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Yamamoto K, Nakajima A, Sonobe M, Akatsu Y, Yamada M, Nakagawa K. A Comparative Study of Clinical Outcomes Between Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Propensity Score-Matched Cohort Study. Cureus 2023; 15:e45775. [PMID: 37872897 PMCID: PMC10590569 DOI: 10.7759/cureus.45775] [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] [Accepted: 09/21/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION We investigated a comparison of clinical outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty. However, it is still controversial which design leads to better clinical results. In clinical settings, choosing either CR or PS is likely based on the surgeon's preferences. In this study, short-term clinical outcomes between CR and PS in patients who received a single knee prosthesis were compared using propensity score matching. METHODS Two hundred and twelve CR and 43 PS of a single knee prosthesis were enrolled in this study. After propensity score matching, 34 knees each in the CR and PS groups were chosen and were without significant differences in age at operation, gender, BMI, preoperative range of motion (ROM), preoperative femorotibial angle (FTA), and presence or absence of patellar replacement. Clinical scores, including ROM, Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), except for the sports subscale, were compared between the CR and PS groups preoperatively and two years postoperatively. RESULTS Postoperatively, there were no significant differences in FTA, ROM, or KSS. Preoperative scores for the KOOS except for the pain subscale were comparable between the groups. Postoperatively, however, the PS group had a significantly higher score in the ADL subscale compared to the CR group (PS: 89.5 vs. CR: 80.8, p = 0.017). The KOOS subscales other than activities of daily living (ADL) were comparable between the groups. CONCLUSIONS In this propensity score-matched cohort study, PS showed a better outcome for the ADL than the CR design. These findings suggest that choosing either CR or PS should not depend on the surgeon's preferences. A PS design may be preferable to CR for elderly patients.
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Affiliation(s)
- Keiichiro Yamamoto
- Orthopaedic Surgery, Toho University Graduate School of Medicine, Tokyo, JPN
- Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, JPN
| | - Arata Nakajima
- Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, JPN
| | - Masato Sonobe
- Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, JPN
| | - Yorikazu Akatsu
- Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, JPN
| | - Manabu Yamada
- Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, JPN
| | - Koichi Nakagawa
- Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, JPN
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Hayashi S, Miyazaki S. Gross Appearances of the Posterior Cruciate Ligament Correlate With Its Histological Features but not With In Vivo Function in Cruciate-Retaining Total Knee Arthroplasty. Cureus 2023; 15:e38128. [PMID: 37252485 PMCID: PMC10212607 DOI: 10.7759/cureus.38128] [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] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background No study has evaluated whether the macroscopic appearance or histological features of the posterior cruciate ligament (PCL) affect the in vivo PCL function in cruciate-retaining (CR) total knee arthroplasty (TKA). The aim of this study is to elucidate the correlation between intraoperative gross appearances of the PCL and clinical parameters, their corresponding histological features, and the in vivo function. Methods The intraoperative gross appearances of the PCLs were evaluated; we also examined their correlations with clinical parameters, corresponding histological features, and the in vivo function in CR-TKA. Results There were significant correlations between intraoperative gross appearances of the PCL and that of the anterior cruciate ligament, the preoperative knee flexion angle, and the intercondylar notch stenosis. There was a significant correlation between the intraoperative gross appearance in the middle part and the corresponding histological features. However, there was no significant correlation between the intraoperative gross appearance or histological features and the PCL tension, amount of rollback, and maximum knee flexion angle. Conclusions The intraoperative gross appearance of the PCL correlated with clinical parameters. Also, there was a significant correlation between the intraoperative gross appearance in the middle part and the corresponding histological features; however, there was no correlation between the intraoperative gross appearance or histological features and the in vivo function.
