Elongation of the collateral ligaments after cruciate retaining total knee arthroplasty and the maximum flexion of the knee

Park, Kwan Kyu; Hosseini, Ali; Tsai, Tsung‐Yuan; Kwon, Young‐Min; Li, Guoan

doi:10.1016/j.jbiomech.2014.12.036

Cited by 11 publications

(13 citation statements)

References 47 publications

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“…29 The only study that investigated length-change patterns of the collateral ligaments in TKA subjects was performed by Park and co-workers. 37 Here, the post-TKA MCL and LCL length-change patterns during singlelegged lunge were very similar to those reported for healthy knees. 38 However, all of these studies have used stationary fluoroscopy which clearly limits the imaging capture volume, and thus the range of activities that can be investigated.…”

Section: Introductionsupporting

confidence: 85%

“…The few studies that have assessed in vivo length-change patterns of the MCL and LCL have generally exploited image-based approaches, combining static video-fluoroscopy and 3D modelling of the knee joint in order to track the relative movement of the ligament attachment sites, and thereby estimate their length-change patterns. 29,37,38 Here, Park and co-workers measured healthy subjects per-forming a forward lunge activity and reported slight lengthening of the MCL anterior bundle and shortening of the MCL posterior bundle and LCL with increasing knee flexion. 38 Using a similar approach, Liu and co-workers assessed the stance phase of treadmill walking in healthy subjects and found a positive relationship between the length of the MCL anterior bundle and the knee flexion angle, whereas a shortening of the posterior bundle was observed.…”

Section: Introductionmentioning

confidence: 85%

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Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

Nasab

Schütz

et al. 2020

Ann Biomed Eng

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This study aimed to quantify the elongation patterns of the collateral ligaments following TKA during functional activities of daily living. Using mobile videofluoroscopy to capture radiographic images of the knee in a group of six patients, each with an ultra-congruent knee implant, tibiofemoral kinematics were reconstructed throughout complete cycles of level gait, downhill walking, stair descent, and squat activities. Kinematic data were then used to drive subject-specific multibody knee models to estimate length-change patterns of the LCL as well as three bundles of the MCL. In addition, a sensitivity analysis examined the role of the attachment site in the elongation patterns. Our data indicate a slackening of the LCL but nonuniform length-change patterns across the MCL bundles (ranging from lengthening of the anterior fibers to shortening of the posterior fibers) with increasing knee flexion angle. Near-isometric behavior of the intermediate fibers was observed throughout the entire cycle of the studied activities. These length-change patterns were found to be largely consistent across different activities. Importantly, lengthchange patterns were critically sensitive to the location of the femoral attachment points relative to the femoral component. Thus, in TKA with ultra-congruent implants, implantation of the femoral component may critically govern postoperative ligament function.

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Section: Introductionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 85%

Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

Nasab

Schütz

et al. 2020

Ann Biomed Eng

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“…However, cadaveric studies is limited as the in‐vitro testing condition cannot properly simulate in‐vivo physiological knee performances . In this study, the ACL and PCL length measurement under in‐vivo conditions was performed using a previously published technique . The ACL and PCL attachment areas on the BCR TKA and non‐operated knees were first determined at each flexion angle.…”

Section: Methodsmentioning

confidence: 99%

“…The ACL and PCL attachment areas on the BCR TKA and non‐operated knees were first determined at each flexion angle. An optimization procedure was implemented to find the shortest 3D wrapping path of each bundle of ACL and PCL portion during STS, and the lengths of each portion were determined . Following that, determination of the wrapping length (ɭ) of each bundle of ACL and PCL during STS was performed.…”

Section: Methodsmentioning

confidence: 99%

In‐vivo elongation of anterior and posterior cruciate ligament in bi‐cruciate retaining total knee arthroplasty

