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Medially congruent total knee arthroplasty in valgus knee deformities yields satisfactory outcomes: a multicenter, international study. Knee Surg Sports Traumatol Arthrosc 2023; 31:407-412. [PMID: 34596693 DOI: 10.1007/s00167-021-06754-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/19/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Postoperative instability represents one of the most common complications following primary total knee arthroplasty (TKA). To prevent this outcome, valgus deformities have been historically treated using more constrained implants. The purpose of this study was to evaluate the outcome of treating a moderate valgus deformity by combining a surgical technique used to release the postero-lateral soft tissue envelope with the use of a medially congruent (MC) TKA design without using classical, semi-constrained inserts. METHODS Seventy-nine MC TKAs were performed by three surgeons at three institutions between 2016 and 2018 as part of a multicenter, international study. Inclusion criteria were: radiographic late-stage osteoarthritic knees with Ranawat's type 1 or 2 classification of valgus deformity and integrity of the medial capsular-ligament complex (less than 10 mm of medial opening during valgus stress test at 10° of knee flexion). Exclusion criteria were: BMI > 40; neuromuscular, metabolic, or immunologic disorders; or the inability to complete outcome measures or radiographic assessment. RESULTS Seventy-seven patients (79 knees), 59 males and 18 females, were evaluated at 2-year minimum follow-up according to the Knee Society Score (KSS) and Forgotten Joint Score (FJS). Mean age at surgery was 70 years (range 48-91). The mean range of motion (ROM) improved from 110° (range 85°-130°) preoperatively to 121° (range 105°-135°) (p < 0.001) at the time of the last follow-up. Preoperative knee extension significantly improved from 3° (range - 15° to 20°) to 1° (range - 5° to 5°) of flexion at the last follow-up in all the patients. KSS and KSS Functional scores were 89 (range 65-100) and 82 points (range 55-100), respectively. The FJS obtained at the last follow-up was 72 (range 49-88). Two patients (2.5%) had major postoperative complications (one periprosthetic joint infection; one postoperative patellar fracture) requiring surgical interventions. CONCLUSIONS In different surgeon's hands, the use of a modern medially congruent TKA design yielded good clinical outcomes at 2 years in a consecutive series of TKA in valgus arthritic knees. Postoperative instability was not recorded in this series and this finding was related to the high conformity design of the MC polyethylene insert, which significantly differs from classical posterior-stabilized (PS) designs. LEVEL OF EVIDENCE IV.
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Kinoshita T, Hino K, Kutsuna T, Watamori K, Miura H. Rotational Soft-Tissue Balance Is Highly Correlated with Rotational Kinematics in Total Knee Arthroplasty. J Knee Surg 2023; 36:47-53. [PMID: 33992034 DOI: 10.1055/s-0041-1729619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recovery of normal knee kinematics is critical for improving functional outcomes and patient satisfaction after total knee arthroplasty (TKA). The kinematics pattern after TKA varies from case to case, and it remains unclear how to reproduce normal knee kinematics. The present study aimed to evaluate rotational knee kinematics and soft-tissue balance using a navigation system and to assess the influence of intraoperative soft-tissue balance on the rotational knee kinematics. We evaluated 81 osteoarthritic knees treated with TKA using a posterior stabilized (50 knees) or cruciate retaining (31 knees) prosthesis. Rotational kinematics were assessed at 0, 30, 45, 60, and 90 degrees flexion angles by using a computer-assisted navigation system. Correlation between femorotibial rotational position and measured soft tissue balance was assessed by using Spearman's rank correlation coefficient. Rotational soft-tissue balance (the median angle of rotational stress) was significantly correlated with rotational kinematics (rotational axis of the femur relative to the tibia throughout the range of motion) at all measured angles after TKA. The correlation coefficients between the median angle of rotational stress and rotational kinematics were 0.97, 0.80, 0.74, 0.71, and 0.70 at 0, 30, 45, 60, and 90 degrees of flexion, respectively (p-values <0.0001 in all measured angles). The correlation coefficient increased as the knee approached full extension. Our findings suggest that soft-tissue balance is a key factor for rotational kinematics, following both cruciate-retaining and posterior-stabilized TKA.
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Affiliation(s)
- Tomofumi Kinoshita
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazunori Hino
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tatsuhiko Kutsuna
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kunihiko Watamori
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
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Kerzner B, Swindell HW, Terhune EB, Ramos P, Fortier LM, Dasari SP, Khan ZA, Gursoy S, Cancienne J, Chahla J. Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction for Valgus Instability After Total Knee Arthroplasty. Arthrosc Tech 2022; 11:e1531-e1539. [PMID: 36185120 PMCID: PMC9519797 DOI: 10.1016/j.eats.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
Medial collateral ligament (MCL) injuries are typically managed non-operatively, with high rates of clinical success. However, patients who present with medial knee laxity with valgus stress testing of a fully extended knee, anteromedial rotatory instability, associated tibial plateau fracture, or multiligament injury or those who continue to be symptomatic after non-operative treatment may benefit from surgical intervention. Patients with a history of total knee arthroplasty who suffer MCL and posterior oblique ligament (POL) injuries represent a challenging patient population and often require surgical attention. In this Technical Note, we describe the preoperative assessment, decision making, and surgical technique for anatomic reconstruction of the superficial MCL and POL with an Achilles allograft in young, active patients with medial-sided knee injuries after total knee arthroplasty.
