Importance of Retention of Posterior Cruciate Ligament

Dorr, Lawrence D.; Scott, Richard D.; Ranawat, Chitranjan S.

doi:10.1007/978-1-4612-5050-0_24

Cited by 9 publications

(7 citation statements)

References 4 publications

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“…Therefore, in this study, changing the tibial slope of the tibial base plate alters the movement of the tibiofemoral contact point to a more physiologic movement especially at knee flexion angles greater than 80°. With these altered movements of relative femoral position and insert position relative to the tibial base plate, quadriceps lever arm should increase and quadriceps extension force needed to exert the same extension moment was reduced, especially in high knee flexion angles [5, 6, 24]. This should improve quadriceps function in walking, raising and stair climbing and should be recognized for postoperative mobilization of patients who undergo TKA.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, these patients showed abnormal functional adaptations and had more significant problems in stair climbing than in control subjects [6,7,23,24]. The inability to extend the knee as strongly as needed for walking, lifting, and chair and stair rising was one of the most often occurring biomechanical reasons for the revision of TKA [19].…”

Section: Introductionmentioning

confidence: 99%

“…After implantation of a total knee arthroplasty (TKA), patients were observed to have altered walking patterns with less flexion and a shorter swing phase in the operated knee [1–3]. Furthermore, these patients showed abnormal functional adaptations and had more significant problems in stair climbing than in control subjects [6, 7, 23, 24] . The inability to extend the knee as strongly as needed for walking, lifting, and chair and stair rising was one of the most often occurring biomechanical reasons for the revision of TKA [19].…”

Section: Introductionmentioning

confidence: 99%

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In vitro investigation of the influence of tibial slope on quadriceps extension force after total knee arthroplasty

Ostermeier

Hurschler

Stukenborg-Colsman

2006

Knee Surg Sports Traumatol Arthrosc

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The purpose of this study was to investigate the influence of tibial base plate angulation on knee kinematics and kinetics during knee arthroplasty. The amount of quadriceps force required to extend the knee and the anteroposterior displacement of a mobile bearing insert as well as tibiofemoral position were measured during an in vitro simulation of an isokinetic knee extension cycle. Human knee specimens (n = 7, mean age 62, range 52-75 years, all male) were tested in a kinematic knee simulating machine after total knee arthroplasty (TKA) with a mobile bearing insert prosthesis (Interax), Stryker/Howmedica). During simulation, a hydraulic cylinder applied sufficient force to the quadriceps tendon to produce an extension moment of 31 N m about the knee. The quadriceps load was measured using a load cell attached to the quadriceps tendon, the anteroposterior displacement of the mobile bearing insert as well as the relative tibiofemoral position was measured using an ultrasound base motion analysis system (CMS 100, Zebris). Quadriceps load, insert and tibial displacement were first investigated with the tibial base plate implanted with a neutral tibial base plate orientation, and subsequently after 10 degrees posterior angulation. The quadriceps forces needed to produce a 31 N m knee extension moment after TKA with neutral slope reached levels as high as 1,391 N (SD 82 N). After applying a posterior slope of 10 degrees , maximum quadriceps force was measured to be up to 1,303 N (SD 34 N, P = 0.04). The mobile bearing insert was observed to move up to 0.1 mm (SD 4.2 mm) anteriorly relative to the tibial base plate with neutral tibial slope, and up to 1.0 mm (SD 4.5 mm, P = 0.47) with tibial slope. Femoral position relative to the tibia moved from a posterior position of 13.1 mm (SD 4.0 mm) anteriorly up to 0.5 mm (SD 6.3 mm), and from 16.0 mm (SD 6.4 mm, P = 0.67) to 9.5 mm (SD 9.9 mm, P = 0.33) with a 10 degrees tibial slope. Posterior slope of the tibial base plate resulted in a more physiologic insert movement with a more posterior position of the femur and reduced quadriceps force especially in knee flexion angles above 60 degrees compared to TKA with a neutral slope of the tibial base plate. Thus, the data suggest that the quadriceps lever arm was improved, which might have positive effect in mobilization of patients after TKA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In vitro investigation of the influence of tibial slope on quadriceps extension force after total knee arthroplasty

Ostermeier

Hurschler

Stukenborg-Colsman

2006

Knee Surg Sports Traumatol Arthrosc

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“…

Long-term good results have been published with both posterior cruciate ligament (PCL) retaining design total knee replacement (TKR) and posterior-stabilized (PS) TKR [27,28,30]. Recent studies still show that this debate is not closed [29].Once the PCL is sacrificed, an alternative to PS implants is the deep-dished (DD) design, which has a deeply dished sagittal profile with an increased anterior lip to compensate the function of the PCL.

