ACL substitution may improve kinematics of PCL-retaining total knee arthroplasty

Chen

et al. 2020

Proc Inst Mech Eng H

Bi-cruciate retaining total knee arthroplasty has several potential advantages including improved anteroposterior knee stability compared to contemporary posterior cruciate-retaining total knee arthroplasty. However, few studies have explored whether there is significant differences of knee biomechanics following bi-cruciate retaining total knee arthroplasty compared to posterior cruciate-retaining total knee arthroplasty. In the present study, subject-specific lower extremity musculoskeletal multi-body dynamics models for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty were developed based on the musculoskeletal modeling framework using force-dependent kinematics method and validated against in vivo telemetric data. The experiment data of two subjects who underwent total knee arthroplasty were obtained for the SimTK “Grand Challenge Competition” repository, and integrated into the musculoskeletal model. Five walking gait trials for each subject were used as partial inputs for the model to predict the knee biomechanics for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty. The results revealed significantly greater range of anterior/posterior tibiofemoral translation, and significantly more posterior tibial location during the early phase of gait and more anterior tibial location during the late phase of gait were found in bi-cruciate retaining total knee arthroplasty without anterior cruciate ligament when compared to the bi-cruciate retaining total knee arthroplasty. No significant differences in tibiofemoral contact forces, rotations, translations, and ligament forces between bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty during normal walking gait, albeit slight differences in range of tibiofemoral internal/external rotation and anterior/posterior translation were observed. The present study revealed that anterior cruciate ligament retention has a positive effect on restoring normal knee kinematics in bi-cruciate retaining total knee arthroplasty. Preservation of anterior cruciate ligament in total knee arthroplasty and knee implant designs interplay each other and both contribute to restoring normal knee kinematics in different types of total knee arthroplasty. Further evaluation of more demanding activities and subject data from patients with bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty via musculoskeletal modeling may better highlight the role of the anterior cruciate ligament and its stabilizing influence.

Section: Introductionmentioning

confidence: 99%

Leveraging subject-specific musculoskeletal modeling to assess effect of anterior cruciate ligament retaining total knee arthroplasty during walking gait

Chen

et al. 2020

Proc Inst Mech Eng H

BioMed Research International

“…Recent computational studies supported the finding that bicruciate retaining TKA exhibited more normal-like knee kinematics [ 17 , 59 ]. Furthermore, Zumbrunn et al reported that the absence of ACL function is linked to abnormal kinematics and joint stability in patients with conventional TKA [ 60 ]. Moreover, ACL-substituting TKA could be a valuable option to overcome the limitations of conventional TKA, especially, when it is not possible to retain the native ACL [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Zumbrunn et al reported that the absence of ACL function is linked to abnormal kinematics and joint stability in patients with conventional TKA [ 60 ]. Moreover, ACL-substituting TKA could be a valuable option to overcome the limitations of conventional TKA, especially, when it is not possible to retain the native ACL [ 60 ]. Van Duren et al also used image analysis and reported that bicruciate stabilized TKA did not exhibit any paradoxical anterior movement and sufficient posterior femoral roll back that corresponded to the engagement of the anterior and posterior post-cam mechanisms [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Post-Cam Design for Normal Knee Joint Kinematic, Ligament, and Quadriceps Force in Patient-Specific Posterior-Stabilized Total Knee Arthroplasty by Using Finite Element Analysis