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Affiliation(s)
- Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Hasani W. Swindell
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Elizabeth B. Terhune
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Pablo Ramos
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Luc M. Fortier
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Suhas P. Dasari
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Safa Gursoy
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Jourdan Cancienne
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, CChicago, Illinois, U.S.A,Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL 60612, U.S.A.
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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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Yamagami R, Inui H, Taketomi S, Kono K, Kawaguchi K, Sameshima S, Kage T, Tanaka S. Proximal tibial morphology is associated with risk of trauma to the posteromedial structures during tibial bone resection reproducing the anatomical posterior tibial slope in bicruciate-retaining total knee arthroplasty. Knee 2022; 36:1-8. [PMID: 35381571 DOI: 10.1016/j.knee.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 07/23/2021] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A tibial cut with the native posterior tibial slope (PTS) is a theoretical prerequisite in bicruciate-retaining total knee arthroplasty (BCRTKA) to regain physiological knee kinematics. The present study reveals tibial morphological risk factors of trauma to the posteromedial structures of the knee during tibial bone resection in BCRTKA. METHODS Fifty patients undergoing BCRTKA for varus knee osteoarthritis were analyzed. A three-dimensional tibial bone model was reconstructed using a computed tomography-based preoperative planning system, and the coronal tibial slope (CTS) and medial PTS (MPTS) were measured. Then, we set the simulated tibial cutting plane neutral on the coronal plane, posteriorly inclined in accordance with the MPTS on the sagittal plane, and 9 mm below the surface of the subchondral cortical bone (i.e., 11 mm below the surface of the cartilage) of the lateral tibial plateau. The association between the tibial morphology and the distance from the simulated cutting plane to the semimembranosus (SM) insertion (Dsm) was analyzed. RESULTS Of the 50 patients, 19 (38%) had negative Dsm values, indicating a cut into the SM (namely, below the posterior oblique ligament) insertion. The MPTS was negatively correlated with Dsm (r = -0.396, p = 0.004), whereas the CTS was positively correlated with Dsm (r = 0.619, p < 0.001). On multivariate linear regression analysis, the MPTS and CTS were independent predictors of Dsm. CONCLUSION In the setting of tibial cuts reproducing the native MPTS in BCRTKA, patients with larger PTS and smaller CTS had more risk of trauma to the posteromedial structures.
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Affiliation(s)
- Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Sun C, Rong W, Du R, Wu S, Liu P, Zhang W, Cai X. Meniscus Graft Augmentation for a Midsubstance Tear of the Medial Collateral Ligament during Total Knee Arthroplasty. J Knee Surg 2022; 35:449-455. [PMID: 32838462 DOI: 10.1055/s-0040-1715115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Multiple surgical techniques exist to repair iatrogenic medial collateral ligament (MCL) injury during total knee arthroplasty (TKA). The objective of the study is to confirm the clinical effectiveness of meniscus transfer for treatment of iatrogenic MCL midsubstance transection in which remaining MCL is of poor quality, and there is a persistent gap between both ligament ends during TKA. From January 2015 to November 2019, we treated 11 patients with MCL injuries of 882 primary TKAs by meniscus transfer. Another 24 primary TKAs were recruited as a control group. The two groups of patients were comparable for age, gender, body mass index (BMI), Knee Society scoring (KSS), knee function score (KFS), and type of prosthesis comparison without significant difference (p > 0.05). We reviewed the patient's stability, as well as objective measures such as KSS and KFS scores, physical examinations, and radiographs. No patient of either group reported impaired wound healing, joint instability on physical examination, pain, radiographic changes, signs of loosening, and other complications. At the final follow-up, there was no significant difference in terms of KSS (p = 0.780) and KFS (p = 0.612) between the injury group and control group at last follow-up. X-ray image review showed no prosthesis loosening or subsidence for both groups. Based on these results, we are cautiously optimistic that midsubstance transections in which the quality of remaining tendon is weak, there is suspicion of stretching, or there is a persistent gap between both ligament ends that can be reconstructed with meniscus autograft transfer augmentation and an unconstrained implant.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, People's Republic of China
| | - Wei Rong
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, People's Republic of China
| | - Ruiyong Du
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, People's Republic of China
| | - Sha Wu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, People's Republic of China