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Affiliation(s)
- Seiju Hayashi
- Orthopedic Surgery, Yawatahama City General Hospital, Ehime, JPN
| | - Satoshi Miyazaki
- Orthopedic Surgery, Yawatahama City General Hospital, Ehime, JPN
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Kinsey TL, Mont MA, Mahoney OM. Increased Prevalence of Posterior Cruciate Ligament Dysfunction Noted With 3-Dimensional Intraoperative Kinematic Evaluation in Total Knee Arthroplasty. J Arthroplasty 2022; 37:S182-S186. [PMID: 35331612 DOI: 10.1016/j.arth.2022.02.035] [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: 11/26/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Poor restoration of cruciate-driven kinematics after total knee arthroplasty may result from technical difficulties, but the ligament may also be functionally compromised by the presence of arthritis. We asked whether the function of the posterior cruciate ligament (PCL) could be assessed intraoperatively to predict the quality of the resulting posterior cruciate kinematics. METHODS PCL integrity was assessed using intraoperative infrared trackers to monitor knee kinematics in 73 patients. Three-dimensional images of the femur and tibia were projected onto a screen, allowing the surgeon to visualize kinematic relationships in real time. We measured femoral rollback (distance of femoral contact as a percentage of antero-posterior tray width) from images captured by the robotic system during initial kinematic assessment, gap balancing, and assessment of the final construct and from lateral flexion radiographs obtained 2 years after surgery. Associations were characterized using Pearson's correlation and graphical methods. RESULTS Thirty-six knees (49%) showed rollback <60% during gap balancing, indicative of PCL insufficiency. The rollback during gap balancing was positively correlated with that seen in the final cruciate retaining constructs (r = 0.60, P < .001), which in turn predicted rollback 2 years after surgery on lateral flexion X-rays (r = 0.50, P = .006). CONCLUSION Intraoperative functional evaluations can allow the surgeon to identify cases where rollback is not consistent with desirable knee kinematics, and posterior stabilization may lead to a better outcome for those patients.
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Roussi K, Saunders C, Ries C, Rolvien T, Boese CK. Anterior cruciate ligament intactness in osteoarthritic patients indicated for total knee arthroplasty: a systematic literature review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3458-3466. [PMID: 32997162 DOI: 10.1007/s00167-020-06292-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
Bi-cruciate retaining total knee arthroplasty (BCR TKA) is thought to result in more natural knee kinematics compared to conventional TKA designs. This may lead to a reduction in dissatisfied patients after TKA. An intact anterior cruciate ligament (ACL) is a prerequisite for implantation of a BCR TKA but the frequency of an intact ACL in patients indicated for TKA is not well known. The objective of this systematic literature review was to determine the presence of an intact ACL in patients undergoing TKA by intraoperative macroscopic or MRI assessment. A systematic literature review was conducted using PubMed™ and EMBASE™ in June 2020. The ACL of patients with knee osteoarthritis (OA) undergoing TKA was classified as present (including intact and degenerated) vs. absent, and as intact vs. not fully intact. Proportional meta-analyses were performed. 2840 articles were identified and screened. 135 full texts were analyzed and 18 studies met the inclusion criteria for subsequent qualitative and quantitative meta-analysis. Analysis of the status of the ACL when assessed intraoperatively during TKA showed that the ligament was present in 79.4% of patients (CI: 73.5-84.3%), from 14 studies with 2067 cases studied. The ACL was determined to be intact in 55.0% of patients (CI: 45.3-64.4%), from 14 studies with 1916 cases. Preoperative ACL assessment using MRI (2 studies) revealed it was present in 82.9% of 193 cases (CI: 76.9-87.6%), and intact in 56.8% of 176 cases (CI: 8.2-94.7%). This systematic literature review shows that the ACL is macroscopically intact in more than half of patients with knee OA undergoing TKA, based on intraoperative assessment of the ligament. The results suggest BCR TKA may be considered as an alternative to traditional TKA in a large number of TKA patients. More high-quality studies are needed to better understand the functional status of the ACL in TKA patients.Level of evidence III.
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Affiliation(s)
| | | | - Christian Ries
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Tim Rolvien
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, 50931, Cologne, Germany. .,Smith + Nephew GmbH, Hamburg, Germany.
