Tibial sagittal and rotational alignment reduce patellofemoral stresses in posterior stabilized total knee arthroplasty

Mizu-uchi, Hideki; Ma, Yu; Ishibashi, Sadato; Colwell, Clifford W.; Nakashima, Yasuharu; D’Lima, Darryl D.

doi:10.1038/s41598-022-15759-6

Cited by 7 publications

(6 citation statements)

References 45 publications

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“…The contemporary literature still lacks studies on modeling various pathological conditions of the knee joint capsuloligamentous apparatus work. The results of our experiment on the biomechanical model of the knee joint showed coincidence of patellar movements with clinical experience when its ligamentous apparatus is damaged [27][28][29][30][31]. In this paper, we presented results for passive knee joint fl exion modeling.…”

Section: Dicsussionmentioning

confidence: 73%

Patellar motion and dysfunction of its stabilizers in a biomechanical model of the knee joint

Yurova,

Tyagunova,

Loginov

et al. 2024

jour

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Aim. To develop a biomechanical model of the knee joint, including a detailed representation of the patellofemoral segment for the normal anatomy of bones, joints, ligaments and muscles, and study patellar movement during passive knee flexion.Materials and methods. The architecture of the biomechanical model was developed using an open source software system for biomechanical modeling OpenSim. Patellofemoral joint with 6 degrees of freedom, patellar stabilizers – medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), lateral retinaculum (LR), and patellar contact surfaces (facets) were included in the model. Gmsh and Paraview were used to generate the contact surfaces. Simulations of knee passive flexion with consistent patellar stabilizers exclusion were carried out to identify their influence on patellar movement.Results. The presented biomechanical model provides a detailed analysis of the normal dynamics of the patella and the role of different anatomical structures in its functioning and can be used for further experiments investigating of the patellar movement. The experiment involving all ligaments is consistent with the physiological norm. Disabling MPTL has minimal effects on patellar tilt and translation, which aligns with its small size. In contrast, deactivating MPFL results in increased lateral tilt and translation of the patella. Additionally, deactivation of LR components 1 and 2 induces more medial tilt and translation. Deactivating LR components 3 and 4 leads to further lateral translation and slight additional medial tilt.Conclusion. Computational results show that all ligaments contribute to the normal movement of the patella. These findings highlight the importance of stabilizing structures in maintaining patellar stability during knee flexion.

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Section: Dicsussionmentioning

confidence: 73%

Patellar motion and dysfunction of its stabilizers in a biomechanical model of the knee joint

Yurova,

Tyagunova,

Loginov

et al. 2024

jour

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“…In contrast, in the control group, the femoral components displayed external rotation, while the tibial components showed internal rotation. This can be explained by the effects of soft‐tissue laxity [ 6 , 13 , 23 , 40 ]. All the patients in the cohort were treated using the measured resection technique with mechanical alignment.…”

Section: Discussionmentioning

confidence: 99%

Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty

Kokubu,

Kawahara,

Mizu‐Uchi

et al. 2024

J. exp. orthop.

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PurposeThis study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient‐reported outcome measures (PROMs).MethodsSeventy‐one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole‐leg and supine knee radiographs using a three‐dimensional‐to‐two‐dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs.ResultsIn the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (>5°) in the supine position but small (<5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (<5°) in the supine position and large (>5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values.ConclusionsThe underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position.Level of EvidenceⅣ, Case series.

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“…Due to the ethical reason according to radiographic exposure, multiple bone models are currently unavailable. Changing the experimental conditions in a bone model, which was hard to be performed in the real world, is the strength of the computer simulation study, and numbers of studies have reported using single validated bone model 8 , 25 , 26 , 28 , 32 – 34 . However, there are anatomic variations depending on sex, race and individual even in healthy volunteer 35 .…”

Section: Discussionmentioning

confidence: 99%

Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty

Nishitani

Kuriyama

Nakamura

et al. 2023

Sci Rep

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Poor clinical outcomes are reported in excessive flexion of the femoral component in total knee arthroplasty (TKA), but their mechanisms have not yet been elucidated. This study aimed to investigate the biomechanical effect of flexion of the femoral component. Cruciate-substituting (CS) and posterior-stabilised (PS) TKA were reproduced in a computer simulation. The femoral component was then flexed from 0° to 10° with anterior reference, keeping the implant size and the extension gap. Knee kinematics, joint contact, and ligament forces were evaluated in deep-knee-bend activity. When the femoral component was flexed 10° in CS TKA, paradoxical anterior translation of the medial compartment was observed at mid-flexion. The PS implant was best stabilised with a 4° flexion model in mid-flexion range. The medial compartment contact force and the medial collateral ligament (MCL) force increased with the flexion of the implant. There were no remarkable changes in the patellofemoral contact force or quadriceps in either implant. In conclusions, excessive flexion of the femoral component yielded abnormal kinematics and contact/ligament forces. Avoiding excessive flexion and maintaining mild flexion of the femoral component would provide better kinematics and biomechanical effects in CS and PS TKA.

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Tibial sagittal and rotational alignment reduce patellofemoral stresses in posterior stabilized total knee arthroplasty

Cited by 7 publications

References 45 publications

Patellar motion and dysfunction of its stabilizers in a biomechanical model of the knee joint

Patellar motion and dysfunction of its stabilizers in a biomechanical model of the knee joint

Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty

Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty

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