| | - Pu Liu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, People's Republic of China
| | - Wei Zhang
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, People's Republic of China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, People's Republic of China
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Oshima Y, Majima T, Iizawa N, Hoshikawa N, Takahashi K, Takai S. The Influence of Posterior Cruciate Ligament Resection on Tibiofemoral Joint Gap in Varus Osteoarthritic Knees. J Knee Surg 2022; 35:323-330. [PMID: 32659819 DOI: 10.1055/s-0040-1713810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posterior cruciate ligament (PCL) resection during posterior-stabilized total knee arthroplasty (PS-TKA) has been reported to preferentially increase the tibiofemoral joint gap in flexion compared with extension. However, previous assessments of the joint gaps have been performed after bone resection and medial soft tissue release. Thus, these procedural steps may have the potential to influence soft tissue balance. In native knees, soft tissue laxity is generally greater in the lateral compartment than in the medial compartment both with the knee in extension and in flexion. Some surgeons may retain this natural soft tissue balance with less aggressive medial release during TKA. We performed this study to evaluate the impact of the PCL resection on the extension and flexion gaps in the absence of bone resection or medial soft tissue release. Tibiofemoral joint gaps for 41 patients (10 males and 31 females) in full extension and at 90 degrees of flexion both before and after the resections of both the anterior cruciate ligament (ACL) and PCL were assessed using a ligament tensioner device. The statistical analyze was performed using the Mann-Whitney U test. The results showed that medial gap in extension and flexion were 6.7 ± 1.0 and 7.3 ± 0.9 mm, and lateral gap in extension and flexion were 7.6 ± 1.1 and 8.4 ± 1.6 mm, respectively. Thus, physiological tibiofemoral gaps just after knee arthrotomy were trapezoidal and asymmetric shape with the significantly wider gaps in lateral and flexion, compared with the medial and extension, respectively (p < 0.05). However, the increases of the gaps with the ACL and PCL resections were less than 1 mm under the existence of medial soft tissues. As the medial collateral ligament is the primary restraint for the valgus instability, it was also considered to prevent the increase of the flexion gap although the PCL-which is the secondary restraint for the valgus instability-was resected. This finding is critically important for orthopedic surgeons applying PS-TKA implants, particularly for preserving soft tissues to achieve natural knee kinematics postoperatively.
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Affiliation(s)
- Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Norishige Iizawa
- Department of Orthopaedic Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Naoya Hoshikawa
- Department of Orthopaedic Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Kenji Takahashi
- Department of Orthopaedic Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Li J, Yan Z, Lv Y, Li Y, Ye P, Deng P, Zhang H, Chen J, Li J, Qi X, Zeng J, Zeng Y, Feng W. Impact of intraoperative medial collateral ligament injury on outcomes after total knee arthroplasty: a meta-analysis and systematic review. J Orthop Surg Res 2021; 16:686. [PMID: 34801058 PMCID: PMC8605566 DOI: 10.1186/s13018-021-02824-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As an uncommon but severe complication, medial collateral ligament (MCL) injury in total knee arthroplasty (TKA) may be significantly under-recognized. We aimed to determine whether MCL injury influences postoperative outcomes of patients undergoing TKA. METHODS Two independent reviewers searched PubMed, Cochrane Library, and EMBASE from their inception to July 1, 2021. The main outcomes were postoperative function, and secondary outcomes included the incidences of revision and complications. RESULTS A total of 403 articles yielded 15 studies eligible for inclusion with 10 studies used for meta-analysis. This study found that there was a statistically significant difference in postoperative functional scores, range of motion (ROM), complications, and revision rates, with adverse outcomes occurring more commonly in patients with MCL injury. CONCLUSIONS This meta-analysis highlights the complexity of MCL injury during TKA and shows the impact on postoperative function, joint mobility, complications, and revision. Surgeons need to prevent and put more emphasis on MCL injury during TKA.
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Affiliation(s)
- Jiahao Li
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Zijian Yan
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yan Lv
- The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, China
| | - Yijin Li
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Pengcheng Ye
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Peng Deng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Haitao Zhang
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Jinlun Chen
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jie Li
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Xinyu Qi
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China.
| | - Wenjun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China.