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Sumida Y, Nakasa T, Ishikawa M, Nakamae A, Adachi N. The evaluation of degeneration of posterior cruciate ligament using CT Hounsfield unit in knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:309. [PMID: 33771140 PMCID: PMC8004421 DOI: 10.1186/s12891-021-04177-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 03/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Posterior cruciate ligament (PCL) degeneration is often seen in knee osteoarthritis (OA); however, there is no established method for its evaluation. The purpose of this study is to investigate whether the Hounsfield unit (HU) using computed tomography (CT) could be a useful scale to evaluate the degeneration of PCL in knee OA. Methods Knee OA treated with total knee arthroplasty (21 patients, 21 knees) and non-osteoarthritic knees (21 patients, 21 knees) were retrospectively observed and studied. All PCLs in the knees were analyzed using CT. The PCL in the sagittal section was divided into three regions: proximal, middle, and distal sections. The HU value of the PCL at each area was measured. In osteoarthritic knees, tissues from the PCL were collected and histologically graded. The correlation between the radiological classification by Kellgren and Lawrence and the histological grade was analyzed. The average CT HU values for each degenerative grade were also calculated and compared. Results The HU values in OA and non-OA were 70.7 and 88.4 HU (p < 0.05) at the proximal region, 75.7 and 85.3 HU (p < 0.05) in the central region, and 82.3 and 86.5 HU (p > 0.05) in the distal region, respectively. The degeneration of PCL was graded as follows: one, three, and 17 mild, moderate, and severe cases at the proximal portion, and 16, 4, and one mild, moderate, and severe cases at the distal portion, respectively. The radiological classification and the grade of degeneration were not correlated in either the proximal (r = 0.047, p = 0.84) or the distal (r = − 0.21, p = 0.35) portions. The HU value was 84.5, 72.1, and 70.6 HU for mild, moderate, and severe grades, respectively (mild versus moderate: p < 0.05, mild versus severe: p < 0.05, moderate versus severe: p > 0.05). Conclusions In knee OA, a lower HU value in the PCL indicates the progression of degeneration. The CT HU value could be a useful measurement to predict the grade of PCL degeneration.
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Affiliation(s)
- Yoshikazu Sumida
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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6
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Kayani B, Konan S, Horriat S, Ibrahim MS, Haddad FS. Posterior cruciate ligament resection in total knee arthroplasty: the effect on flexion-extension gaps, mediolateral laxity, and fixed flexion deformity. Bone Joint J 2019; 101-B:1230-1237. [PMID: 31564152 DOI: 10.1302/0301-620x.101b10.bjj-2018-1428.r2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). PATIENTS AND METHODS This prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4). RESULTS PCL resection increased the mean flexion gap significantly more than the extension gap in the medial (2.4 mm (sd 1.5) vs 1.3 mm (sd 1.0); p < 0.001) and lateral (3.3 mm (sd 1.6) vs 1.2 mm (sd 0.9); p < 0.01) compartments. The mean gap differences after PCL resection created significant mediolateral laxity in flexion (gap difference: 1.1 mm (sd 2.5); p < 0.001) but not in extension (gap difference: 0.1 mm (sd 2.1); p = 0.51). PCL resection significantly improved the mean FFD (6.3° (sd 4.4) preoperatively vs 3.1° (sd 1.5) postoperatively; p < 0.001). There was a strong positive correlation between the preoperative FFD and change in FFD following PCL resection (Pearson's correlation coefficient = 0.81; p < 0.001). PCL resection did not significantly affect limb alignment (mean change in alignment: 0.2° valgus (sd 1.2); p = 0.60). CONCLUSION PCL resection creates flexion-extension mismatch by increasing the flexion gap more than the extension gap. The increase in the lateral flexion gap is greater than the increase in the medial flexion gap, which creates mediolateral laxity in flexion. Improvements in FFD following PCL resection are dependent on the degree of deformity before PCL resection. Cite this article: Bone Joint J 2019;101-B:1230-1237.
