Hip and Knee Replacement, Columbia University Medical Center, 622 West 168th Street, PH 1147, New York, NY, 10032, USA
| | - Jeffrey A Geller
- Center for Hip and Knee Replacement, Columbia University Medical Center, 622 West 168th Street, PH 1147, New York, NY, 10032, USA.
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Effect of the Referencing System on the Posterior Condylar Offset and Anterior Flange-Bone Contact in Posterior Cruciate-Substituting Total Knee Arthroplasty. J Arthroplasty 2018; 33:1069-1075. [PMID: 29195851 DOI: 10.1016/j.arth.2017.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/01/2017] [Accepted: 11/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The effect of referencing system on posterior condylar offset (PCO) after total knee arthroplasty (TKA) is still controversial. Moreover, there is a lack of concern about the anterior flange-bone contact according to the referencing system. METHODS One hundred four TKAs using the anterior referencing (AR) system and 107 TKAs using the posterior referencing (PR) system were analyzed with 2-year follow-up. The PCO, PCO ratio (PCOR), and contact at the anterior flange-bone interface were compared between the 2 groups. The flexion and extension gaps and the degree of medial release were measured, and clinical outcomes were evaluated. Finally, the correlation between changes in PCO and knee flexion angle was analyzed. RESULTS The mean postoperative PCO and PCOR were significantly larger in the PR group than in the AR group. Incomplete contact between the anterior flange and anterior femur occurred more frequently in the AR group than in the PR group (48.1% vs 13.1%, P < .001). The medial and lateral flexion gaps were significantly larger in the AR group than in the PR group. The groups showed no differences in soft tissue release, degree of flexion, and clinical scores. In both groups, there was no correlation between postoperative change of PCO and improvement in flexion. CONCLUSION The PR system produced larger PCO and PCOR, and smaller flexion gap compared to the AR system. Additionally, the PR group showed more favorable contact between the anterior flange and anterior femur. However, these differences were not related to the degree of soft tissue release and clinical outcomes.
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Sim JA, Na YG, Go JY, Lee BK. Clinical and radiologic evaluation of medial epicondylar osteotomy for varus total knee arthroplasty. Knee 2018; 25:177-184. [PMID: 29325838 DOI: 10.1016/j.knee.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In varus total knee arthroplasty (TKA), a pathologic contracture of the medial soft tissue should be released for ligament balancing. A medial epicondylar osteotomy has been performed as an alternative method for this. The purpose of this study was to demonstrate the clinical and radiologic results of medial epicondylar osteotomy for varus TKA, focusing on the union type of osteotomy site. METHODS The study retrospectively evaluated 61 cases with a mean femorotibial angle of 10.4° varus and a mean flexion contracture angle of 8.5±9.8°. Intraoperative medial and lateral gap difference in extension and 90° flexion was accepted at <2mm. Clinical outcomes (Knee Society Scores, range of motion) and radiologic outcomes (coronal alignment and valgus stability) were compared between the two groups divided by the union type of osteotomy site (bony union or fibrous union). RESULTS The clinical and radiologic outcomes were significantly improved at the latest follow-up. Bony union was achieved in 39 (63.9%) patients, whereas 22 patients showed fibrous union. There was no difference in the varus-valgus angle on the stress radiographs between the bony union and fibrous union group (1.6±1.2° vs. 1.6±0.8°, P<0.916). The Knee Society Scores (knee, function), range of motion and radiographic alignment did not differ between the two groups. CONCLUSION Medial epicondylar osteotomy was a good option for gap balancing during TKA, as it provided satisfactory clinical and radiological results, regardless of union type of the osteotomy site.
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Affiliation(s)
- Jae Ang Sim
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Young Gon Na
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jae Yun Go
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Beom Koo Lee
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Kim MS, Koh IJ, Choi YJ, Kim YD, In Y. Correcting Severe Varus Deformity Using Trial Components During Total Knee Arthroplasty. J Arthroplasty 2017; 32:1488-1495. [PMID: 28017574 DOI: 10.1016/j.arth.2016.11.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/20/2016] [Accepted: 11/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Extensive medial soft tissue release may be necessary to correct severe varus deformity during total knee arthroplasty (TKA). However, this procedure may result in instability. Here, we describe a novel soft tissue balancing technique, which can minimize medial release in severe varus deformity during TKA. METHODS Fifty knees (40 patients) with hip-knee-ankle angle of more than 20° of varus were corrected using this technique (group 1). After achieving flexion gap balancing by needle puncturing and spreading of the superficial medial collateral ligament, extension gap balancing was obtained by gradual extension with the trial components in place. After group 1 was set, a one-to-one patient-matched control group who had mild varus deformity was selected by propensity score matching (50 knees, 48 patients, group 2). At postoperative 1 year, mediolateral laxity was compared between the 2 groups using the stress radiographs. Clinical outcomes were also compared using the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index score. RESULTS There were no differences in mean medial and lateral laxities between groups 1 and 2 at 1 year after the operation (medial laxity: 2.3° ± 1.4° and 2.7° ± 1.3°, respectively, P = .310) (lateral laxity: 3.6° ± 1.7° and 3.2° ± 2.0°, respectively, P = .459). There were no significant differences in postoperative clinical scores and knee alignment. CONCLUSION Our technique of obtaining extension gap balancing using trial components led to safe and effective balancing by avoiding unnecessary extensive release in severe varus deformity during TKA.