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Iizawa N, Oshima Y, Kataoka T, Watanabe H, Majima T, Takai S. The relationship between severity of varus osteoarthritic knees and contracture of the medial structures. J NIPPON MED SCH 2021; 89:108-113. [PMID: 34526449 DOI: 10.1272/jnms.jnms.2022_89-113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe varus osteoarthritic knee has possibility of medial structure contracture. There is no report concerning the relationship between severity of varus deformity and contracture of medial structure. We aimed to reveal a threshold angle that could be corrected in proportion to the width of medial osteophyte removal, and to examine correction differences between larger and smaller than the threshold angle in total knee arthroplasty. METHODS This study included 27 varus osteoarthritic knees scheduled for total knee arthroplasty (TKA). Each knee was measured the hip-knee-ankle angles (HKA) using a navigation system, at maximum extension, 30˚ and 60˚ flexion before and after osteophyte removal, with and without external 10 N-m valgus torque loads. Subsequently, resected osteophyte widths were measured. Mean correction angle per 1 mm osteophyte removal was calculated, and the threshold angle was calculated using the receiver operating characteristic curve. HKA differences were compared against larger and smaller deformity than the threshold angle. RESULTS Mean osteophyte width was 7.1±2.20 mm. Osteophyte removal produced a mean 3.1° correction, which equaled a 0.4° correction per 1 mm osteophyte width removal. The varus deformity threshold angle was 9.5°, however, when comparing the groups larger and smaller than the threshold, there were no significant differences in HKA differences between each step and flexion angle. CONCLUSIONS The threshold angle for expected correction with medial osteophyte removal was 9.5˚. However, with no differences in correction between those with larger or smaller than this angle, medial structure contracture seemed to be unrelated to severity of deformity.
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Affiliation(s)
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School
| | | | | | | | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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Kuriyama S, Hamamoto Y, Arai R, Nakamura S, Nishitani K, Ito H, Matsuda S. Anatomical evaluation of the femoral attachment of the posterior oblique ligament. Arch Orthop Trauma Surg 2021; 141:1035-1041. [PMID: 33417017 DOI: 10.1007/s00402-020-03728-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Tibiofemoral joint instability reduces patient satisfaction after total knee arthroplasty (TKA). However, surgeons sometimes encounter excessive medial joint laxity without medial over-release on the tibial side. It was hypothesized that over-resection of the posteromedial femoral condyle can injure the medial stabilizers, especially the posterior oblique ligament (POL) at its femoral attachments. MATERIALS AND METHODS Thirteen fixed cadaveric knees were exposed, and 3 anatomical points were identified: the posterior edge and midpoint of the POL femoral attachment, and the posterior edge of the superficial medial collateral ligament (sMCL) femoral attachment. The distance from the surface of the posteromedial femoral condyle to each point was measured. Correlations between each point and the anterior-posterior or medial-lateral dimensions of the distal femur were also calculated. RESULTS The average distances to the posterior edge and midpoint of the POL femoral attachment and the posterior edge of the sMCL femoral attachment were 13.7 mm (9.0-18.4), 17.9 mm (11.5-22.6), and 22.7 mm (14.7-29.4), respectively. There were moderate correlations between the distance to each point and the anterior-posterior or medial-lateral dimensions of the distal femur. CONCLUSIONS The minimal distance from the surface of the posteromedial condyle to the POL posterior edge was 9.0 mm. Over-resection of the posteromedial femoral condyle, even with a general TKA femoral component, might injure the POL at its femoral attachments, especially in patients with small distal femurs, while the sMCL is rarely damaged. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yosuke Hamamoto
- Department of Orthopaedic Surgery, Hamamoto Orthopaedic Clinic, 45-5 Johoku, Aoi-ku, Shizuoka, 420-0805, Japan
| | - Ryuzo Arai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Kawaguchi K, Inui H, Taketomi S, Yamagami R, Takagi K, Kage T, Sameshima S, Tanaka S. Rotational kinematics differ between mild and severe valgus knees in total knee arthroplasty. Knee 2021; 28:81-88. [PMID: 33310669 DOI: 10.1016/j.knee.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/29/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no consensus regarding femorotibial rotational kinematics in total knee arthroplasty (TKA) for valgus knee deformity. Additionally, whether the degree of valgus deformity influences intraoperative rotational kinematics and postoperative clinical scores remains unclear. The objectives of this study were to investigate whether the valgus angle is associated with intraoperative rotational kinematics in TKA for valgus knee deformity and to examine the relationship between rotational kinematics and postoperative clinical results. MATERIALS AND METHODS A total of 24 knees with valgus deformity for TKA were included in this study and were divided into two groups depending on the femorotibial angle (FTA); there were 11 knees in the severe valgus group (FTA < 160°) and 13 knees in the mild valgus group (FTA ≥ 160°). Intraoperative femorotibial rotational kinematics from knee extension to flexion were evaluated using an image-free navigation system and postoperative clinical results (range of motion and subjective outcomes) were evaluated 1 year postoperatively. All parameters were compared between the two groups. RESULT Mild valgus knee showed tibial internal rotation during knee flexion before implantation, whereas severe valgus knee showed tibial external rotation during knee flexion before implantation. The postoperative flexion angle was positively correlated with the tibial internal rotation angle after implantation in the mild valgus group only. CONCLUSION Intraoperative rotational kinematics before implantation differed between mild and severe valgus knee deformity in TKA. Intraoperative tibial rotation influenced the postoperative knee flexion angle in mild, but not severe, valgus knee deformity. Ideal postoperative rotational kinematics may be different between the two groups and the difference may be taken into consideration in implant selections and surgical techniques.