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mentioning

confidence: 99%

Assessment of posterior stability in total knee replacement by stress radiographs

Louisia¹,

Siebold²,

Canty³

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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The aim of this study was to assess the posterior stability of two different designs of total knee replacement (TKR) with deep-dished mobile bearing (MB) implants using stress X-rays. In a prospective non-randomized consecutive study, 34 patients with primary osteoarthritis of the knee underwent TKR. In group A (17 knees), they received a MB insert with a Duracon prosthesis and in group B (18 knees), a Genesis prosthesis. In all cases the posterior cruciate ligament (PCL) was resected. All patients had pre- and post-operative kneeling X-rays and were clinically evaluated with the Knee Society Score. Measurements on the radiographs were taken by tracing a line along the posterior cortex of the tibia and then measuring the perpendicular distance to a point marked at the posterior corner of Blumensaat's line. The average follow up was 10.7 months for group A and 5.4 months for group B. No statistical difference could be found in terms of clinical results and pre- and post-operative kneeling X-rays between the two groups. In each group, all knees demonstrated a significant posterior tibial translation postoperatively compare to their pre-operative status (p<0.0001). There are advantages in resecting the PCL in TKR: mobile flexion gap, correction of fixed deformity, more flexibility to adjust the joint line. The use of a deep dished polyethylene (PE) insert provides stability and use of MB insert reduces PE wear whilst retaining congruity. Two designs of deep-dished MB inserts showed significant posterior tibial translation on stress X-rays. It remains to be determined what amount of laxity is optimal for clinical function and polyethylene longevity.

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“…It may be better to preserve the posterior cruciate ligament, which will transfer stress directly to bone [28], but the posterior cruciate-retaining prostheses are more difficult to insert, especially in severely deformed knees. Various studies have suggested that the clinical results using the various prosthetic designs are essentially the same [9,24,25].…”

Section: Discussionmentioning

confidence: 99%

Posteriorly stabilised (Insall-Burstein) total condylar knee arthroplasty

Patel

Aichroth

Wand

1991

International Orthopaedics

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We reviewed 157knees in ll8patients who underwent posteriorly stabilised (Insall-Burstein) knee replacement arthroplasty. Their mean age at operation was 69years (range 47 to 85years) and the average follow-up was 3.5years (range 2 to 7years). The "BASK" knee function assessment chart was utilised to evaluate the functional and clinical results. One hundred and thirtyfive knees (86%) had excellent or good results, 16 knees (10%) had fair results and six (4%) had poor results. The mean postoperative B A S K score was 79 points and the average postoperative knee flexion was 95 ° (range 65 ° to 130°). Two patients had a superficial infection, one deep sepsis requiring revision arthroplasty and two mechanical loosening. Patellar impingement symptoms were present in 8% of the knees, although they were troublesome in less than half. Varus alignment of the knee and a varus tilt of the tibial component of more than 2 ° correlated with the incidence o f radiolucent lines around the tibial prosthesis. 90% of the patients were pleased or satisfied with the functional result. The total condylar knee is a safe, reliable and versatile prosthesis. R~sum& Nous avons revu 157 genoux chez 118 malades ayant bOnOficiO d'une arthroplastie par prothose semi-contrainte (Insall-Burstein). L ~ge moyen lots de l'op&ation btait de 69 ans (de 47 d 85) et le recul moyen Otait de 3 ans et demi (de 2 fi 7). Pour Ovaluer les rOsultats fonctionnels et cliniques, nous avons eu recours d l'Ochelle de cotation fonctionnelle ¢¢BASK)). Le r&ultat Otait excellent Reprint request to: P. M. Aichroth ou bon dans 135 genoux (86%), moyen dans 16 (10%) et mauvais dans 6 (4%). La cotation post-opdratoire ,¢BASK~ dtait en moyenne de 79 points et la flexion post-op&atoire moyenne de 95 ° (de 65 ° ~i 130°). Deux opdr& avaient pr&entb une infection superficielle, un seul un sepsis profond ayant nOces-sitO une reprise de l'arthroplastie et deux un descellement m&anique. Des signes d'hyperpression rotulienne pouvaient ~tre not& dans 8% des genoux mais ils n'avaient de traduction clinique que dans moins de la moitiO des cas. L'existence d'un liserO autour de la pi&e tibiale 6tait correlOe avec une dbsaxation du genou en varus ou avec un positionnement en varus du composant tibial sup&ieur d 2 °. La proth&e total-condylar est donc s~tre, efficace et susceptible de s'adapter aux diverses bventualit&.

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Importance of Retention of Posterior Cruciate Ligament

Cited by 9 publications

References 4 publications

In vitro investigation of the influence of tibial slope on quadriceps extension force after total knee arthroplasty

In vitro investigation of the influence of tibial slope on quadriceps extension force after total knee arthroplasty

Assessment of posterior stability in total knee replacement by stress radiographs

Posteriorly stabilised (Insall-Burstein) total condylar knee arthroplasty

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