Semimembranosus Release Reduces Tibial Internal Rotation and Flexion Angle in Cruciate-Retaining Total Knee Arthroplasty

Matsumoto, Tomoyuki; Takayama, Koji; Muratsu, Hirotsugu; Matsushita, Takehiko; Kuroda, Ryosuke; Kurosaka, Masahiro

doi:10.1016/j.arth.2015.03.039

Cited by 33 publications

(18 citation statements)

References 35 publications

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“…Previous studies mainly focused on analyzing the effect of the hamstring muscles in ACL-deficient knees 5,14-16,19 or evaluated the effect of SM release among patients undergoing total knee arthroplasty. 10,17,18 Results, however, indicate an ACL-protective effect of hamstring loading, which is reflected by reducing medial compartment translation in response to ER and anteromedial rotation in the present study. One possibility for balancing among patients undergoing total knee arthroplasty is to perform a soft tissue release of the SM, which resulted in a reduction of IR of 4° (60°-120°) as compared with the prerelease state.…”

Section: Discussioncontrasting

confidence: 59%

Dynamic Restraints of the Medial Side of the Knee: The Semimembranosus Corner Revisited

et al. 2019

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Background: Little is known about the dynamic restraints of the semimembranosus muscle (SM). Purpose and Hypothesis: The goal of the present study was to elucidate the role of (1) passive and (2) active restraints to medial-side instability and to analyze (3) the corresponding tightening of the posteromedial structures by loading the SM. It was hypothesized that points 1 to 3 will significantly restrain medial knee instability. This will aid in understanding the synergistic effect of the semimembranosus corner. Study Design: Controlled laboratory study. Methods: Nine knees were tested in a 6 degrees of freedom robotic setup and an optical tracking system. External rotation (ER; 4 N·m), internal rotation (4 N·m), anteromedial rotation (4-N·m ER and 89-N anterior tibial translation), and valgus rotation (8 N·m) were applied at 0°, 30°, 60°, and 90°, with and without an SM load of 75 N. Sequential cutting of the medial collateral ligament and posterior oblique ligament was then performed. At the intact state of the knee and after each cut, the aforementioned simulated laxity tests were performed. Results: The medial collateral ligament was found to be the main passive stabilizer to ER and anteromedial rotation, resulting in 9.3° ± 6.8° (P < .05), 8.1° ± 3.6° (P < .05), and 7.6° ± 4.2° (P < .05) at 30°, 60°, and 90°, respectively. Conversely, after the posterior oblique ligament was cut, internal rotation instability increased significantly at early flexion angles (9.3° ± 3.2° at 0° and 5.2° ± 1.1 at 30°). Loading the SM had an overall effect on restraining ER (P < .001) and anteromedial rotation (P < .001). This increased with flexion angle and sectioning of the medial structures and resulted in a pooled 2.8° ± 1.7° (not significant), 5.4° ± 2° (P < .01), 7.5° ± 2.8° (P < .001), and 8.3° ± 4.4° (P < .001) at 0°, 30°, 60°, and 90° when compared with the unloaded state. Conclusion: The SM was found to be a main active restraint to ER and anteromedial rotation, especially at higher flexion angles and in absence of the main passive medial restraints. The calculated tensioning effect was small in all flexion angles for all simulated laxity tests. Clinical Relevance: A complete semimembranosus avulsion may indicate severe medial knee injury, and refixation should be considered in multiligament injury.

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Section: Discussioncontrasting

confidence: 59%

Dynamic Restraints of the Medial Side of the Knee: The Semimembranosus Corner Revisited

et al. 2019

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“…Similarly, compared with substantial medial release including semimembranosus, minimal medial release with only osteophyte removal and release of the deep layer of the MCL was reported to maintain tibial internal rotation in CR TKA. 24 Altogether, a minimal medial release is easy to perform and may maintain tibial internal rotation and lateral laxity during flexion in patients with modified kinematically aligned TKA.…”

Section: Discussionmentioning

confidence: 99%

“…Before femoral bone cut was performed, minimum medial release (osteophyte removal and release of the deep layer of the medial collateral ligament [MCL]) was performed to maintain medial stability. 24 Femoral bone cut was performed after correcting for wear from the distal and posterior femur which were equal in thickness (9 mm) to the condyles of the femoral component. With the assistance of the navigation system, as all patients were varus-osteoarthritic patients, consistent distal and posterior resection with a 9-mm thickness were performed laterally, and a distal thickness of 7 mm and posterior thickness of 8 to 9 mm were performed medially, based on the damage of the posterior condyle cartilage.…”