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Affiliation(s)
- Kohei Kawaguchi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Hiroshi Inui
- Department of Orthopaedics, Tokyo University Hospital, Japan.
| | - Shuji Taketomi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Ryota Yamagami
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Kentaro Takagi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Tomofumi Kage
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Shin Sameshima
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Sakae Tanaka
- Department of Orthopaedics, Tokyo University Hospital, Japan
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12
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Hsu CE, Huang JT, Tong KM, Huang KC. Total knee arthroplasty according to the original knee phenotypes with kinematic alignment surgical technique-early clinical and functional outcomes. BMC Musculoskelet Disord 2020; 21:839. [PMID: 33308196 PMCID: PMC7731459 DOI: 10.1186/s12891-020-03862-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background The kinematic alignment (KA) technique in total knee arthroplasty (TKA) aims to restore the native alignment of pre-disease knee joint anatomy. Determining the individualized alignment targets is crucial for pre-operative planning, which can be set according to different original knee phenotypes. Five most common knee phenotypes have been categorized for KA-TKA alignment target setting in our previous study. The purpose of this study was to investigate the distribution of the five phenotypes in advanced OA knee patients and evaluate the clinical outcomes of this phenotype-oriented KA-TKA using the generic instrument, with particular emphasis on alignment strategy, surgical technique, survivorship, radiographic and functional outcomes. Methods The clinical data of 123 patients (88 women, 35 men) who had undergone 140 TKAs in our hospital were reviewed. All the TKAs were performed with alignment targets set according to the original phenotypes of the knee, with the KA method, using the generic total knee instrument. The patients’ demographics, preoperative and postoperative knee alignment angles, one-year postoperative range of motion (ROM), Oxford knee scores (OKS), Combined knee society score (CKSS) were collected and analyzed. Results The 3 years survivorship was 99.3% for all cause of revision, and 100% with revision other than infection as the endpoint. The preoperative phenotypes of the knee were as follows: neutral alignment 20.1% (type 1: 3.6%, type 2: 16.5%), varus alignment 71.2% (type 3: 46.0%, type 4: 25.2%), and valgus alignment (type 5: 8.6%). Using our protocol, patients with different knee phenotypes could get similar great functional improvement though the postoperative alignment parameters were significantly different between the knee phenotypes (P < 0.05). Conclusion The early outcomes of this phenotype-oriented KA-TKA using generic total knee instruments are promising. Setting individualized alignment target according to original knee phenotype is rational and practical. The residual varus alignment did not cause any aseptic loosening in the 3 years follow-up. Long-term survivorship and functional outcomes need to be evaluated in future studies.
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Affiliation(s)
- Cheng-En Hsu
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan.,Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Ting Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kwok-Man Tong
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kui-Chou Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan. .,Department of Occupational Therapy, Asia University, Taichung, Taiwan.
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13
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Kataoka T, Oshima Y, Iizawa N, Majima T, Takai S. Influence of Total Knee Arthroplasty on Hip Rotational Range of Motion. J NIPPON MED SCH 2020; 87:191-196. [PMID: 31902856 DOI: 10.1272/jnms.jnms.2020_87-401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) aims to correct the rotation, as well as the alignment and articulation, of the osteoarthritic knee. We hypothesized that, in addition to improving knee kinematics, TKA affects hip rotational movement. The objective of this study was to evaluate variation in lower extremity alignment and hip rotational range of motion (ROM) after TKA. METHODS A total of 47 patients (53 knees) with primary varus knee osteoarthritis who were scheduled for primary TKA at our center were enrolled. Hip rotational ROM was measured with the patient in supine position with 90° flexion of the hip and knee before and 3 weeks after TKA. Plain radiography and computed tomography were used to compare variations in tibial axis alignment and femoral axis alignment after bone resection, which was defined as changes in the joint lines of the distal femur and the proximal tibia. RESULTS Average internal ROM, and the sum of internal and external hip rotational ROM, increased significantly; however, external hip rotational ROM did not significantly differ after TKA. Imaging findings showed that the axis of the lower leg externally rotated by 2.5°, with a 4° internal rotation of the distal femur and a 6.5° correction of the varus deformity. CONCLUSION TKA changed the neutral position of hip rotational movement and increased hip rotational ROM.
