Increased valgus laxity in flexion with greater tibial resection depth following total knee arthroplasty

Sappey‐Marinier, Elliot; White, Nathan J.; Gaillard, Romain; Chèze, Laurence; Servien, Elvire; Neyret, Philippe; Lustig, Sébastien

doi:10.1007/s00167-018-4988-1

Cited by 7 publications

(3 citation statements)

References 20 publications

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“…Sappey-Marinier has demonstrated that an increased tibial resection depth is associated with significantly greater laxity in valgus between 30 and 90°of flexion, particularly with a tibial resection ! 14 mm [32]. Increasing the tibial resection could jeopardize the medial collateral ligament and could complicate TKA revision if required.…”

Section: Inverse Kinematic Alignment Principlesmentioning

confidence: 99%

Personalized alignment in total knee arthroplasty: current concepts

Lustig

Sappey‐Marinier

Fary

et al. 2021

SICOT-J

105

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Traditionally in total knee arthroplasty (TKA), a post-operative neutral alignment was the gold standard. This principle has been contested as functional outcomes were found to be inconsistent. Analysis of limb alignment in the non-osteoarthritic population reveals variations from neutral alignment and consideration of a personalized or patient-specific alignment in TKA is challenging previous concepts. The aim of this review was to clarify the variations of current personalized alignments and to report their results. Current personalized approaches of alignment reported are: kinematic, inverse kinematic, restricted kinematic, and functional. The principle of “kinematic alignment” is knee resurfacing with restitution of pre-arthritic anatomy. The aim is to resurface the femur maintaining the native femoral joint line obliquity. The flexion and extension gaps are balanced with the tibial resection. The principle of the “inverse kinematic alignment” is to resurface the tibia with similar medial and lateral bone resections in order to keep the native tibial joint line obliquity. Gap balancing is performed by adjusting the femoral resections. To avoid reproducing extreme anatomical alignments there is “restricted kinematic alignment” which is a compromise between mechanical alignment and true kinematic alignment with a defined safe zone of alignment. Finally, there is the concept of “functional alignment” which is an evolution of kinematic alignment as enabling technology has progressed. This is obtained by manipulating alignment, bone resections, soft tissue releases, and/or implant positioning with a robotic-assisted system to optimize TKA function for a patient’s specific alignment, bone morphology, and soft tissue envelope. The aim of personalizing alignment is to restore native knee kinematics and improve functional outcomes after TKA. A long-term follow-up remains crucial to assess both outcomes and implant survivorship of these current concepts.

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Section: Inverse Kinematic Alignment Principlesmentioning

confidence: 99%

Personalized alignment in total knee arthroplasty: current concepts

Lustig

Sappey‐Marinier

Fary

et al. 2021

SICOT-J

105

View full text Add to dashboard Cite

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“…Van Opstal et al demonstrated that on average 67% of the PCL insertion was removed in routine primary knee arthroplasty, especially with increasing posterior slope 23,24 . Patients are also at risk of valgus instability in flexion when the tibia is cut more distally, as demonstrated by Sappey-Marinier et al 25 .…”

Section: Resultsmentioning

confidence: 91%

Free subchondral screws in tibial plateau fractures: do they hinder a total knee arthroplasty? Strategies to prevent complications

SCHUERMANS,

REUL,

MONTEBAN

et al. 2023

Acta Orthop Belg

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Open reduction and internal fixation of extended lateral column tibial plateau fractures through a tibial condyle osteotomy and limited arthrotomy with the use of free subchondral locking screws is a straightforward and safe technique. However, these free subchondral screws are enclosed in the subchondral bone and therefore virtually impossible to remove after bone healing. The question arises whether these free subchondral screws might hinder a future total knee arthroplasty. In order to refute this, we retrospectively reviewed all surgically managed tibial plateau fractures in our tertiary center during one year and assessed the number, position and configuration of these in situ subchondral screws and K-wires. In addition, we performed a cadaver study, wherein we prepared 7 tibial plateaus for a total knee arthroplasty tibial component placement with free subchondral screws in situ. In this experiment, we demonstrated that free subchondral screws do not interfere with total knee arthroplasty, but they can increase operative time in some cases. We also provide recommendations to avoid difficulties and potential complications.

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“…One of the concerns regarding the KA and rKA is that balancing is often achieved by re-cutting the tibia, with increasingly thicker polyethylene inserts being required. We have previously demonstrated that this approach for balancing leads to increased valgus laxity through an arc of flexion [ 33 ]. For this reason, in FA, the maximum alteration to joint line-height is set within the limits of ±3 mm , and when large gaps are present (for example, 21 mm), we adjust the depth of the cuts through a combination of femoral and tibial alignment adjustment.…”

Section: Introductionmentioning

confidence: 99%

Functional Alignment Philosophy in Total Knee Arthroplasty – Rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning

Shatrov

Battelier

Sappey‐Marinier

et al. 2022

SICOT-J

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Introduction: Alignment techniques in total knee arthroplasty (TKA) continue to evolve. Functional alignment (FA) is a novel technique that utilizes robotic tools to deliver TKA with the aim of respecting individual anatomical variations. The purpose of this paper is to describe the rationale and technique of FA in the varus morphotype with the use of a robotic platform. Rationale: FA reproduces constitutional knee anatomy within quantifiable target ranges. The principles are founded on a comprehensive assessment and understanding of individual anatomical variations with the aim of delivering personalized TKA. The principles are functional pre-operative planning, reconstitution of native coronal alignment, restoration of dynamic sagittal alignment within 5° of neutral, maintenance of joint-line-obliquity and height, implant sizing to match anatomy and a joint that is balanced in flexion and extension through manipulation of implant positioning rather than soft tissue releases. Technique: An individualized plan is created from pre-operative imaging. Next, a reproducible and quantifiable method of soft tissue laxity assessment is performed in extension and flexion that accounts for individual variation in soft tissue laxity. A dynamic virtual 3D model of the joint and implant position that can be manipulated in all three planes is modified to achieve target gap measurements while maintaining the joint line phenotype and a final limb position within a defined coronal and sagittal range. Conclusion: Functional alignment is a novel knee arthroplasty technique that aims to restore constitutional bony alignment and balance the laxity of the soft tissues by placing and sizing implants in a manner that it respects the variations in individual anatomy. This paper presents the approach for the varus morphotype.

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Increased valgus laxity in flexion with greater tibial resection depth following total knee arthroplasty

Cited by 7 publications

References 20 publications

Personalized alignment in total knee arthroplasty: current concepts

Personalized alignment in total knee arthroplasty: current concepts

Free subchondral screws in tibial plateau fractures: do they hinder a total knee arthroplasty? Strategies to prevent complications

Functional Alignment Philosophy in Total Knee Arthroplasty – Rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning

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