Correlation between preoperative and postoperative knee kinematics in total knee arthroplasty using cruciate retaining designs

Abstract

The authors evaluated the relationships between preoperative and postoperative kinematics in 50 osteoarthritic knees scheduled for cruciate retaining total knee arthroplasty with regards to posterior femoral roll back and external femoral rotation using a navigation system from 10°to 120°of knee flexion. Although posterior femoral roll back was maintained, external femoral rotation was significantly decreased compared to those of the preoperative knee after total knee arthroplasty. However, the amount of posterior roll back and external femoral rotation after total knee arthroplasty were found to be significantly positively related to those measured preoperatively (r=0.62 and 0.57, respectively). These significant kinematic correlations may explain why preoperative range of knee motion influences range of motion after total knee arthroplasty.

Patients with no functional improvement after total knee arthroplasty show different kinematics

“…Patients presenting with deterioration of function scores had rotational mismatch of 10°or more and significantly less femoral external rotation during passive flexion (Tables 1 and 2). It has been demonstrated that knee kinematics is different after TKA [19] with decreased femoral external rotation [24] and altered patellar tracking [25]. Previous studies have demonstrated a link between component alignment and outcome [26][27][28][29][30][31].…”

Semimembranosus Release Reduces Tibial Internal Rotation and Flexion Angle in Cruciate-Retaining Total Knee Arthroplasty

“…The tibial rotational axis was defined along the line from the medial border of the tibial tubercle to the middle of the posterior cruciate ligament [24]. Tibial rotation was defined as the relative displacement of the origin of the tibial coordinate system in relation to the origin of the femoral coordinate system as described previously [8,25]. The kinematic assessment were performed in 25 knees at 3 points; (1) after ACL resection (pre-release), (2) after medial tibial and femoral osteophyte removal and release of minimum deep layer of MCL (minimum release) and (3) partial release of semimembranosus tendon and posterior capsule (semimembranosus release).…”

“…In addition, intraoperative kinematic assessment with a navigation system showed a close relationship between tibial internal rotation and soft tissue balance assessed by the tensor; the amount of tibial internal rotation during flexion showed positive correlation with varus ligament balance (lateral laxity) and joint component gap at flexion in CR TKA [7]. Furthermore, tibial internal rotation is reported to be important for acquisition of postoperative high flexion angle [8,9]. Whereas surgeons began to realize intraoperative pattern of soft tissue balance in TKA to date, achievement of proper tibial internal rotation leading to medial stability may be the next step to just an assessment of intraoperative soft tissue balance.…”

In vivo function of posterior cruciate ligament before and after posterior cruciate ligament-retaining total knee arthroplasty

“…PCL retention is mainly based on the assumption that the retained PCL facilitates the femoral rollback and therefore increases range of motion (ROM) of the knee and moment arm of the quadriceps [6,14]. However, various studies have found that knee kinematics and ROM after PCL-retaining TKA are significantly different from the native knee [4,22,23]. Many clinical studies show that postoperative outcomes, including ROM, stability, loosening rate, gait and patient satisfaction level are similar between patients receiving PCL-retaining TKA with or without the PCL [6,13,17].…”