Bi-cruciate stabilized total knee arthroplasty can reduce the risk of knee instability associated with posterior tibial slope

Hada, Masaru; Mizu-uchi, Hideki; Okazaki, Ken; Kaneko, Takao; Murakami, Koji; Ma, Yu; Hamai, Satoshi; Nakashima, Yasuharu

doi:10.1007/s00167-017-4718-0

Cited by 9 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Anterior engagement was identified in 54.5% of knees in WB and 36.3% in NWB, indicating that the articular surface of the BCS‐TKA design could influence anterior stability. In a simulation study, Hada et al [12] reported an absence of anterior engagement with a PTS of < 6°. In this study, the average PTS was 3.4 ± 2.7°, and this small PTS angle likely explains the low occurrence of anterior engagement.…”

Section: Discussionmentioning

confidence: 99%

Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities

Kono

Inui

Tomita

et al. 2019

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose Bicruciate‐stabilised total knee arthroplasty (BCS‐TKA) uses a dual‐post‐cam mechanism as a substitute for the anterior cruciate ligament and posterior cruciate ligament (PCL), with the surface geometry providing additional guidance for axial rotation and posterior translation. However, the effect of weight‐bearing on the kinematics of BCS‐TKA has not been investigated. Therefore, the aim of this study was to clarify the effect of weight‐bearing on the kinematics of BCS‐TKA during high‐flexion activities. Methods The kinematics of 11 BCS‐TKAs were evaluated under fluoroscopy, with two‐ and three‐dimensional image registration, during squatting weight‐bearing and active‐assisted knee flexion non‐weight‐bearing. The following variables were measured: knee range of motion, axis of femoral rotation relative to the tibial component, anteroposterior (AP) translation of the medial contact point, kinematic path of the joint surfaces, lateral femorotibial contact point, and anterior and post‐cam engagement. Results The weight‐bearing condition did not influence the range of knee flexion, axis of femoral rotation, medial pivot pattern during early flexion, or bicondylar rollback beyond mid‐flexion. With regard to AP translation, both the medial and lateral contact points had more posterior locations in weight‐bearing than in non‐weight‐bearing at the mid‐flexion angle. Anterior engagement was identified in 6/11 knees (54.5%) in weight‐bearing and 4/11 knees (36.3%) in non‐weight‐bearing. Post‐cam engagement was observed in all knees, with the angle of flexion at engagement being larger in weight‐bearing than in non‐weight‐bearing. Conclusion Although weight‐bearing resulted in a posterior location of the medial and lateral contact points of the BCS‐TKA design compared with non‐weight‐bearing in the mid‐range of knee flexion, the amount of anterior translation was small overall. Therefore, BCS‐TKA provides good stability during high‐flexion weight‐bearing activities. However, BCS‐TKA is associated with high rate of the anterior engagement during early flexion. Therefore, understanding a patient's activities is an important factor when selecting the most appropriate TKA method.

show abstract

Section: Discussionmentioning

confidence: 99%

Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities

Kono

Inui

Tomita

et al. 2019

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Contrarily, further studies 18,21,53,55 have reported continuous posterior translation due to increased tibial slopes. A higher posterior translation will lead to a greater lever arm of the quadriceps, which can be expected to improve motion efficiency, resulting in a reduced quadriceps force 21,24,53 . This can be explained with the resulting posterior force on the femur produced by an increased tibial slope and the gravity, thus locating the femur more posteriorly due to the ACL loss 58 .…”

Section: Discussionmentioning

confidence: 93%

“…In addition to intraoperative examinations, knee joint stability can be investigated using computational, experimental, or clinical studies. Although computational studies have shown great potential in clinical decision-making 11,12,17,18,21,38,45,48,53,54 , they are associated with uncertainties regarding the prediction of realistic contact conditions. On the other hand, experimental studies 16,24,26,34,36,55 lack the consideration of the complex soft tissue structures acting at the lower extremity.…”

Section: Discussionmentioning

confidence: 99%

Effect of surgical parameters on the biomechanical behaviour of bicondylar total knee endoprostheses – A robot-assisted test method based on a musculoskeletal model

