Using a patella reduced technique while balancing a TKA results in restored physiological strain in the collateral ligaments: an ex vivo kinematic analysis.
Collateral ligament strain
Ligament balancing
Ligament laxity
Patella-in-place balancing
Total knee arthroplasty
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
received:
14
01
2021
accepted:
18
06
2021
pubmed:
4
7
2021
medline:
25
6
2022
entrez:
3
7
2021
Statut:
ppublish
Résumé
Poor soft tissue balance in total knee arthroplasty (TKA) often results in patient dissatisfaction and reduced joint longevity. Patella-in-place balancing (PIPB) is a novel technique which aims to restore native collateral ligament behavior without collateral ligament release, while restoring post-operative patellar position. This study aimed to assess the effectiveness of this novel technique through a detailed ex vivo biomechanical analysis by comparing post-TKA tibiofemoral kinematics and collateral ligament behavior to the native condition. Eight fresh-frozen cadaveric legs (89.2 ± 6 years) were tested on a validated dynamic knee simulator, following computed tomography imaging. Specimens were subjected to passive flexion (10-120°), squatting (35-100°), and varus/valgus laxity testing (10 Nm at 0°, 30°, 60°, 90° flexion). An optical motion capture system recorded markers affixed rigidly to the femur, tibia, and patella, while digital extensometers longitudinally affixed to the superficial medial collateral ligament (MCL) and lateral collateral ligament (LCL) collected synchronized strain data. Following native testing, a Stryker Triathlon CR TKA (Stryker, MI, USA) was performed on each specimen and the identical testing protocol was repeated. Statistical analyses were performed using a linear mixed model for functional motor tasks, while Wilcoxon signed-rank test was used for laxity tests (p < 0.05). Postoperative laxity was lower than the native condition at all flexion angles while post-operative ligament strain was lowered only for MCL at 30° (p = 0.017) and 60° (p = 0.011). Postoperative femoral rollback patterns were comparable to the native condition in passive flexion but demonstrated a more pronounced medial pivot during squatting. Balancing a TKA with the PIPB technique resulted in reduced joint laxity, while restoring collateral ligament strains. The technique also seemed to restore kinematics and strains, especially in passive flexion.
Identifiants
pubmed: 34216262
doi: 10.1007/s00402-021-04010-y
pii: 10.1007/s00402-021-04010-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1633-1644Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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