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Affiliation(s)
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School
| | | | | | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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14
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The Medial Collateral Ligament in Primary Total Knee Arthroplasty: Anatomy, Biomechanics, and Injury. J Am Acad Orthop Surg 2020; 28:e510-e516. [PMID: 32097134 DOI: 10.5435/jaaos-d-19-00355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Understanding the anatomy and biomechanics of the medial collateral ligament (MCL) is crucial in producing good outcomes after total knee arthroplasty. A solid grasp of the surgical techniques that address the MCL are necessary to ensure good coronal plane ligament balance. Furthermore, intraoperative injury to the MCL in total knee arthroplasty is an uncommon yet serious complication which often goes unrecognized. Loss of the integrity of the MCL can lead to instability, loosening, and accelerated polyethylene wear. There is still controversy regarding the ideal method of treatment of intraoperative MCL injuries with suggested treatment modalities ranging from conservative management to use of varus-valgus constrained implants.
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15
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Ishida K, Shibanuma N, Sasaki H, Takayama K, Kuroda R, Matsumoto T. Influence of Narrow Femoral Implants on Intraoperative Soft Tissue Balance in Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2020; 35:388-393. [PMID: 31604592 DOI: 10.1016/j.arth.2019.08.055] [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: 04/15/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Narrow femoral implants were developed to improve fit and prevent overhang in primary total knee arthroplasty (TKA). We compared intraoperative soft tissue balance between standard and narrow implants in posterior-stabilized (PS) TKA. METHODS We enrolled 30 consecutive patients with varus osteoarthritis undergoing PS TKA using an image-free navigation system. Standard and narrow femoral trial implants were inserted, and their soft tissue balance was measured. Subgroup analysis, based on the actual implanted femoral implant, was performed to assess the influence of narrow implants on soft tissue balance. RESULTS Narrow trial group had significantly larger joint component gaps than standard trial group at all measured flexion angles, except at 60° (P < .05). For the standard implant cohort, narrow trial group had significantly larger joint component gaps than standard trial group at 30°, 120°, and 135° flexion (P < .05). For the narrow implant cohort, narrow trial group had significantly larger joint component gaps than standard trial group at all measured flexion angles, except at 0° and 60° (P < .05). Narrow trial group had significantly larger varus ligament balance than standard trial group at 45° and 60° flexion (P < .05). The varus angles for standard implants were comparable between groups; however, narrow trial group had significantly larger varus angles for narrow implants than standard trial group at 45°, 60°, and 120° flexion (P < .05). CONCLUSION The medial-lateral dimension and volume of the femoral component may influence intraoperative soft tissue balance in PS TKA. The effects may be greater when narrow implants are selected to avoid component overhang.
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Affiliation(s)
- Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Nada, Kobe, Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Nada, Kobe, Japan
| | - Hiroshi Sasaki
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Nada, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo, Kobe, Japan
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16
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Iizawa N, Oshima Y, Kataoka T, Majima T, Takai S. Effect of Medial Osteophyte Removal on Correction of Varus Deformity in Total Knee Arthroplasty. J NIPPON MED SCH 2020; 87:215-219. [PMID: 32009073 DOI: 10.1272/jnms.jnms.2020_87-503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND To restore neutral limb alignment in total knee arthroplasty (TKA), the procedure usually starts with removing osteophytes in varus osteoarthritic knees. However, the exact effect on alignment correction is unknown. The purpose of this study was to determine the effect of osteophyte removal alone during TKA for varus knees on correction of limb alignment on the coronal plane. METHODS Fifteen knees with medial osteoarthritis and varus malalignment scheduled for TKA were studied. After registration in a navigation system, each knee was tested at maximum extension, and at 30, 40, and 60 degrees of flexion, before and after osteophyte removal. External loads of 10 N·m valgus torque at each angle and in both states were applied. Later, the widths of the resected osteophytes were measured. RESULTS The average preoperative hip-knee-ankle angle was -14.2 degrees. The average width of osteophytes was 7.6 mm in the femur and 5.3 mm in the tibia. Angle corrections after osteophyte removal were 3.4 degrees at maximum extension, 3.4 degrees at 30 degrees flexion, and 3.6 degrees at 60 degrees flexion; the difference was significant for all angles. There was a positive correlation between osteophyte width and the degree of angle correction at 30 degrees. CONCLUSION At 30 degrees of knee flexion, osteophyte width was correlated with the degree of angle correction on the coronal plane in TKA. The degree of angle correction per 1 mm of width of removed osteophytes was 0.4 degrees.