Koh

Son

Kwon

et al. 2018

The purpose of this study is to investigate post-cam design via finite element analysis to evaluate the most normal-like knee mechanics. We developed five different three-dimensional computational models of customized posterior-stabilized (PS) total knee arthroplasty (TKA) involving identical surfaces with the exception of the post-cam geometry. They include flat-and-flat, curve-and-curve (concave), curve-and-curve (concave and convex), helical, and asymmetrical post-cam designs. We compared the kinematics, collateral ligament force, and quadriceps force in the customized PS-TKA with five different post-cam designs and conventional PS-TKA to those of a normal knee under deep-knee-bend conditions. The results indicated that femoral rollback in curve-and-curve (concave) post-cam design exhibited the most normal-like knee kinematics, although the internal rotation was the closest to that of a normal knee in the helical post-cam design. The curve-and-curve (concave) post-cam design showed a femoral rollback of 4.4 mm less than the normal knee, and the helical post-cam design showed an internal rotation of 5.6° less than the normal knee. Lateral collateral ligament and quadriceps forces in curve-and-curve (concave) post-cam design, and medial collateral ligament forces in helical post-cam design were the closest to that of a normal knee. The curve-and-curve (concave) post-cam design showed 20% greater lateral collateral ligament force than normal knee, and helical post-cam design showed medial collateral ligament force 14% greater than normal knee. The results revealed the variation in each design that provided the most normal-like biomechanical effect. The present biomechanical data are expected to provide useful information to improve post-cam design to restore normal-like knee mechanics in customized PS-TKA.

Mechanical Engineering Reviews

“…The decreased contact stress on the opposite compartment may reduce the overall risk of progressive osteoarthritis (Kang, Son, Suh, Kwon, Kwon and Koh, 2018k). Studies on biomimetic TKA were also conducted using an MBD model (Varadarajan et al, 2015a;Varadarajan et al, 2015b;Zumbrunn et al, 2018;Zumbrunn et al, 2015). These studies demonstrated that the biomimetic-CR showed medial pivot motion, while other CR implants showed abnormal motion including lateral or no pivot, and paradoxical anterior sliding during deep knee bend and chairsitting (Varadarajan, Zumbrunn, Rubash, Malchau, Li and Muratoglu, 2015a).…”

Section: Application Of Computational Simulation In Knee Arthroplastymentioning

confidence: 99%

“…In addition, restoring native knee geometry with ACL preservation provided kinematic improvements over contemporary ACL-preserving and ACL-sacrificing implants (Zumbrunn, Varadarajan, Rubash, Malchau, Li and Muratoglu, 2015). In other words, many studies stated that prosthetic design with native knee anatomy is required to preserve native knee kinematics (Kang, Son, Suh, Kwon, Kwon and Koh, 2018k;Koh, Lee, Chung and Kang, 2019a;Koh, Nam and Kang, 2018a;Koh, Son, Kwon, Kwon and Kang, 2018b;Koh, Son, Kwon, Kwon and Kang, 2018c;Varadarajan, Zumbrunn, Rubash, Malchau, Li and Muratoglu, 2015a;Varadarajan, Zumbrunn, Rubash, Malchau, Muratoglu and Li, 2015b;Zumbrunn, Duffy, Rubash, Malchau, Muratoglu and Varadarajan, 2018;Zumbrunn, Varadarajan, Rubash, Malchau, Li and Muratoglu, 2015). ACL-substituting implants could be an effective surgical treatment capable of overcoming the limitations of contemporary TKA, especially in cases Kang, Koh, Lee and Chun, Mechanical Engineering Reviews, Vol.7, No.1 (2020) [DOI: 10.1299/mer.…”

Section: Application Of Computational Simulation In Knee Arthroplastymentioning

confidence: 99%

Computational biomechanics of knee joint arthroplasty : a review

Kang

Koh

Lee

et al. 2020

Computational models have been widely used for more than four decades to evaluate the mechanical behavior of knee joint arthroplasty. Validated computational models provide a virtual platform to develop optimal articular surfaces which achieve desired implant characteristics. This review paper provides a comprehensive overview of the computational models available to represent knee joint arthroplasty. A brief overview of knee joint anatomy and arthroplasty is provided, followed by computational model development techniques. Use of the computational models in development of knee joint arthroplasty and pre-or post-clinical evaluation is summarized. This review paper presents current modeling capabilities for implant design and stability, with further suggestions for studying the performance of implants on a population level. However, simulations must include closely corroborated multi-domain analysis in order to account for real-life variability.