Posterior Tibial Slope Increases Anterior Cruciate Ligament Stress in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematic Analysis

2020 ◽  
Author(s):  
Christian Klemt ◽  
Georges Bounajem ◽  
Venkatsaiakhil Tirumala ◽  
Liang Xiong ◽  
Ruben Oganesyan ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Weight Bearing ◽  
Knee Kinematics ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
Total Knee ◽  
Anterior Cruciate ◽  
Pl Bundle ◽  
Bcr Tka

AbstractThe study design involved here is experimental in nature. The resection of the anterior cruciate ligament (ACL) during conventional total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal in vivo knee kinematics. Bi-cruciate retaining (BCR) TKA designs allow the preservation of the ACL with the potential to restore native knee kinematics. This study aimed to investigate the effect of posterior tibial slope (PTS) on stress experienced by the ACL during weight bearing sit-to-stand (STS) and single-leg deep lunge. The ACL elongation patterns were measured in 30 unilateral BCR TKA patients during weight-bearing STS and single-leg deep lunge using a validated dual fluoroscopic tracking technique. The minimum normalized stress within the anteromedial (AM) and posterolateral (PL) bundle of the ACL during weight-bearing STS and single-leg deep lunge was found at a PTS of 3.7 degrees. The maximum AM and PL bundle stresses were observed at a PTS of 8.5 and 9.3 degrees, respectively during STS and at 8.4, and 9.1 degrees, respectively during single-leg deep lunge. There was a significant positive correlation between PTS and stress observed within the AM and PL bundle of the ACL during weight-bearing STS (R 2 = 0.37; p < 0.01; R2  = 0.36; p = 0.01) and single-leg deep lunge (R 2 = 0.42; p < 0.01; R 2 = 0.40; p < 0.01). The study demonstrates that PTS of operated BCR TKA knees has a significant impact on the stress experienced by the preserved ACL during weight-bearing STS and single-leg deep lunge. This suggests that avoiding excessive PTS may be one of the surgical implant alignment factors to consider during surgery to minimize increased loading of the preserved ACL.

Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

2019 ◽  
Vol 33 (08) ◽  
pp. 798-803
Author(s):  
Yun Peng ◽  
Paul Arauz ◽  
Shuai An ◽  
Sakkadech Limmahakhun ◽  
Christian Klemt ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Tibial Slope ◽  
Component Alignment ◽  
Posterior Tibial ◽  
Patient Reported ◽  
Total Knee ◽  
Bcr Tka

AbstractThis is an experimental study. Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) retaining bicruciate retaining (BCR) total knee arthroplasty (TKA) have the potential to restore normal knee kinematics and thus improve patient outcome. Limited studies have examined the relationship between component alignment and patient-reported outcome measures (PROM). This study aims to determine (1) accurate three-dimensional (3D) component alignment of BCR TKA and (2) whether the component alignment of BCR TKA affects PROMs. The 3D modeling analysis was performed based on computed tomography images from 29 BCR TKAs. Component orientations were quantified for femoral and tibial components in the sagittal, axial, and coronal planes. The knee society scores (KSS) were collected preoperatively and postoperatively at 1-year follow-up. Multiple comparisons were performed to analyze the relationship between component alignment and patient outcomes. High variability was observed in the tibial component alignment (root–mean-square values: axial plane 6.6 degrees, sagittal plane 5.1 degrees, and coronal plane 4.0 degrees). At 1-year follow-up, significant improvement in KSS was noted in BCR TKA patients (p < 0.001). However, regression analysis adjusting for baseline KSS demonstrated the postoperative KSS was negatively associated with the posterior tibial slope (B [slope of the output of the regression analysis] = 2.597, p = 0.006). Patients with greater posterior tibial slopes were reported poorer postoperative functions at 1-year follow-up. Excessive posterior tibial slope may generate greater posterior force on the femur that leads to continuous overloading of the preserved ACL, suggesting optimal sagittal plane alignment of the tibial component may be important for the optimization of postoperative functions of BCR TKA patients.

scholarly journals In vivo kinematics and cruciate ligament forces in bicruciate-retaining total knee arthroplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenichi Kono ◽  
Hiroshi Inui ◽  
Tetsuya Tomita ◽  
Takaharu Yamazaki ◽  
Shoji Konda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Knee Kinematics ◽  
Anteroposterior Translation ◽  
Total Knee ◽  
Bcr Tka ◽  
Femoral Condyles

AbstractWe analyzed the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on knee kinematics and cruciate ligament forces. Patients (N = 15) with osteoarthritis (OA) and an intact anterior cruciate ligament (ACL) underwent magnetic resonance imaging and single-plane fluoroscopy to measure tibiofemoral kinematics during two deep knee bend activities before and after BCR-TKA: (1) weight-bearing squat; (2) non-weight-bearing cross-legged sitting. Forces in ligament bundles were calculated using VivoSim. The dynamic range of varus-valgus angulation decreased from 3.9 ± 4.4° preoperatively to 2.2 ± 2.7° postoperatively. Preoperatively, the medial femoral condyle translated anteriorly from 10° to 50° of flexion, and posteriorly beyond 50° of flexion. Postoperatively, the medial and lateral femoral condyles translated posteriorly throughout flexion in a medial pivot pattern. ACL forces were high in extension and decreased with flexion pre- and postoperatively. PCL forces increased with flexion preoperatively and did not change significantly postoperatively. Preoperatively, ACL forces correlated with anteroposterior translation of the femoral condyles. Postoperatively, PCL forces correlated with anteroposterior translation of the lateral femoral condyle. BCR-TKA altered knee kinematics during high flexion activity which correlated significantly with changes in cruciate ligament forces.

scholarly journals Posterior tibial slope and anterior post-cam contact can change knee kinematics in extension in bi-cruciate stabilized total knee arthroplasty

2020 ◽  
Vol 9 (11) ◽  
pp. 761-767
Author(s):  
Masaru Hada ◽  
Hideki Mizu-uchi ◽  
Ken Okazaki ◽  
Koji Murakami ◽  
Takao Kaneko ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Weight Bearing ◽  
Knee Kinematics ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Forward Movement ◽  
Posterior Tibial ◽  
Tibial Insert ◽  
Total Knee

Aims This study aims to investigate the effects of posterior tibial slope (PTS) on knee kinematics involved in the post-cam mechanism in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) using computer simulation. Methods In total, 11 different PTS (0° to 10°) values were simulated to evaluate the effect of PTS on anterior post-cam contact conditions and knee kinematics in BCS TKA during weight-bearing stair climbing (from 86° to 6° of knee flexion). Knee kinematics were expressed as the lowest points of the medial and lateral femoral condyles on the surface of the tibial insert, and the anteroposterior translation of the femoral component relative to the tibial insert. Results Anterior post-cam contact in BCS TKA was observed with the knee near full extension if PTS was 6° or more. BCS TKA showed a bicondylar roll forward movement from 86° to mid-flexion, and two different patterns from mid-flexion to knee extension: screw home movement without anterior post-cam contact and bicondylar roll forward movement after anterior post-cam contact. Knee kinematics in the simulation showed similar trends to the clinical in vivo data and were almost within the range of inter-specimen variability. Conclusion Postoperative knee kinematics in BCS TKA differed according to PTS and anterior post-cam contact; in particular, anterior post-cam contact changed knee kinematics, which may affect the patient’s perception of the knee during activities. Cite this article: Bone Joint Res 2020;9(11):761–767.

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