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Affiliation(s)
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School
| | | | | | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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17
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Sappey-Marinier E, White N, Gaillard R, Cheze L, Servien E, Neyret P, Lustig S. Increased valgus laxity in flexion with greater tibial resection depth following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1450-1455. [PMID: 29846753 DOI: 10.1007/s00167-018-4988-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/15/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Soft tissue balancing is of central importance to outcome following total knee arthroplasty (TKA). However, there are lack of data analysing the effect of tibial bone cut thickness on valgus laxity. A cadaveric study was undertaken to assess the biomechanical consequences of tibial resection depth on through range knee joint valgus stability. We aimed to establish a maximum tibial resection depth, beyond which medial collateral ligament balancing becomes challenging, and a constrained implant should be considered. METHODS Eleven cadaveric specimens were included for analysis. The biomechanical effects of increasing tibial resection were studied, with bone cuts made at 6, 10, 14, 18 and 24 mm from the lateral tibial articular surface. A computer navigation system was used to perform the tibial resection and to measure the valgus laxity resulting from a torque of 10 Nm. Measurements were taken in four knee positions: 0° or extension, 30°, 60° and 90° of flexion. Intra-observer reliability was assessed. A minimum sample size of eight cadavers was necessary. Statistical analysis was performed using a nonparametric Spearman's ranking correlation matrix at the different stages: in extension, at 30°, 60° and 90° of knee flexion. Significance was set at p < 0.05. RESULTS There was no macroscopic injury to the dMCL or sMCL in any of the specimens during tibial resection. There was no significant correlation found between the degree of valgus laxity and the thickness of the tibial cut with the knee in extension. There was a statistically significant correlation between valgus laxity and the thickness of the tibial cut in all other knee flexion positions: 30° (p < 0.0001), 60° (p < 0.001) and 90° (p < 0.0001). We identified greater than 5° of valgus laxity, at 90° of knee flexion, after a tibial resection of 14 mm. CONCLUSION Increased tibial resection depth is associated with significantly greater valgus laxity when tested in positions from 30° to 90° of flexion, despite stability in extension. Greater than 5° of laxity was identified with a tibial resection of 14 mm. When a tibial bone cut of 14 mm or greater is necessary, as may occur with severe preoperative coronal plane deformity, it is recommended to consider the use of a constrained knee prosthesis.
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Affiliation(s)
- E Sappey-Marinier
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France
| | - N White
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France
| | - R Gaillard
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - L Cheze
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - E Servien
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France
| | - P Neyret
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France
| | - S Lustig
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France.
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France.
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18
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Ishida K, Shibanuma N, Takayama K, Kurosaka M, Kuroda R, Matsumoto T. Posterior Reference Position Affects Intraoperative Kinematic and Soft Tissue Balance in Navigated Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2018; 33:2851-2857. [PMID: 29805103 DOI: 10.1016/j.arth.2018.04.038] [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: 01/12/2018] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The importance of medial compartment stability is recognized in total knee arthroplasty (TKA). To manage the medial extension-flexion gap, the posterior reference position can be changed from conventional posterior center to posterior medial in measured resection techniques. This study aimed to compare the intraoperative soft tissue balance and rotational kinematics between the posterior medial and posterior center reference groups. METHODS We enrolled 57 consecutive patients with varus osteoarthritis undergoing posterior-stabilized (PS) TKA using an image-free navigation system. The detailed surgical plan in both groups and intraoperative kinematics were recorded using navigation, and soft tissue balance measured with an offset-type tensor was statistically compared between groups. RESULTS Patients were divided into the posterior center reference group (n = 32) and posterior medial reference group (n = 25). The posterior medial and posterior lateral condyles were significantly thicker in the posterior center reference group (P < .05). Although preoperative rotational kinematics were comparable between groups, the tibial rotational position was significantly more externally rotated in the posterior center reference group than in the posterior medial reference group at 45°, 60°, and 90° of flexion (P < .05). The varus angle and joint component gap were significantly smaller in the posterior medial reference group than in the posterior center reference group at 60° and 90° of flexion (P < .05). CONCLUSION The posterior reference position affects intraoperative kinematics and soft tissue balance in navigated PS TKA. Posterior medial reference PS TKA decreases the excessive tibial external rotation during midflexion and increases the flexion stability compared with conventional posterior center reference PS TKA.
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Affiliation(s)
- Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Tang Q, Yu HC, Shang P, Tang SK, Xu HZ, Liu HX, Zhang Y. Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty. J Orthop Surg Res 2017; 12:174. [PMID: 29137667 PMCID: PMC5686887 DOI: 10.1186/s13018-017-0681-1] [Citation(s) in RCA: 8] [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: 06/27/2017] [Accepted: 11/07/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To obtain the correct coronal alignment and balancing in flexion and extension, we established a selective medial release technique and investigated the effectiveness and safety of the technique during primary total knee arthroplasty (TKA). METHODS Four hundred sixty-six primary TKAs with varus deformity were prospectively evaluated between June 2013 and June 2015. A knee joint position similar to Patrick's sign was used to release the medial structure. The medial release technique consisted of release of the capsule and the deep medial collateral ligament (dMCL) (step1), selective release of superficial medial collateral ligament (sMCL) or posterior oblique ligament (POL) (step 2), and selective tibial reduction osteotomy (step 3). Improvement of medial joint gap at each step and other clinical outcomes were evaluated. RESULTS Among the 466 knees, symmetrical gaps could be achieved by the limited release of the capsule and the dMCcL in 276 (59%) knees. One hundred fifty-two (33%) required additional sMCL release with 2-5 cm from the joint line distally or POL release. Thirty-eight (8%) necessitated an additional tibial reduction osteotomy. Anterior-medial release and 4-mm medial osteotomy contributed to more improvement of medial gap in flexion than in extension (each p < 0.01). Posteromedial release and posteromedial osteotomy contributed to more improvement in extension than in flexion (each p < 0.01). No specific complication related to our technique was identified. CONCLUSION The technique of the tibial reduction osteotomy combined with medial soft structure release using Patrick's sign is effective, safe, and minimally invasive to obtain balanced mediolateral and extension-flexion gaps in primary TKA.