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Affiliation(s)
- Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Sujith Konan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Saman Horriat
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Mazin S Ibrahim
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Intraarticular Ligament Degeneration Is Interrelated with Cartilage and Bone Destruction in Osteoarthritis. Cells 2019; 8:cells8090990. [PMID: 31462003 PMCID: PMC6769780 DOI: 10.3390/cells8090990] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 12/16/2022] Open
Abstract
Osteoarthritis (OA) induces inflammation and degeneration of all joint components including cartilage, joint capsule, bone and bone marrow, and ligaments. Particularly intraarticular ligaments, which connect the articulating bones such as the anterior cruciate ligament (ACL) and meniscotibial ligaments, fixing the fibrocartilaginous menisci to the tibial bone, are prone to the inflamed joint milieu in OA. However, the pathogenesis of ligament degeneration on the cellular level, most likely triggered by OA associated inflammation, remains poorly understood. Hence, this review sheds light into the intimate interrelation between ligament degeneration, synovitis, joint cartilage degradation, and dysbalanced subchondral bone remodeling. Various features of ligament degeneration accompanying joint cartilage degradation have been reported including chondroid metaplasia, cyst formation, heterotopic ossification, and mucoid and fatty degenerations. The entheses of ligaments, fixing ligaments to the subchondral bone, possibly influence the localization of subchondral bone lesions. The transforming growth factor (TGF)β/bone morphogenetic (BMP) pathway could present a link between degeneration of the osteochondral unit and ligaments with misrouted stem cell differentiation as one likely reason for ligament degeneration, but less studied pathways such as complement activation could also contribute to inflammation. Facilitation of OA progression by changed biomechanics of degenerated ligaments should be addressed in more detail in the future.
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Foge DA, Baldini TH, Hellwinkel JE, Hogan CA, Dayton MR. The Role of Complete Posterior Cruciate Ligament Release in Flexion Gap Balancing for Total Knee Arthroplasty. J Arthroplasty 2019; 34:S361-S365. [PMID: 30948290 DOI: 10.1016/j.arth.2019.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The sequence of posterior cruciate ligament (PCL) release in posterior-substituting designs, when performing gap balancing in total knee arthroplasty (TKA), is variable. We hypothesize that early complete PCL release during knee exposure will change the flexion balance to result in a uniform medial-lateral flexion gap symmetry at the time of implant placement. METHODS Ten cadaveric knees were prepared for TKA using standard medial parapatellar approach. Medial and lateral flexion gaps were measured in the conditions of intact, partial (50%) resection, and full resection of PCL. Measurements were performed with both surgical navigation and a caliper. Flexion gap distances were reported for medial and lateral compartments in the 3 PCL conditions. RESULTS Medial flexion gap increased after only complete release of the PCL (mean 3.94-5.05 mm). The lateral flexion gap increased as well (mean 4.17-4.67 mm). Complete PCL release resulted in a statistically significant increase in medial flexion gap compared to intact (P = .013) and partially released (P = .012) specimens. No significant differences were noted in lateral flexion gap change. Notable change in medial versus lateral gap (flexion gap symmetry) relationship occurred after just partial PCL release (P = .018). CONCLUSION Among the 3 PCL states, changes in flexion gap distance were most conspicuous in the medial compartment. This suggests gap balancing performed with incomplete PCL release will not accurately reflect gap distance after eventual PCL removal, thus supporting the hypothesis. It is recommended that the PCL should be released to the fullest extent possible before ligament tensioning for femoral component rotation in posterior-stabilized TKA.
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Affiliation(s)
- Derrick A Foge
- Department of Orthopedics, University of Colorado Hospital, Aurora, CO
| | - Todd H Baldini
- Department of Orthopedics, University of Colorado Hospital, Aurora, CO
| | | | - Craig A Hogan
- Department of Orthopedics, University of Colorado Hospital, Aurora, CO
| | - Michael R Dayton
- Department of Orthopedics, University of Colorado Hospital, Aurora, CO
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Kawaguchi K, Michishita K, Manabe T, Akasaka Y, Arakawa T, Higuchi J. Mucoid degeneration of the cruciate ligaments in osteoarthritis under primary total knee arthroplasty. Asia Pac J Sports Med Arthrosc Rehabil Technol 2018; 12:1-4. [PMID: 29963370 PMCID: PMC6022358 DOI: 10.1016/j.asmart.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/09/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023] Open
Abstract
Mucoid degeneration of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with osteoarthritis is rarely reported. We experienced two knee osteoarthritic patients who had symptomatic mucoid degeneration of their ACL, and their PCL was also diagnosed as mucoid degeneration in histological evaluation. Preoperative radiological evaluation could not reveal precisely whether the degeneration had extended to the PCL. We obtained good clinical results treating them with posterior-stabilized (PS) total knee arthroplasty (TKA) sacrificing both ligaments. In cases of osteoarthritis with mucoid degenerated ACL, PS TKA should be considered, sacrificing both cruciate ligaments, because mucoid degeneration might expand both cruciate ligaments.
