Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

Toyooka, Seikai; Masuda, Hideyuki; Nishihara, Nobuhiro; Kobayashi, Takashi; Miyamoto, Wataru; Ando, Shuji; Kawano, Hirotaka; Nakagawa, Takumi

doi:10.1177/23094990211002002

Cited by 2 publications

(2 citation statements)

References 28 publications

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“…Other studies have indicated that PCL resection increases the lateral flexion gap more than the medial flexion gap 15,22 . Some researchers have reported that varus knee deformity results in a progressive laxity of the lateral soft tissues 23,24 . Our results showed that the greater the varus deformity, the greater the ratio of the lateral to medial gaps, which indicates that varus deformity is correlated with an imbalance of the medial and lateral gaps.…”

Section: Discussionsupporting

confidence: 58%

“…15,22 Some researchers have reported that varus knee deformity results in a progressive laxity of the lateral soft tissues. 23,24 Our results showed that the greater the varus deformity, the greater the ratio of the lateral to medial gaps, which indicates that varus deformity is correlated with an imbalance of the medial and lateral gaps. Even after the osteophytes were removed and the ACL resected, that is, before PCL resection, a correlation still exists.…”

Section: Flexion and Extension Gapsmentioning

confidence: 62%

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Effect of Posterior Cruciate Ligament Resection on Gap Balancing in Robot‐assisted Total Knee Arthroplasty

Zhu,

Wang,

Dai

et al. 2024

Orthopaedic Surgery

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ObjectiveRetention or sacrifice of the posterior cruciate ligament (PCL) is one of the most controversial issues while performing total knee arthroplasty (TKA). This study aimed to evaluate the impact of PCL resection on flexion–extension gaps, femoral component rotation, and bone resection amounts during robot‐assisted TKA.MethodsThis prospective study included 40 patients with knee osteoarthritis who underwent robot‐assisted posterior‐stabilized (PS) TKA between September 2021 and February 2022. Of the patients, 75% were women (30/40) with a mean age and BMI of 72.6 years and 27.4 kg/m2, respectively. The guidance module and camera stand assembly were used to capture gaps before and after PCL resection. Measurements of femoral component rotation and bone resection amounts were made in cruciate‐retaining (CR) TKA mode and PS‐TKA mode.ResultsAfter PCL resection, the mean change in the medial and lateral compartments of flexion gaps increased by 2.0 and 0.6 mm, respectively (p < 0.001). Compared with the CR‐TKA mode group, the bone resection amounts of the medial posterior condyle and the lateral posterior condyle in the PS‐TKA mode group decreased by 2.0 ± 1.1 and 1.1 ± 1.1 mm, respectively, and the external rotation of the femoral prosthesis relative to the posterior condylar axis and trans‐epicondylar line was reduced by 1.0° ± 1.3° and 1.2° ± 1.6°, respectively (p < 0.001).ConclusionThe release of the PCL did not affect the extension gap, but significantly increased the flexion gap. Moreover, the increases in the medial flexion gap were greater than those of the lateral flexion gap. After PCL resection, less external rotation of the femoral prosthesis and fewer bone cuts of the posterior femur were needed in PS‐TKA.

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Section: Discussionsupporting

confidence: 58%

Section: Flexion and Extension Gapsmentioning

confidence: 62%

Effect of Posterior Cruciate Ligament Resection on Gap Balancing in Robot‐assisted Total Knee Arthroplasty

Zhu,

Wang,

Dai

et al. 2024

Orthopaedic Surgery

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Soft tissue laxity is highly variable in patients undergoing total knee arthroplasty

Weiner,

Shah,

Neuwirth

et al. 2024

Arthroplasty

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Background One major goal of total knee arthroplasty (TKA) is to achieve balanced medial and lateral gaps in flexion and extension. While bone resections are planned by the surgeon, soft tissue laxity is largely intrinsic and patient-specific in the absence of additional soft tissue releases. We sought to determine the variability in soft tissue laxity in patients undergoing TKA. Methods We retrospectively reviewed 113 patients undergoing TKA. Data on preoperative knee deformity were collected. Data from a dynamic intraoperative stress examination were collected by a robotic tracking system to quantify maximal medial and lateral opening in flexion (85–95 degrees) and extension (-5–20 degrees). T-tests were used to assess the differences between continuous variables. Results A valgus stress opened the medial compartment a mean of 4.3 ± 2.3 mm (0.0–12.4 mm) in extension and 4.6 ± 2.3 mm (0.0–12.9 mm) in flexion. A varus stress opened the lateral compartment a mean of 5.4 ± 2.4 mm (0.3–12.6 mm) in extension and 6.2 ± 2.5 mm (0.0–13.4 mm) in flexion. The medial compartment of varus knees opened significantly more in response to valgus stress than valgus knees in both extension (5.2 mm vs. 2.6 mm; P < 0.0001) and flexion (5.4 mm vs 3.3 mm; P < 0.0001). The lateral compartment of valgus knees opened significantly more in response to varus stress than varus knees in both extension (6.7 mm vs. 4.8 mm; P < 0.0001) and flexion (7.4 mm vs. 5.8 mm; P = 0.0003). Conclusions Soft tissue laxity is highly variable in patients undergoing TKA, contributing anywhere from 0–13 mm to the post-resection gap. Only a small part of this variability is predictable by preoperative deformity. These findings have implications for either measured-resection or gap-balancing techniques. Level of Evidence Level III.

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Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

Cited by 2 publications

References 28 publications

Effect of Posterior Cruciate Ligament Resection on Gap Balancing in Robot‐assisted Total Knee Arthroplasty

Effect of Posterior Cruciate Ligament Resection on Gap Balancing in Robot‐assisted Total Knee Arthroplasty

Soft tissue laxity is highly variable in patients undergoing total knee arthroplasty

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