Intraoperative analysis of the kinematics of the native knee including two-dimensional translation of the femur using a navigation system : a cadaveric study

Wada, Keizo; Hamada, Daisuke; Takasago, Tomoya; Kamada, Mitsuhiro; Goto, Tomohiro; Tsuruo, Yoshihiro; Sairyo, Koichi

doi:10.2152/jmi.66.367

Cited by 7 publications

(6 citation statements)

References 25 publications

(24 reference statements)

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“…Researchers have also developed many kinematic analysis methods, such as skin marking, X-ray, CT, magnetic resonance imaging (MRI), computer simulation and other auxiliary means have been used in the kinematic study of the knee joint. [10] In recent years, some scholars have used the intraoperative navigation system to study the kinematics of the native knee joint [11] . In the native knee joint, the motion the femoral condyle and the tibial plateau is an important part of the study of the exion and extension of the knee joint.…”

Section: Discussionmentioning

confidence: 99%

CR prosthesis or PS prosthesis, which one is closer to the natural rollback of the knee joint? ——A vivo kinematics study using Mako robot-assisted im-based-system measurement

Huang,

Zhao,

Wang

et al. 2024

Preprint

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Background Cruciate-retaining (CR) prosthesis and posterior-substituting (PS) prosthesis are widely used in total knee arthroplasty (TKA). The main discrepancy in kinematics between two designs is that the mechanism of rollback motion during knee flexion is different. In this study, by using image-based robotic assisted system (mako), femoral-tibial contact points of these two types of prostheses during 0°to 140°flexion were recorded to compared with the natural kinematic characteristics of knee joints before TKA, so as to explore which type of prosthesis is close to the natural rollback. Method Twelve patients (15 knees) with MAKO-assisted TKA in our center were included. ①After the registration was completed, the knee joint of the patients was flexed at 0°to 140°(10°increasing, A total of 16 angles, including 45°), the contact point of femur and tibia at each angle was recorded by Mako software; ②After the anterior cruciate ligament(ACL) removed and the posterior cruciate ligament(PCL) retained, the CR model was placed, and the contact point of the femur and tibia at each knee flexion angle was recorded again from 0°to 140 °;③The PCL was removed, and the PS prosthesis was implanted finally. Then the contact position of the femur and tibia at each knee flexion angle from 0°to 140 °was recorded for the third time. Through the above process, we obtained the contact position of the femoral condyle and the tibia during the passive flexion of the knee joint at 16 angles in three conditions (1, the patient with natural knee; 2, the patient with CR prosthesis;3, the patient with PS prosthesis) in order to simulate the rollback of the knee joint and compare the difference of rollback in three groups. Results There was no statistical difference in contact points of the femur and tibia between the CR prosthesis and the natural knee at all 16 flexion angles (P > 0.05). The contact points of the femur and tibia in the PS prosthesis group was close to those of the natural knee at flexion range from 20 ~ 50°(P > 0.05); but at 0 ~ 10°flexion and 60 ~ 140°flexion, there was a statistical difference in contact points of the femur and tibia between the PS prosthesis group and the patient 's natural knee joint(P<0.05). Conclusion By using the intraoperative real-time positioning function of image-based robotic assisted system(Mako)to detect the characteristics of knee joint rollback motion, we found that compared with PS prosthesis, the knee joint rollback of patients using CR prosthesis was closer to the natural state.

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Section: Discussionmentioning

confidence: 99%

CR prosthesis or PS prosthesis, which one is closer to the natural rollback of the knee joint? ——A vivo kinematics study using Mako robot-assisted im-based-system measurement

Huang,

Zhao,

Wang

et al. 2024

Preprint

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“…With this assumption, lengthening per row would have been approximately 0.8 mm. This is clinically relevant lengthening and puncturing of 1-3 rows could produce correct ligament lengthening, measured by spatulas [2], navigated surgery [18] or/ and a ligament tensor (e.g. DePuy CAS Ligament Tensor).…”

Section: Discussionmentioning

confidence: 99%

A novel instrument for ligament balancing: a biomechanical study in human cadaveric knees