Kebbach

Grawe

Geier

et al. 2019

Sci Rep

View full text Add to dashboard Cite

The complicated interplay of total knee replacement (TKR) positioning and patient-specific soft tissue conditions still causes a considerable number of unsatisfactory outcomes. Therefore, we deployed a robot-assisted test method, in which a six-axis robot moved and loaded a bicondylar cruciate-retaining (CR)-TKR in a virtual lower extremity emulated by a musculoskeletal multibody model. This enabled us to systematically analyse the impact of the posterior cruciate ligament (PCL), tibial slope, and tibial component rotation on TKR function while considering the physical implant components and physiological-like conditions during dynamic motions. The PCL resection yielded a decrease of femoral rollback by 4.5 mm and a reduction of tibiofemoral contact force by 50 N. A reduced tibial slope led to an increase of tibiofemoral contact force by about 170 N and a decrease of femoral rollback up to 1.7 mm. Although a higher tibial slope reduced the contact force, excessive tibial slopes should be avoided to prevent joint instability. Contrary to an external rotation of the tibial component, an internal rotation clearly increased the contact force and lateral femoral rollback. Our data contribute to improved understanding the biomechanics of TKRs and show the capabilities of the robot-assisted test method based on a musculoskeletal multibody model as a preoperative planning tool.

show abstract

“…The computer simulation study has shown that anterior contact between the anterior aspect of the tibial post- and femoral component was observed if the posterior tibial slope was 6° or more. 25 Unlike VERASENSE system, compressive force of anterior cam and post can be measured in the current study and cases with less than 6° of the posterior inclination of tibia did not engage with anterior cam and post, therefore, we should aim for the patient’s physiological posterior inclination of tibia to substitute for ACL.…”

Section: Discussionmentioning

confidence: 93%

The influence of tibiofemoral joint forces on patient-reported outcome measurements after bicruciate stabilized total knee arthroplasty

Kaneko

Kono

Mochizuki

et al. 2020

J Orthop Surg (Hong Kong)

Self Cite

View full text Add to dashboard Cite

Objective: Insall advocated that a successful clinical outcome of total knee arthroplasty (TKA) depends on soft tissue balance procedure. Spacer blocks, balancer, and instrumented tibial sensor (VERESENSE, OrthoSensor, Dania, Florida, USA) are the current methods of soft tissue balancing during TKA. The purpose of the study is to assess intraoperative medial and lateral tibiofemoral compressive force (TFCF) using novel insert sensor and investigate the relationship between TFCF and patient-reported outcome measurements (PROMs). Methods: Twenty-five patients who underwent bicruciate stabilized (BCS) TKA were evaluated retrospectively. We measured intraoperative medial and lateral TFCF in neutral position as well as the force ratio (FR %:medial TFCF/medial + lateral TFCF) in varus and valgus position using the novel insert sensor throughout the range of motion (ROM) and assessed the relationship between intraoperative medial and lateral TFCF and PROM at 6 months after TKA. Results: Medial TFCF increased and lateral TFCF decreased throughout ROM. The mean FR was 0.44% ± 0.22 throughout ROM. Medial and lateral TFCF differences at 60° of ROM in neutral position showed a positive correlation with physical function in Western Ontario and McMaster Universities scores ( r = 0.60, p < 0.05). Medial and lateral TFCF differences at 30° and 140° of ROM in valgus stress test showed a positive correlation with symptoms in 2011 Knee Society Scores ( r = 0.49, p < 0.05; r = 0.51, p < 0.05). Conclusion: The present study revealed that BCS TKA reproduces the coronal laxity, which is similar to healthy knee. These results suggest that intraoperative medial stability is important for function and symptoms, therefore, surgeons should not release medial soft tissue for achieving better clinical outcomes after BCS TKA. Level of Evidence: II

show abstract

Bi-cruciate stabilized total knee arthroplasty can reduce the risk of knee instability associated with posterior tibial slope

Cited by 9 publications

References 28 publications

Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities

Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities

Effect of surgical parameters on the biomechanical behaviour of bicondylar total knee endoprostheses – A robot-assisted test method based on a musculoskeletal model

The influence of tibiofemoral joint forces on patient-reported outcome measurements after bicruciate stabilized total knee arthroplasty

Contact Info

Product

Resources

About