Section: Operative Proceduresmentioning

confidence: 99%

Intraoperative Soft Tissue Balance/Kinematics and Clinical Evaluation of Modified Kinematically versus Mechanically Aligned Total Knee Arthroplasty

et al. 2019

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AbstractRecently, kinematically aligned total knee arthroplasty has been found to achieve better clinical outcomes than mechanically aligned TKA. Despite the good clinical outcomes that are reported at short- to mid-term follow-up, intraoperative variables that are associated with a better outcome have not been measured. Therefore, this study was conducted to compare intraoperative kinematics/soft tissue balance and the clinical outcomes of patients who underwent modified kinematically (restricted tibial cut) or mechanically aligned total knee arthroplasty. Sixty cruciate-retaining total knee arthroplasties (30 modified kinematically [3-degree varus and 7-degree posterior slope in tibial cut] and 30 mechanically aligned) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative kinematics assessed by the navigation system and soft tissue balance assessed by an offset-type tensor were compared between the groups. One year postoperatively, the range of motion and 2011 Knee Society scores were compared between the groups. Kinematic assessment exhibited that tibial internal rotation during flexion was significantly maintained in the kinematic compared with the mechanical group (p < 0.05). Varus/valgus ligament balance at 90 and 120 degrees of flexion significantly maintained lateral laxity in the kinematic compared with the mechanical group (p < 0.05). Improvement of flexion angles, functional activity scores, and patient satisfaction were significantly better in the kinematic than in the mechanical group (p < 0.05). Modified kinematically aligned cruciate-retaining total knee arthroplasty maintained more tibial internal rotation and lateral laxity during flexion than mechanically aligned total knee arthroplasty; thus, the former may result in better clinical outcomes.

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“…Prior to the femoral osteotomy, minimum medial release (osteophyte removal and release of deep layer of the medial collateral ligament) was performed to maintain medial stability. 17 Then, a femoral osteotomy was performed after correcting for wear from the distal and posterior femur. The femur was made to be equal in thickness (9 mm) to the condyles of the femoral component.…”

Section: Operative Proceduresmentioning

confidence: 99%

Comparison between Single- and Multi-Radius Prostheses Used in Modified Kinematically Aligned Cruciate-Retaining Total Knee Arthroplasty

et al. 2020

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Kinematically aligned total knee arthroplasty (TKA) has gained interest for achieving more favorable clinical outcomes than mechanically aligned TKA. The present study aimed to compare the clinical outcomes of kinematically aligned TKAs using single-radius (SR) or multi-radius (MR) prostheses. Sixty modified kinematically aligned cruciate-retaining TKAs (30 SR and 30 MR type prostheses) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative and postoperative patellar tracking were compared between the two groups. Trochlea shape was also compared between the prostheses and preoperative native anatomy using three-dimensional simulation software. Total 2 years postoperatively, the range of motion and 2011 Knee Society Scores (KSS) were compared between the two groups. There were no differences in patellar maltracking including patellar lateral shift and tilt between the two groups; however, the ratio of intraoperative lateral retinacular release for adjusting patellar tracking was significantly higher in the MR group than in the SR group. Lateral and medial facet heights in both prostheses were understuffed compared with native knee anatomy, while the deepest point of the trochlear groove was significantly more medial in the MR group. The postoperative clinical outcomes showed no significant differences between the two groups. In conclusion, modified kinematically aligned TKAs using a SR or MR prosthesis showed no significant differences in clinical outcomes or patellar tracking when appropriate lateral retinacular release was performed.

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Semimembranosus Release Reduces Tibial Internal Rotation and Flexion Angle in Cruciate-Retaining Total Knee Arthroplasty

Cited by 33 publications

References 35 publications

Dynamic Restraints of the Medial Side of the Knee: The Semimembranosus Corner Revisited

Dynamic Restraints of the Medial Side of the Knee: The Semimembranosus Corner Revisited

Intraoperative Soft Tissue Balance/Kinematics and Clinical Evaluation of Modified Kinematically versus Mechanically Aligned Total Knee Arthroplasty

Comparison between Single- and Multi-Radius Prostheses Used in Modified Kinematically Aligned Cruciate-Retaining Total Knee Arthroplasty

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