Diagnostic Algorithm in Patients with Flexion Instability after Cruciate-Retaining Total Knee Arthroplasty: A Case Report

Moser, Lukas B.; Prabhakar, Ponnaian; Hess, Silvan; Hirschmann, Michael T.

doi:10.3390/clinpract11030084

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…A patellar overload can suggest an abnormal posterior tibial translation. 10 Based on our reported case, we recommend immediate close reduction, comprehensive vascular assessment followed for trans-articular external fixator for three weeks followed for rigid brace locked in extension to walk. We understand that every case should be individually addressed based on its primary intraoperative report, radiologic assessment, and clinical examination.…”

Section: Discussionmentioning

confidence: 92%

“…A sobrecarga patelar pode indicar a translação posterior anormal da tíbia. 10 Com base em nosso relato, recomendamos redução fechada imediata, avaliação vascular abrangente, uso de fixador externo transarticular por 3 semanas e, a seguir, uso de órtese rígida travada em extensão para deambulação. Entendemos que cada caso deve ser tratado individualmente conforme o avaliação inicial intraoperatória, a avaliação radiológica e o exame clínico.…”

Section: Discussionunclassified

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Tratamento não invasivo após luxação traumática anterior do joelho em artroplastia total de joelho com preservação do ligamento cruzado posterior: Relato de caso

Pires e Albuquerque,

Vivacqua,

de Faria

et al. 2024

Rev Bras Ortop (Sao Paulo)

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ResumoO caso relatado descreve uma luxação anterior traumática do joelho que era assintomática após uma artroplastia primária da articulação com preservação do ligamento cruzado posterior. A paciente descrita rolou acidentalmente sobre o joelho 6 anos após a intervenção cirúrgica. A luxação anterior traumática após artroplastia do joelho é um evento incomum, muitas vezes levando à revisão dos componentes protéticos devido às lesões ligamentares associadas. Uma abordagem não invasiva, composta por fixação externa temporária e um curto período de uso de joelheira rígida, foi realizada com sucesso.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionunclassified

Tratamento não invasivo após luxação traumática anterior do joelho em artroplastia total de joelho com preservação do ligamento cruzado posterior: Relato de caso

Pires e Albuquerque,

Vivacqua,

de Faria

et al. 2024

Rev Bras Ortop (Sao Paulo)

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“…Once the PCL failed the flexion gap no longer remained balanced allowing increased sagittal plane translation. 30 , 31 …”

Section: Discussionmentioning

confidence: 99%

Stress Radiograph Confirmation of Translational Instability After Cruciate-Retaining Total Knee Arthroplasty

Shah¹,

Hauschild²,

Hope³

et al. 2022

JAAOS Glob Res Rev

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Introduction:Late rupture of the posterior cruciate ligament (PCL) in cruciate-retaining total knee arthroplasty (TKA) can lead to increased AP instability. This results in increased stress on the medial hamstrings resulting in hamstring-based pain. We looked to identify patients with late PCL failure using a lateral stress radiograph.Methods:A prospective cohort analysis was completed at a single institution. Eligible patients were divided into two groups based on the amount of anterior knee pain. Pain was defined as a visual analog scale of greater than or equal to 3. Each group completed a visual analog scale, Knee Injury and Osteoarthritis Outcome Score Junior, Patient-Reported Outcome Measurement Information System score and underwent a lateral posterior stress/nonstress radiograph. Amount of posterior translation and posterior tibial slope was measured.Results:Patients who had painful TKAs at the follow-up had lower Knee Injury and Osteoarthritis Outcome Score Junior (45.86 ± 13.52 versus 78.00 ± 13.26 P < 0.001). Those patients were also found to have significantly higher posterior tibial translation with stress radiograph (6.89 ± 1.874 versus 3.91 ± 2.15 mm P < 0.001) and significantly increased tibial slope (6.51 ± 2.37° versus 3.98 ± 1.79°, P = 0.004). Seven of the 14 patients in the pain group underwent revision surgery, with 6 patients found to have incompetent PCLs.Discussion:Patients with increased AP translation and increased posterior tibial slope after cruciate-retaining TKA are likely to have worse pain and outcome measures.

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“…This might be because clinical examination and standard radiographs are often not sensitive enough to detect a PCL insufficiency [4]. Stress radiographs (30 • and 90 • flexion) are the gold standard in the quantification of posterior instability [12][13][14]. As the PCL performs its stabilizing function mainly between 60 • and 120 • flexion, posterior drawer testing at 30 • flexion may not accurately show anteroposterior instability [15].…”

Section: Introductionmentioning

confidence: 99%

Stress Radiographs in the Posterior Drawer Position at 90° Flexion Should Be Used for the Evaluation of the PCL in CR TKA with Flexion Instability

Moser

Koch

Hess

et al. 2022

JCM

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The purpose of this study was to define a cut-off value for the posterior drawer position in stress radiography that confirms an insufficiency of the posterior cruciate ligament (PCL) in cruciate-retaining (CR) total knee arthroplasty (TKA). In this retrospective study, 20 symptomatic patients with flexion instability and suspected PCL insufficiency in CR TKA were included. Asymptomatic patients served as an age- and sex-matched control group. All of the patients had undergone stress radiography, and the posterior translation was measured in a posterior drawer position at 30° and 90° flexion. The two groups were compared using t-tests and chi-square tests. The stress radiographs showed significantly more posterior translation in the symptomatic group (p < 0.01). Stress radiographs at 90° flexion more effectively discriminated between the patients with and without PCL insufficiency compared with those carried out at 30° flexion. Sensitivity and specificity testing revealed the best sensitivity (90.5%) and the best specificity (94.7%) at 90° posterior drawer radiographs at a cut-off value of 10 mm. Stress radiographs including the posterior drawer position at 90° flexion should be part of the diagnostic algorithm in patients with suspected flexion instability. A posterior translation of more than 10 mm in CR TKA strongly indicates an insufficiency of the PCL.

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Diagnostic Algorithm in Patients with Flexion Instability after Cruciate-Retaining Total Knee Arthroplasty: A Case Report

Cited by 4 publications

References 14 publications

Tratamento não invasivo após luxação traumática anterior do joelho em artroplastia total de joelho com preservação do ligamento cruzado posterior: Relato de caso

Tratamento não invasivo após luxação traumática anterior do joelho em artroplastia total de joelho com preservação do ligamento cruzado posterior: Relato de caso

Stress Radiograph Confirmation of Translational Instability After Cruciate-Retaining Total Knee Arthroplasty

Stress Radiographs in the Posterior Drawer Position at 90° Flexion Should Be Used for the Evaluation of the PCL in CR TKA with Flexion Instability

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