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

Tsai, Tsung‐Yuan; Liow, Ming Han Lincoln; Peng, Yun; Arauz, Paul; Li, Guoan; Kwon, Young‐Min

doi:10.1002/jor.24132

Cited by 20 publications

(24 citation statements)

References 47 publications

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“…12 In addition, Tsai et al have reported overstretching of the PCL in BCR-TKA knees. 10 Higher ACL tension of knees after The Journal of Knee Surgery BCR-TKA may prevent posterior femoral rollback. Furthermore, in normal knee kinematics, a lateral pivot pattern was observed from early-flexion to mid-flexion during cross-leg.…”

Section: Figmentioning

confidence: 99%

“…[7][8][9] Tsai et al reported that BCR-TKA did not fully restore the cruciate ligament elongation patterns and anteroposterior stability of normal knees. 10 Moreover, several studies have demonstrated that the kinematics of knees that underwent BCR-TKA differed from that of normal knees during passive flexion, passive extension, sit-to-stand exercises, deep lunges, and stair climbing. [11][12][13] Arauz et al reported that these kinematic differences between BCR-TKA knees and normal knees might be attributed to the articular surface.…”

mentioning

confidence: 99%

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In Vivo Kinematics of Bicruciate-Retaining Total Knee Arthroplasty with Anatomical Articular Surface under High-Flexion Conditions

et al. 2019

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Bicruciate-retaining total knee arthroplasty (BCR-TKA) recreates normal knee movement by preserving the anterior cruciate and posterior cruciate ligaments. However, in vivo kinematics of BCR-TKA with the anatomical articular surface remains unknown. The objective of this study was to evaluate in vivo kinematics of BCR-TKA with the anatomical articular surface during high-flexion activities. For this purpose, 17 knees after BCR-TKA with an anatomical articular surface were examined. Under fluoroscopy, each patient performed squatting and cross-legged sitting motions. To estimate the spatial position and orientation of the knee, a two-dimensional or three-dimensional registration technique was used. Rotation, varus-valgus angle, and anteroposterior translation of medial and lateral contact points of the femoral component relative to the tibial component were evaluated in each flexion angle. The results showed that from 80 to 110° of flexion, the femoral external rotation during squatting was significantly larger than that during cross-legged sitting. At maximum flexion, the knees during sitting indicated significantly more varus alignment than during squatting. During squatting, a medial pivot pattern was observed from minimum flexion to 10° flexion, with no significant movement beyond 10° of flexion. Conversely, during cross-legged sitting, no significant movement was detected from minimum flexion to 60° of flexion, with a medial pivot beyond 60° of flexion. Therefore, the knees showed relatively normal kinematics after BCR-TKA with an anatomical articular surface; however, it varied during high-flexion activities depending on the activity.

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Section: Figmentioning

confidence: 99%

mentioning

confidence: 99%

In Vivo Kinematics of Bicruciate-Retaining Total Knee Arthroplasty with Anatomical Articular Surface under High-Flexion Conditions

et al. 2019

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“…15 A recent in vivo study investigated ACL elongation patterns during sit-to-stand (STS), demonstrating that BCR TKA did not fully restore healthy knee ACL elongation patterns. 16 In addition, this study suggested that joint gap changes are significantly correlated with alterations in ACL elongation patterns. Although recent studies indicated that surgical technique is important for patient outcomes, 11,12 there is limited studies assessing the potential effect of implant alignment on ACL elongation patterns.…”

mentioning

confidence: 62%

“…Nevertheless, the accuracy of this validated approach has been demonstrated in the literature and thus this method has been implemented in a variety of studies in the literature. 16,31 Second, although all patients had morphologically intact cruciate ligaments, there may be degenerative histological changes, which may affect in vivo cruciate ligament function. Several studies have reported histological degeneration in macroscopically normal cruciate ligaments in osteoarthritic knees.…”

Section: Discussionmentioning

confidence: 99%

“…29 The change in ligament bundle length divided by the reference length multiplied by 100% was used to define the percentage elongation of each bundle: 30 In concordance with previous literature, finite element analysis was used to determine the stress of each bundle at each flexion angle. 16 The ACL was modeled as a hyperelastic, collagenous matrix with varying fiber groups, with each of those groups becoming taut at unique elongation levels. 31…”