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Affiliation(s)
- Qian Tang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027, Wenzhou, China
| | - Hua-Chen Yu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027, Wenzhou, China
| | - Ping Shang
- Department of Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027, Wenzhou, China
| | - Shang-Kun Tang
- Department of Clinical Medicine, Second Clinical Medical College, Wenzhou Medical University, 325000, Wenzhou, China
| | - Hua-Zi Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027, Wenzhou, China
| | - Hai-Xiao Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027, Wenzhou, China.
| | - Yu Zhang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027, Wenzhou, China.
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Sirisena D, Papi E, Tillett E. Clinical assessment of antero-medial rotational knee laxity: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:1068-1077. [PMID: 27787588 DOI: 10.1007/s00167-016-4362-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/13/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To inventory the examination methods available to assess antero-medial rotational laxity (AMRL) of the knee following medial collateral ligament injury. METHODS Searches were conducted in accordance with the PRISMA guidelines and using four online databases: WEB OF SCIENCE, MEDLINE, EMBASE, and AMED. The Critical Appraisal Skills Programme guidelines for Diagnostic Test Studies were used for the quality assessment of the articles. RESULTS A total of 2241 articles were identified from the database searches. From this, four articles were included in the final review. All were case-control studies, considered a combined ACL/MCL injury and had small study populations. Specialised equipment was required in all studies, and one needed additional imaging support before measurements could be taken. Two employed commercially available measuring equipment as part of the assessment process. CONCLUSION Clinical assessment of AMRL in relation to a MCL injury remains challenging. Although methods have been developed to support clinical examination, they are limited by a number of factors, including the need for additional time in the clinical environment when setting up equipment, the need for specific equipment to produce and measure rotational movement and imaging support. In addition, there are patient safety concerns from the repeated imaging. A reliable and valid clinical examination remains to be found to truly assess antero-medial rotational laxity of the knee. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dinesh Sirisena
- Institute for Sport, Exercise and Health, University College London, London, UK. .,Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828, Singapore.
| | - Enrica Papi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Eleanor Tillett
- Institute for Sport, Exercise and Health, University College London, London, UK
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Influence of Medial Collateral Ligament Release for Internal Rotation of Tibia in Posterior-Stabilized Total Knee Arthroplasty: A Cadaveric Study. J Arthroplasty 2017; 32:270-273. [PMID: 27460300 DOI: 10.1016/j.arth.2016.06.013] [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: 02/08/2016] [Revised: 05/10/2016] [Accepted: 06/06/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Previous studies suggested that changes in kinematics in total knee arthroplasty (TKA) affected satisfaction level. The aim of this cadaveric study was to evaluate the effect of medial collateral ligament (MCL) release by multiple needle puncture on knee rotational kinematics in posterior-stabilized TKA. METHODS Six fresh, frozen cadaveric knees were included in this study. All TKA procedures were performed with an image-free navigation system using a 10-mm polyethylene insert. Tibial internal rotation was assessed to evaluate intraoperative knee kinematics. Multiple needle puncturing was performed 5, 10, and 15 times for the hard portion of the MCL at 90° knee flexion. Kinematic analysis was performed after every 5 punctures. After performing 15 punctures, a 14-mm polyethylene insert was inserted, and kinematic analysis was performed. RESULTS The tibial internal rotation angle at maximum knee flexion without multiple needle puncturing was significantly larger (9.42°) than that after 15 punctures (3°). Negative correlation (Pearson r = -0.715, P < .001) between tibial internal rotation angle at maximum knee flexion and frequency of puncture was observed. The tibial internal rotation angle with a 14-mm insert was significantly larger (7.25°) compared with the angle after 15 punctures. CONCLUSION Tibial internal rotation during knee flexion was reduced by extensive MCL release using multiple needle puncturing and was recovered by increasing of medial tightness. From the point of view of knee kinematics, medial tightness should be allowed to maintain the internal rotation angle of the tibia during knee flexion which might lead to patient satisfaction.
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