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Affiliation(s)
- Kohei Kawaguchi
- Orthopaedic Department, Japan Community Healthcare Organization, Yugawara Hospital, Japan
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10
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Martins GC, Camanho G, Rodrigues MI, Filho LFM, Demange MK. Histopathological analysis of the posterior cruciate ligament in primary osteoarthritis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:691-699. [PMID: 29417349 DOI: 10.1007/s00590-018-2136-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/04/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND According to some authors, the indication of an arthroplasty maintaining the posterior cruciate ligament (PCL) demands adequate structural preservation and proprioceptive function of this ligament. The nervous fibers contained in the synovial neurovascular bundle (NVB) around the PCL are involved in proprioception. A study evaluating the grade of PCL and NVB degeneration by using clinical, radiological, and perioperative parameters in knee arthritis patients, in theory, could help surgeons in the decision of preserving or not preserving the PCL in a particular patient. QUESTIONS (1) Can the degree of the PCL collagen fibers degeneration be predicted by clinical, radiographic, and perioperative parameters in knee arthritis patients? (2) Is the NVB histological degeneration status predictable using clinical, radiographic, and perioperative parameters in the same subset of patients? (3) Is there a correlation between the degree of the PCL collagen fibers degeneration and NVB status in knee arthritis patients? METHODS Eighty-nine PCLs (85 patients) obtained from total knee replacement surgery were studied. The histologic degeneration of PCL collagen fibers and the NVB status (preserved, degenerated, not detected) were evaluated. These histological degeneration patterns were correlated with clinical and radiographic parameters and with anterior cruciate ligament (ACL) status. RESULTS A small prevalence of preserved NVB was related to Grades IV and V of Ahlbäck's classification, ACL absence, and severe PCL degeneration. The clinical and radiological parameters studied were not able to predict the grade of histological degeneration of the PCL. CONCLUSIONS Ahlbäck's classification and ACL status provided useful information about NVB integrity. LEVEL OF EVIDENCE Basic Science Level IV.
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Affiliation(s)
- Glaucus Cajaty Martins
- Department of Orthopedics and Traumatology, Hospital Federal de Ipanema, Rua: Anita Garibaldi, 29 ap 201, Rio de Janeiro, RJ, CEP: 22041080, Brazil.
| | - Gilberto Camanho
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of Sao Paulo (IOT/HC/FMUSP), Avenida Ovidio Pires de Camargo 303, São Paulo, SP, CEP: 22411020, Brazil
| | - Mara Ibis Rodrigues
- Department of Histology, Faculty of Medicine, University of the State of Rio de Janeiro (UERJ), Boulevard 28 de Setembro 77, Rio de Janeiro, RJ, CEP: 20551030, Brazil
| | | | - Marco Kawamura Demange
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of Sao Paulo (IOT/HC/FMUSP), Avenida Ovidio Pires de Camargo 303, São Paulo, SP, CEP: 22411020, Brazil
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11
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Ashraf M, Sharma OP, Priyavadhana S, Sambandam SN, Mounasamy V. Rationale of Cruciate Retaining Design in Rheumatoid Arthritis: A Review of Clinical Analysis and its Role in Rheumatoid Arthritis. Open Orthop J 2017; 11:1023-1027. [PMID: 29114338 PMCID: PMC5646171 DOI: 10.2174/1874325001711011023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/01/2017] [Accepted: 07/18/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Over the years, proponents of total knee designs (cruciate retaining and posterior stabilised) have conducted several long-term
studies to claim the potential of these designs in several subsets of patients. Total knee arthroplasty (TKA)
in patients with rheumatoid arthritis has also been one such domain where numerous studies were conducted in the past.