Engseth

Grønsund²,

Aunan

et al. 2023

J. exp. orthop.

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Purpose Ligament balancing is a prerequisite for good function and survival in total knee arthroplasty (TKA). Various balancing techniques exist, but none have shown superior results. The pie-crusting technique by Bellemans of the medial collateral ligament is commonly utilized; however, it can be difficult to achieve repeatable ligament lengthening with this technique. Therefore, we invented a novel instrument to standardize the pie-crusting technique of the superficial and deep medial collateral ligament (hereafter MCL). The purpose was to examine if pie-crusting with the instrument could produce repeatable ligament lengthening. Methods The MCL was isolated in 16 human cadaveric knees, and subjected to axial tension. The instrument was composed of a specific grid of holes in rows, used to guide sequential pie-crusting puncturing of the MCL with a Ø1.6 mm end-cutting cannula. Ligament lengthening was measured after each row of punctures. Regression analysis was performed on the results. Results Mean lengthening ± SD in human cadaveric MCL for puncturing of row 1 in the instrument was 0.06 ± 0.09 mm, 0.06 ± 0.04 mm for row 2, 0.09 ± 0.08 mm for row 3, 0.06 ± 0.05 mm for row 4 and 0.06 ± 0.04 mm for row 5, giving a mean total lengthening of 0.33 ± 0.20 mm. Linear regression revealed that MCLs were repeatably lengthened by 0.07 mm per row when punctured using the instrument. Conclusions MCLs showed linear lengthening in human cadavers for subsequent use of the instrument. Our instrument shows promising results for repeatable ligament lengthening.

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“…The test-retest reliability of AP position, ML position, and IE angle were evaluated, observing suiciently high interclass and intraclass correlation coeicients of > 0.9 at each measured angle of knee lexion. Preoperative knee kinematics were assessed according to a previously reported method [23]. Following the information obtained by a navigation system, two-dimensional translation of the femoral centre was measured, knee kinematics were evaluated, the femoral axial axis at all measured angles was projected onto the tibial axial plane, and the femoral movement was evaluated relative to the tibia.…”

Section: Methodsmentioning

confidence: 99%

“…Preoperative knee kinematics were assessed according to a previously reported method [23]. Following the information obtained by a navigation system, two‐dimensional translation of the femoral centre was measured, knee kinematics were evaluated, the femoral axial axis at all measured angles was projected onto the tibial axial plane, and the femoral movement was evaluated relative to the tibia.…”

Section: Methodsmentioning

confidence: 99%

“…Following the information obtained by a navigation system, two‐dimensional translation of the femoral centre was measured, knee kinematics were evaluated, the femoral axial axis at all measured angles was projected onto the tibial axial plane, and the femoral movement was evaluated relative to the tibia. Regarding AP kinematics, the femoral centre movement relative to the tibia was evaluated, as previously confirmed [23]. From the anteroposterior and compression‐distraction positions of the tibia relative to the femur obtained by the navigation system, the AP position of the femur relative to the tibia was calculated (Fig.…”

Section: Methodsmentioning

confidence: 99%

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Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion

Kinoshita

Hino

Kutsuna

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to investigate the position of the femur relative to the tibia throughout range of motion in the osteoarthritic knee to evaluate knee kinematics and assess its relationship with the degree of varus deformity. MethodsIn this study, 116 preoperative knees with varus deformity were evaluated using a navigation system. The internal–external, anteroposterior, and mediolateral positions of the femur relative to the tibia were measured at maximum extension, 15°, 30°, 45°, 60°, 90°, 105°, and 120°, and maximum flexion angles. From these parameters, two‐dimensional translation of the surgical epicondylar axis was projected onto the tibial axial plane, and the femoral movement was evaluated relative to the tibia. In addition, the knees were retrospectively classified into three groups according to their degrees of preoperative hip–knee–ankle angle: mild (< 10°), moderate (10°–20°), and severe (> 20°). Then, the differences in each parameter between these groups were investigated. The Steel–Dwass test was performed to identify the difference among three groups. Statistical significance was set at p values < 0.05. ResultsThere was a significant difference in the anteroposterior position of the femur relative to the tibia among the three groups, especially from extension to early flexion (p < 0.05). The anteroposterior position at knee extension deviated posteriorly according to the progression of varus deformity. Rotational and mediolateral translation were not significantly different among the groups. Normal knee kinematics were diminished in almost all cases in each group. In addition, anterior paradoxical motion of the femur during early knee flexion was observed in 45.6% (n = 26), 57.1% (n = 28), and 80.0% (n = 8) of cases in the mild, moderate, and severe groups, respectively. The anteroposterior position of the femur relative to the tibia at knee extension was significantly more posterior in patients with than in those without anterior paradoxical motion (p < 0.0001). ConclusionThe anteroposterior position of the femur relative to the tibia changed according to the progression of varus deformity in osteoarthritic knees, especially from knee extension to early flexion. Posterior deviation of the femur at knee extension induced its anteroposterior movement relative to the tibia, resulting in anterior paradoxical motion. Level of evidenceIII.

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Intraoperative analysis of the kinematics of the native knee including two-dimensional translation of the femur using a navigation system : a cadaveric study

Cited by 7 publications

References 25 publications

CR prosthesis or PS prosthesis, which one is closer to the natural rollback of the knee joint? ——A vivo kinematics study using Mako robot-assisted im-based-system measurement

CR prosthesis or PS prosthesis, which one is closer to the natural rollback of the knee joint? ——A vivo kinematics study using Mako robot-assisted im-based-system measurement

A novel instrument for ligament balancing: a biomechanical study in human cadaveric knees

Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion

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