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Affiliation(s)
- Man S Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In J Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young J Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong D Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Choi NY, In Y, Bae JH, Do JH, Chung SJ, Koh IJ. Are Midterm Patient-Reported Outcome Measures Between Rotating-Platform Mobile-Bearing Prosthesis and Medial-Pivot Prosthesis Different? A Minimum of 5-Year Follow-Up Study. J Arthroplasty 2017; 32:824-829. [PMID: 27667531 DOI: 10.1016/j.arth.2016.08.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 07/23/2016] [Accepted: 08/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Both rotating-platform (RP) mobile-bearing and medial-pivot (MP) fixed-bearing prostheses allow axial femorotibial rotation using a highly conforming polyethylene insert. However, limited comparative data are available between the 2 designs. This study was performed to compare the midterm clinical outcomes and patient-reported outcome measures (PROMs) of RP and MP prostheses. METHODS We retrospectively reviewed the records of 52 total knee arthroplasties using RP mobile-bearing prosthesis and 49 total knee arthroplasties using MP fixed prosthesis with a minimum follow-up period of 5 years. Clinical and radiological outcomes, failure rates, and PROMs, including the Western Ontario and McMaster Universities Osteoarthritis Index score and satisfaction, were compared. RESULTS There was no difference in clinical or radiographic outcomes (P > .1 for all comparisons), with the exception of the larger flexion contracture (FC) in the MP group (0.3° in RP vs 2.3° in MP, P < .01). No failure in either group was recorded during the study period. PROMs were comparable (P > .1 in all comparisons), with the exception of higher satisfactions in the RP group while performing light household duties (P < .01) and leisure or recreational activities (P = .014) in patients without FC. CONCLUSION The midterm clinical results with both the RP mobile-bearing and MP fixed-bearing prostheses were satisfactory. Although both prostheses provided comparable PROMs, patients with an RP prosthesis were more satisfied than those with an MP prosthesis for highly demanding activities that are strongly associated with the presence of postoperative FC.
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Affiliation(s)
- Nam Y Choi
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jae-Ho Bae
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea
| | - Jung-Hoon Do
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea
| | - Seung J Chung
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In J Koh
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
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Algorithmic pie-crusting of the medial collateral ligament guided by sensing technology affects the use of constrained inserts during total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 41:1139-1145. [DOI: 10.1007/s00264-017-3413-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
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Xu HT, Dong JT, Wang J, Gao SJ. Surgical Technique of Total Knee Arthroplasty without Soft Tissue Balance. Orthop Surg 2016; 8:519-522. [PMID: 28032705 DOI: 10.1111/os.12289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 10/08/2016] [Indexed: 11/30/2022] Open
Abstract
Total knee arthroplasty (TKA) without soft tissue balance can create a balanced knee to a mechanical axis of near neutral with bone cuts, and remove osteophytes thoroughly. In this study, the authors present detailed steps for performing TKA. The attached video demonstrates the TKA procedure. The patient is a 77-year-old man who had suffered from knee pain for 12 years. Physical examination showed the Apley test to be positive and that the range of motion (ROM) decreased. An X-ray filmed at the positive lateral of the knee joint and the double lower extremity revealed a progression of degenerative osteoarthritis with genu varum. The key point of no soft tissue release is to make a rectangular extensional space by osteotomy. In addition, the osteophytes, especially syndesmophytes, should be removed thoroughly. As a result, the ligaments can achieve ideal length and the flexion contracture can also be remedied. Moreover, in surgeries without soft tissue release, bone mass and normal tissue are retained. Patients are satisfied to the surgery not only with less blood loss, anterior knee pain and DVT, but also faster rehabilitation. In summary, TKA without soft tissue balance is an efficient procedure for patients with knee osteoarthritis which can result in good prognosis.