A general perception among majority of arthroplasty surgeons is that, posterior stabilised (PS) is the implanted design
of choice among patients with Rheumatoid arthritis (RA). However, with the available literature there is a significant
disparity related to the selection of implants in patients with rheumatoid RA. In this review of literature, an attempt is made
to identify the clinical performance and role of one such implant design, the cruciate retaining (CR) prosthesis in rheumatoid arthritis. Method: The review was conducted after a series of advanced search in the following medical databases; Pub med, Biomed central, Cochrane
and Google scholar for articles related to long term follow up studies of cruciate retaining total knee arthroplasty in rheumatoid
arthritis using the keywords cruciate retaining prosthesis, total knee arthroplasty, rheumatoid arthritis. Results: The
available data demonstrate that the CR design is attributed with an excellent long term survivorship and functional outcome even in
follow up studies up to twenty-five years. Conclusion: The advantages of using a CR design are long term survivorship, controlled
femoral roll back and preservation of bone stock. Thus, the data gathered in this review lead to a consideration that the CR design is an implant
design on par with PS design in patients with RA.
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Affiliation(s)
- Munis Ashraf
- Department of Orthopedic Surgery, KG Hospital and Post Graduate Medical Institute. Coimbatore, Tamil Nadu, India
| | - Om Prakash Sharma
- Department of Orthopedic Surgery, KG Hospital and Post Graduate Medical Institute. Coimbatore, Tamil Nadu, India
| | - Sruthi Priyavadhana
- Department of Orthopedic Surgery, KG Hospital and Post Graduate Medical Institute. Coimbatore, Tamil Nadu, India
| | - Senthil Nathan Sambandam
- Department of Orthopedic Surgery, KG Hospital and Post Graduate Medical Institute. Coimbatore, Tamil Nadu, India
| | - Varatharaj Mounasamy
- Department of Orthopedic Surgery, KG Hospital and Post Graduate Medical Institute. Coimbatore, Tamil Nadu, India
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Hunt NC, Ghosh KM, Blain AP, Rushton SP, Longstaff LM, Deehan DJ. No statistically significant kinematic difference found between a cruciate-retaining and posterior-stabilised Triathlon knee arthroplasty. Bone Joint J 2015; 97-B:642-8. [DOI: 10.1302/0301-620x.97b5.34999] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to compare the maximum laxity conferred by the cruciate-retaining (CR) and posterior-stabilised (PS) Triathlon single-radius total knee arthroplasty (TKA) for anterior drawer, varus–valgus opening and rotation in eight cadaver knees through a defined arc of flexion (0º to 110º). The null hypothesis was that the limits of laxity of CR- and PS-TKAs are not significantly different. The investigation was undertaken in eight loaded cadaver knees undergoing subjective stress testing using a measurement rig. Firstly the native knee was tested prior to preparation for CR-TKA and subsequently for PS-TKA implantation. Surgical navigation was used to track maximal displacements/rotations at 0º, 30º, 60º, 90º and 110° of flexion. Mixed-effects modelling was used to define the behaviour of the TKAs. The laxity measured for the CR- and PS-TKAs revealed no statistically significant differences over the studied flexion arc for the two versions of TKA. Compared with the native knee both TKAs exhibited slightly increased anterior drawer and decreased varus-valgus and internal-external roational laxities. We believe further study is required to define the clinical states for which the additional constraint offered by a PS-TKA implant may be beneficial. Cite this article: Bone Joint J 2015; 97-B:642–8.
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Affiliation(s)
- N. C. Hunt
- Newcastle University, Newcastle-upon-Tyne
NE1 7RU, UK
| | - K. M. Ghosh
- Freeman Hospital, High
Heaton, Newcastle-upon-Tyne NE7 7DN, UK
| | - A. P. Blain
- Newcastle University, Newcastle-upon-Tyne
NE1 7RU, UK
| | - S. P. Rushton
- Newcastle University, Newcastle-upon-Tyne
NE1 7RU, UK
| | | | - D. J. Deehan
- Freeman Hospital, High
Heaton, Newcastle-upon-Tyne NE7 7DN, UK
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