Tsai

Liow

Peng

et al. 2018

Journal Orthopaedic Research

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Anterior and posterior cruciate ligament (ACL and PCL) sacrifice in contemporary total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal knee kinematics. Bi-cruciate retaining (BCR) TKA design allows retention of both ACL and PCL. However, there is a limited data on the ACL/PCL in-vivo elongation characteristics of BCR TKA. The study aimed to evaluate and compare the in-vivo elongation patterns of ACL/PCL between BCR TKA and contralateral non-implanted knee and to explore potential factors leading to the changed elongation patterns between limbs. ACL/PCL elongations of both knees during sit-to-stand were measured in 29 unilateral BCR TKA patients using a validated dual fluoroscopic tracking technique. Joint gap changes of the BCR TKA knees relative to the contralateral knee were quantified. BCR TKA and the contralateral non-implanted knee exhibited similar ACL elongation at extension and clinical anterior knee laxity. However, BCR TKA showed significantly greater PCL elongation during flexion than the non-implanted knee. Variation of changed elongation was observed for both ACL and PCL, suggesting a heterogeneous restoration of normal ACL/PCL functions. A significant correlation was found between extension joint gap change and the change of ACL elongation, highlighting the importance of precise joint line restoration and soft tissue balancing during BCR TKA surgery. Our findings suggest that BCR TKA did not fully restore "near-normal" cruciate ligament elongation patterns and anteroposterior stability. Considerable heterogeneity remains in the retained ligament elongation patterns and warrants further investigations of multifactorial factors to optimize ACL/PCL functions in BCR TKA. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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“…Our previous study revealed that the elongation of the anterior collateral ligament bundles was significantly increased at high flexion angles of the knee after the CR TKA, implying tightening of the knee. 36 Therefore, an increase in posterior tibiofemoral space at deep knee flexion, although may delay tibiofemoral impingement, may not help promote the flexion capability of the knee. Instead, an increase of PCO could limit the maximal flexion of the knee.…”

Section: Discussionmentioning

confidence: 99%

Posterior Condyle Offset and Maximum Knee Flexion Following a Cruciate Retaining Total Knee Arthroplasty

et al. 2018

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Inconsistent data has been reported on the effect of the femoral posterior condyle offset (PCO) on the maximal knee flexion after total knee arthroplasty (TKA). This study investigated the relationship between the postoperative changes of the PCO and the changes of maximal knee flexion after a cruciate retaining (CR) TKA. Nine patients with medial osteoarthritis (OA) in one knee were investigated. Before operation, each index knee was magnetic resonance imaging (MRI) scanned for construction of a three-dimensional (3D) knee model. The patient then performed a maximal weight-bearing (WB) flexion and the index knee flexion was measured using a dual fluoroscopy technique. At an average of 8 months after a CR TKA, all patients performed the same WB knee flexion. The postoperative changes of the PCO, the posterior cruciate ligament (PCL) elongation, and the posterior tibial slope (PTS) were determined. The postoperative changes of maximal knee flexion were determined by comparing with the preoperative maximal flexion angles of the knee. The correlations of the postoperative changes of PCO and PTS with the postoperative changes of the maximal flexion angle and PCL elongation of the knee were analyzed. The preoperative PCO (28.5 ± 4.5 mm) was significantly smaller than the postoperative PCO (31.1 ± 5.1 mm) ( < 0.05). The increasing of PCO after surgery is correlated with the decreasing of maximal knee flexion angle ( = 0.74) and the increasing of PCL elongation ( = 0.64) after the TKA. The PTS was not found to change significantly after the TKA and was not significantly correlated to the maximal knee flexion angle and PCL elongation. The postoperative increases of the PCO were shown to cause overstretching of the PCL and poor flexion angle of the knee after the CR TKA. Restoration of PCO could help optimize the maximal flexion of the knee after the TKA with consideration about PCL tension.

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Elongation of the collateral ligaments after cruciate retaining total knee arthroplasty and the maximum flexion of the knee

Cited by 11 publications

References 47 publications

Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

In‐vivo elongation of anterior and posterior cruciate ligament in bi‐cruciate retaining total knee arthroplasty

Posterior Condyle Offset and Maximum Knee Flexion Following a Cruciate Retaining Total Knee Arthroplasty

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