Section: In Vivo Measurement Of Acl Stressmentioning

confidence: 99%

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Posterior Tibial Slope Increases Anterior Cruciate Ligament Stress in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematic Analysis

et al. 2020

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The study design involved here is experimental in nature. The resection of the anterior cruciate ligament (ACL) during conventional total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal in vivo knee kinematics. Bi-cruciate retaining (BCR) TKA designs allow the preservation of the ACL with the potential to restore native knee kinematics. This study aimed to investigate the effect of posterior tibial slope (PTS) on stress experienced by the ACL during weight bearing sit-to-stand (STS) and single-leg deep lunge. The ACL elongation patterns were measured in 30 unilateral BCR TKA patients during weight-bearing STS and single-leg deep lunge using a validated dual fluoroscopic tracking technique. The minimum normalized stress within the anteromedial (AM) and posterolateral (PL) bundle of the ACL during weight-bearing STS and single-leg deep lunge was found at a PTS of 3.7 degrees. The maximum AM and PL bundle stresses were observed at a PTS of 8.5 and 9.3 degrees, respectively during STS and at 8.4, and 9.1 degrees, respectively during single-leg deep lunge. There was a significant positive correlation between PTS and stress observed within the AM and PL bundle of the ACL during weight-bearing STS (R 2 = 0.37; p < 0.01; R2 = 0.36; p = 0.01) and single-leg deep lunge (R 2 = 0.42; p < 0.01; R 2 = 0.40; p < 0.01). The study demonstrates that PTS of operated BCR TKA knees has a significant impact on the stress experienced by the preserved ACL during weight-bearing STS and single-leg deep lunge. This suggests that avoiding excessive PTS may be one of the surgical implant alignment factors to consider during surgery to minimize increased loading of the preserved ACL.

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A Stretchable Strain Sensor System for Wireless Measurement of Musculoskeletal Soft Tissue Strains

Zhang

Bossuyt

Adam

et al. 2023

Adv Materials Technologies

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Measurement of in vivo strain patterns of musculoskeletal soft tissues (MSTs) during functional activities reveals their biomechanical function, supports the identification and understanding of pathologies, and quantifies tissue adaptation during healing. These scientific and clinical insights have motivated the development and application of various strain sensors to quantify MST strains in either intraoperative or dynamic in vivo conditions. In this study, a strain sensor system is developed based on stretchable electronics and radio frequency identification technologies. In this system, a flexible inductor‐capacitor‐resistor sensor is fabricated such that it can be wirelessly excited by a custom‐designed readout box through electronic resonance. The resonant frequency of the sensor changes when the capacitor is stretched, which is then also recorded by the readout box at a sampling rate of 1024 Hz. Suturing the stretchable capacitor onto the MST allows it to be stretched in line with musculoskeletal deformations, hence providing an indirect method to assess strain patterns in vivo. Application of the system ex vivo indicates that the signal remains linear between 0 and 25% strain and is electronically stable in a simulated in vivo environment for one week and over 100 000 cycles of fatigue loadings. The strain sensor exhibits excellent resolution (0.1% strain, ≈9 µm) during wireless strain measurement. Finally, sensor implantation and strain measurement onto the medial gastrocnemius tendon of a sheep indicate that the sensor is able to record repetitive strain patterns in vivo during dynamic movements. This study indicates the potential scientific and clinical applicability in vivo.

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

Cited by 20 publications

References 47 publications

In Vivo Kinematics of Bicruciate-Retaining Total Knee Arthroplasty with Anatomical Articular Surface under High-Flexion Conditions

In Vivo Kinematics of Bicruciate-Retaining Total Knee Arthroplasty with Anatomical Articular Surface under High-Flexion Conditions

Posterior Tibial Slope Increases Anterior Cruciate Ligament Stress in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematic Analysis

A Stretchable Strain Sensor System for Wireless Measurement of Musculoskeletal Soft Tissue Strains

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