Primary and coupled motions of the native knee in response to applied varus and valgus load

Gladnick, Brian P.; Boorman-Padgett, James; Stone, Kyle; Kent, Robert N.; Cross, Michael B.; Mayman, David J.; Pearle, Andrew D.; Imhauser, Carl W.

doi:10.1016/j.knee.2016.01.006

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…Gladnick et al reported that although from extension to 90° of exion normal knee exhibited an increase in varus-valgus laxity as the exion angle increase, the variability of AP translation in response to the varus and valgus load was small [22]. On the other hand, in the current study, the ipsilateral knees displayed valgus movement, whereas the contralateral knees displayed varus movement.…”

Section: Discussioncontrasting

confidence: 54%

In Vivo Three-dimensional Kinematics of Normal Knees During Sitting Sideways

Kono

Yamazaki

Konda

et al. 2021

Preprint

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Background The normal knee kinematics during asymmetrical kneeling such as the sitting sideways remains unknown. This study aimed to clarify in vivo kinematics during sitting sideways of normal knees. Methods Twelve knees from six volunteers were examined. Under fluoroscopy, each volunteer performed a sitting sideways. A two-dimensional/three-dimensional registration technique was used. The rotation angle, varus-valgus angle, anteroposterior translation of the medial and lateral sides of the femur relative to the tibia, and kinematic pathway in each flexion angle was evaluated. Results Bilateral knees during sitting sideways showed a femoral external rotation relative to the tibia with flexion. Whereas the ipsilateral knees showed valgus movement, and the contralateral knees showed varus movement. The medial side of the contralateral knees was more posteriorly located than that of the ipsilateral knees beyond 110° of flexion. The lateral side of the contralateral knees was more anteriorly located than that of the ipsilateral knees from 120° to 150° of flexion. In the ipsilateral knees, a medial pivot pattern followed by a bicondylar rollback was observed. In the contralateral knees, no significant movement followed by a bicondylar rollback was observed. Conclusion Even though the asymmetrical kneeling such as sitting sideways, the knees did not display asymmetrical movement.

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Section: Discussioncontrasting

confidence: 54%

In Vivo Three-dimensional Kinematics of Normal Knees During Sitting Sideways

Kono

Yamazaki

Konda

et al. 2021

Preprint

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“…Greater laxity in the lateral compartment in extension has been reported in a cadaver study by Roth et al [9], similar to the present study. Increased native laxity and asymmetry of laxity, however, was reported by Roth and others [10] in contrast to the mid-flexion and flexion windows for improved outcomes found here. This may be due to the increasing contribution of the posterior cruciate ligament (PCL) in flexion which was resected in all knees here.…”

Section: Discussioncontrasting

confidence: 67%

Intra-Operative Soft Tissue Targets For Improved Outcomes In Total Knee Arthroplasty

Wakelin¹,

Shalhoub²,

Lawrence³

et al.

EPiC Series in Health Sciences

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A poorly balanced, unstable or stiff joint is a leading cause of dissatisfaction and revision after surgery. The quantitative definition of a well-balanced joint, however, remains a source of controversy. This study investigates joint gaps measured by a digitally-controlled ligament tensioning device throughout flexion and its effect on post- operative outcome.Surgeries were performed using the OMNIBotics robot-assisted TKA platform and BalanceBot device. Joint gaps were recorded by the BalanceBot throughout flexion during trialing. Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected at 1-year post-op. Correlations between joint gaps and KOOS outcome were investigated.Knees that reported: a medial gap ≤ lateral gap in extension (p = 0.007, median ∆ = 8.3); an average joint gap of between 1 mm tighter and 1 mm looser than the final insert thickness in midflexion (p = 0.006, median ∆ = 5.5); and an imbalance of less than 1.5 mm in flexion (p = 0.012, median ∆ = 2.8) reported significantly improved pain scores. Patients which satisfied both extension and flexion criteria, or midflexion and flexion criteria reported improved outcomes compared to those which satisfied only one or neither criterion (p = 0.0002, median ∆ = 9.7, p = 0.0019, median ∆ = 8.4 respectively).KOOS Pain scores correlated with joint gap measurements across all flexion angles investigated. Combining joint gap windows, subgroups of patients were found that reported a change in the median KOOS Pain outcome beyond the minimally clinically important difference.

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“…Fourth, a medial gap between 0 and 2 mm and a lateral gap less than 3 mm was considered balanced in flexion, which contradicts the common notion of creating rectangular gaps in TKA 10 . Recent studies, however, suggest that maintaining these gap targets in flexion is comparable to that measured in native knees 33,34,52 . Fifth, the sample size of knee models was small (n = 6).…”

Section: Discussionmentioning

confidence: 95%

“…10 Recent studies, however, suggest that maintaining these gap targets in flexion is comparable to that measured in native knees. 33,34,52 Fifth, the sample size of knee models was small (n = 6). However, the confidence interval and low P-value relating the MCL ratio and the medial gap indicate high certainty in the existence of a relationship when controlling for ligament properties and adequate statistical power (CI: −9.87, −4.42; P < .001).…”

Section: Discussionmentioning

confidence: 99%

A geometric ratio to predict the flexion gap in total knee arthroplasty

Elmasry

Sculco

Kia

et al. 2020

Journal Orthopaedic Research

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Measured resection is a common technique for obtaining symmetric flexion and extension gaps in posterior‐stabilized (PS) total knee arthroplasty (TKA). A known limitation of measured resection, however, is its reliance on osseous landmarks to guide bone resection and component alignment while ignoring the geometry of the surrounding soft tissues such as the medial collateral ligament (MCL), a possible reason for knee instability. To address this clinical concern, we introduce a new geometric proportion, the MCL ratio, which incorporates features of condylar geometry and MCL anterior fibers. The goal of this study was to determine whether the MCL ratio can predict the flexion gaps and to determine whether a range of MCL ratio corresponds to balanced gaps. Six computational knee models each implanted with PS TKA were utilized. Medial and lateral gaps were measured in response to varus and valgus loads at extension and flexion. The MCL ratio was related to the measured gaps for each knee. We found that the MCL ratio was associated with the flexion gaps and had a stronger association with the medial gap (β = −7.2 ± 3.05, P < .001) than with the lateral gap (β = 3.9 ± 7.26, P = .04). In addition, an MCL ratio ranging between 1.1 and 1.25 corresponded to balanced flexion gaps in the six knee models. Future studies will focus on defining MCL ratio targets after accounting for variations in ligament properties in TKA patients. Our results suggest that the MCL ratio could help guide femoral bone resections in measured resection TKA, but further clinical validation is required.

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Primary and coupled motions of the native knee in response to applied varus and valgus load

Cited by 9 publications

References 19 publications

In Vivo Three-dimensional Kinematics of Normal Knees During Sitting Sideways

In Vivo Three-dimensional Kinematics of Normal Knees During Sitting Sideways

Intra-Operative Soft Tissue Targets For Improved Outcomes In Total Knee Arthroplasty

A geometric ratio to predict the flexion gap in total knee arthroplasty

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