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Affiliation(s)
- Hong-Tao Xu
- Department of Joint Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jiang-Tao Dong
- Department of Joint Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Juan Wang
- Department of Joint Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Shi-Jun Gao
- Department of Joint Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
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31
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Burkhart TA, Perry KI, Dobbin E, Howard J, Lanting B. Effect of Soft Tissue Releases on Joint Space Opening in Total Knee Arthroplasty. J Arthroplasty 2016; 31:2912-2916. [PMID: 27350023 DOI: 10.1016/j.arth.2016.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/03/2016] [Accepted: 05/10/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the gap achieved to the medial and lateral compartments following sectioning and release of the relevant soft tissues in preparation for a total knee arthroplasty. METHODS A custom-designed knee tensioner allowed the application of forces to the medial and lateral compartments of 12 cadaveric knee specimens. Loads of 100 N and 200 N were applied to each compartment, and the resulting displacement was measured in the following conditions: (1) All soft tissues intact, (2) an arthrotomy, (3) anterior cruciate ligament (ACL) sectioned, (4) posterior cruciate ligament (PCL) sectioned, and (5) release of the anterior aspect of the deep medial collateral ligament (MCL) fibers. Tensions were applied for all conditions from 90° to 0° of knee flexion in 30° increments. RESULTS No differences were found in medial or lateral displacement after the arthrotomy or releasing the ACL or PCL at either 100 N or 200 N. At the 100 N load application, there was a significant increase in gap width when the anterior portion of the deep MCL was released (7.49 mm) compared to the intact (5.28 mm) and arthrotomy (5.75 mm) conditions. With respect to the 200 N load application, there were statistically significant differences detected between the deep MCL fiber release (11.09 mm) and intact conditions (8.05 mm) and release of the deep MCL and arthrotomy conditions (8.77 mm). CONCLUSION The medial parapetellar arthrotomy, ACL and PCL sectioning did not result in medial or lateral displacement changes. The release of the anterior fibers of the deep MCL as part of the surgical exposure increased the medial gap magnitude.
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Affiliation(s)
- Timothy A Burkhart
- Department of Surgery, Lawson Health Research Institute, London, Ontario, Canada; Department of Engineering, Western University, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Kevin I Perry
- Division of Orthopedic Surgery, Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Emily Dobbin
- Department of Kinesiology, Western University, London, Ontario, Canada
| | - James Howard
- Division of Orthopedic Surgery, Department of Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent Lanting
- Division of Orthopedic Surgery, Department of Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
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Goudarz Mehdikhani K, Morales Moreno B, Reid JJ, de Paz Nieves A, Lee YY, González Della Valle A. An Algorithmic, Pie-Crusting Medial Soft Tissue Release Reduces the Need for Constrained Inserts Patients With Severe Varus Deformity Undergoing Total Knee Arthroplasty. J Arthroplasty 2016; 31:1465-9. [PMID: 26897489 DOI: 10.1016/j.arth.2016.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/14/2015] [Accepted: 01/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We studied the need to use a constrained insert for residual intraoperative instability and the 1-year result of patients undergoing total knee arthroplasty (TKA) for a varus deformity. In a control group, a "classic" subperiosteal release of the medial soft tissue sleeve was performed as popularized by pioneers of TKA. In the study group, an algorithmic approach that selectively releases and pie-crusts posteromedial structures in extension and anteromedial structures in flexion was used. METHODS All surgeries were performed by a single surgeon using measured resection technique, and posterior-stabilized, cemented implants. There were 228 TKAs in the control group and 188 in the study group. Outcome variables included the use of a constrained insert, and the Knee Society Score at 6 weeks, 4 months, and 1 year postoperatively. The effect of the release technique on use of constrained inserts and clinical outcomes were analyzed in a multivariate model controlling for age, sex, body mass index, and severity of deformity. RESULTS The use of constrained inserts was significantly lower in study than in control patients (8% vs 18%; P = .002). There was no difference in the Knee Society Score and range of motion between the groups at last follow-up. No patient developed postoperative medial instability. CONCLUSION This algorithmic, pie-crusting release technique resulted in a significant reduction in the use of constrained inserts with no detrimental effects in clinical results, joint function, and stability. As constrained TKA implants are more costly than nonconstrained ones, if the adopted technique proves to be safe in the long term, it may cause a positive shift in value for hospitals and cost savings in the health care system.
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Affiliation(s)
| | - Beatriz Morales Moreno
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Jeremy J Reid
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Ana de Paz Nieves
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Yuo-Yu Lee
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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Lee SY, Yang JH, Lee YI, Yoon JR. A Novel Medial Soft Tissue Release Method for Varus Deformity during Total Knee Arthroplasty: Femoral Origin Release of the Medial Collateral Ligament. Knee Surg Relat Res 2016; 28:153-60. [PMID: 27274473 PMCID: PMC4895088 DOI: 10.5792/ksrr.2016.28.2.153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/10/2015] [Accepted: 11/19/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Numerous methods of medial soft tissue release for severe varus deformity during total knee arthroplasty (TKA) have been reported. These include tibial stripping of the superficial medial collateral ligament (MCL), pie-crusting technique, and medial epicondylar osteotomy. However, there are inherent disadvantages in these techniques. Authors hereby present a novel quantitative method: femoral origin release of the medial collateral ligament (FORM). Surgical Technique For medial tightness remaining even after the release of the deep MCL and semimembranosus, the FORM is initiated with identification of the femoral insertion area of the MCL with the knee in flexion. Starting from the most posterior part of the femoral insertion, one third of the MCL femoral insertion is released from its attachment. If necessary, further sequential medial release is performed. Materials and Methods Seventeen knees that underwent the FORM were evaluated for radiological and clinical outcomes. Results Regardless of the extent of the FORM, no knees showed residual valgus instability at 24 weeks after surgery. Conclusions As the FORM is performed in a stepwise manner, fine adjustment during medial release might be beneficial to prevent inadvertent over-release of the medial structures of the knee.
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Affiliation(s)
- Seung-Yup Lee
- Department of Orthopedic Surgery, Seoul Barunsesang Hospital, Seoul, Korea
| | - Jae-Hyuk Yang
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Yong-In Lee
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
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Dubois de Mont-Marin G, Babusiaux D, Brilhault J. Medial collateral ligament lengthening by standardized pie-crusting technique: A cadaver study. Orthop Traumatol Surg Res 2016; 102:S209-12. [PMID: 27055933 DOI: 10.1016/j.otsr.2016.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pie-crusting (PC) is a tissue expansion technique using multiple perforation to lengthen the medial collateral ligament (MCL), but has still to be codified. HYPOTHESIS Standardized MCL PC allows measured opening of the medial femorotibial (MFT) joint line, without risk of MCL tear. MATERIAL AND METHOD Thirty-one knees were dissected, with medial parapatellar arthrotomy and resection of the cruciate ligaments and menisci. The deep MCL bundle was sectioned, and the thick anterior bundle (AB) of the MCL was observed in each knee. Knees were randomly allocated between AB sparing (AB+; n=15) or sectioning (AB-; n=16). A graduated dynometric tensor applied constant 80N distraction on the MFT joint line. MCL PC used a 19-G needle at the joint line, with a horizontal series of perforations every 2mm over the width of the MCL. MFT compartment opening was measured after each PC series. RESULTS Mean MFT space after sectioning the cruciate ligaments was 5.52±0.37mm, increasing by 1.64±1.28mm with AB sectioning. Twenty-five perforations were made in the AB+ and 16 in the AB- group. Final mean joint-line increase was 0.18±0.18mm in AB+ and 3.16±2.70mm in AB-. There were no MCL tears. DISCUSSION MCL pie-crusting was reliable and reproducible, achieving progressive MFT joint-line lengthening to a mean 8.71±2.62mm when associated to sectioning of the cruciate ligaments and MCL AB. TYPE OF STUDY Cadaver. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- G Dubois de Mont-Marin
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France
| | - D Babusiaux
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France
| | - J Brilhault
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de médecine de Tours, 10, boulevard Tonnelé, 37032 Tours cedex 1, France.
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Kim MW, Koh IJ, Kim JH, Jung JJ, In Y. Efficacy and Safety of a Novel Three-Step Medial Release Technique in Varus Total Knee Arthroplasty. J Arthroplasty 2015; 30:1542-7. [PMID: 25922122 DOI: 10.1016/j.arth.2015.03.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/10/2015] [Accepted: 03/30/2015] [Indexed: 02/01/2023] Open
Abstract
We investigated the efficacy and safety of our novel three-step medial release technique in varus total knee arthroplasty (TKA) over time. Two hundred sixty seven consecutive varus TKAs were performed by applying the algorithmic release technique which consisted of sequential release of the deep medial collateral ligament (step 1), the semimembranosus (step 2), and multiple needle puncturing of the superficial medial collateral ligament (step 3). One hundred seventeen, 114, and 36 knees were balanced after step 1, 2, and 3 releases, respectively. There were no significant differences in changes of medial and lateral laxities between groups in over a year. Our novel stepwise medial release technique was efficacious and safe in balancing varus knees during TKA.
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Affiliation(s)
- Min Woo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Hwan Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Jong Jung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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