Effects of Posterior Cruciate Ligament Resection on the Tibiofemoral Joint Gap

Kadoya, Y.; Kobayashi, Akio; Komatsu, Takeshi; Nakagawa, S.; Yamano, Yoshiki

doi:10.1097/00003086-200110000-00023

Cited by 132 publications

(91 citation statements)

References 12 publications

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“…Dorr and Boiardo 20 determined that cutting the PCL opened the flexion space an additional 3-4 mm; however, they did not define the applied distraction force. With a somewhat larger distraction force of 40 lb ($178 N), Kadoya et al 21 found an increased flexion gap after PCL resection of 4.8 mm medially and 4.5 mm laterally. However, these values were ascertained after bone cuts were made and to some extent after medial release, which explains the equalization between the two sides.…”

Section: Discussionmentioning

confidence: 99%

Measurement of knee joint gaps without bone resection: “Physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes

Nowakowski

Majewski

Müller‐Gerbl

et al. 2011

Journal Orthopaedic Research

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General agreement is that flexion and extension gaps should be equal and symmetrical in total knee arthroplasty (TKA) procedures. However, comparisons using a standard TKA approach to normal knee joints that have not undergone bone resection are currently unavailable. Since bony preparation can influence capsule and ligament tension, our purpose was to perform measurements without this influence. Ten normal cadaveric knees were assessed using a standard medial parapatellar TKA approach with patellar subluxation. Gap measurements were carried out twice each alternating 100 and 200 N per compartment using a prototypical forcedetermining ligament balancer without the need for bony resection. Initial measurements were performed in extension, followed by 908 of flexion. The ACL was then resected, and finally the PCL was resected, and measurements were carried out in an analogous fashion. In general, the lateral compartment could be stretched further than the medial compartment, and the corresponding flexion gap values were significantly larger. ACL resection predominantly increased extension gaps, while PCL resection increased flexion gaps. Distraction force of 100 N per compartment appeared adequate; increasing to 200 N did not improve the results. ß

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Section: Discussionmentioning

confidence: 99%

Measurement of knee joint gaps without bone resection: “Physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes

Nowakowski

Majewski

Müller‐Gerbl

et al. 2011

Journal Orthopaedic Research

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“…1) provided by a ratchet-type hex wrench, which limited applicable force at 40 pounds. The 40-pound distracting force was chosen based on previous studies [12,16] regarding joint gap measurement during surgery and to maintain the integrity of the bone and soft tissues. The width of the joint gap was defined as the center distance between the upper side of the seesaw plate and the underside of the lower plate.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, equality of the distance from the femoral component to the tibial surface (the joint gap) throughout the full range of knee motion prevents liftoff of the femoral component and theoretically assists in obtaining the proper contact pressure and kinematics. However, the flexion gap reportedly increases after resection of the posterior cruciate ligament (PCL) during posterior-stabilized (PS) TKA [12,17].…”

Section: Introductionmentioning

confidence: 99%

Joint Gap Changes with Patellar Tendon Strain and Patellar Position During TKA

Gejo

Morita

Matsushita

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Balancing of the joint gap in extension and flexion is a prerequisite for success of a total knee arthroplasty. The joint gap is influenced by patellar position. We therefore hypothesized the state of the knee extensor mechanism (including the patellar tendon) would influence the joint gap. In 20 knees undergoing posterior-stabilized type total knee arthroplasties, we measured the joint gap and the patellar tendon strain from 0°to 135°flexion with the femoral component in position. When the patella was reduced, the joint gap was decreased at 90°and 135°(by

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“…We followed the recommendation of Kesman et al [12] to rely on distraction distance rather than tension. Posterior resection was based on tensiometer metric scale to match extension gap, and tight PCL portions in flexion were routinely released to match extension gap [11].…”

Section: Patients and Materialsmentioning

confidence: 99%

Does a Modified Gap-balancing Technique Result in Medial-pivot Knee Kinematics in Cruciate-retaining Total Knee Arthroplasty?: A Pilot Study

Fitz¹,

Sodha

Reichmann

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Normal knee kinematics is characterized by posterior femorotibial rollback with tibial internal rotation and medial-pivot rotation in flexion. Cruciate-retaining TKAs (CR-TKAs) do not reproduce normal knee kinematics. Questions/purposes We hypothesized a more anatomic reconstruction of the medial femoral condyle, simultaneously preserving the tension of the PCL and medial collateral ligament, resulted in (1) medial-pivot rotation and tibial internal rotation, (2) lateral femoral rollback, and (3) reduced liftoff. Patients and Methods We compared 10 patients who underwent CR-TKA using the new technique at their 1-year followup to a matched control group of nine patients using a traditional gap-balancing technique at their 2-to 4-year followup. All patients received lateral radiographs in extension and flexion, which we utilized for threedimensional implant matching to calculate tibial internal rotation, lateral rollback, and lateral liftoff in extension and flexion. Results The new gap-balancing technique resulted in a median of 3.5°tibial internal rotation with 2.7-mm rollback of the lateral femoral condyle relative to the medial condyle in flexion, which was different from the control group. We found no differences in liftoff between the groups. Conclusions The new technique resulted in tibial internal rotation with flexion and lateral rollback comparing the lateral to the medial condyle in flexion, but no differences in condylar liftoff. These preliminary results were comparable to published kinematic results of an asymmetric CR-TKA or medial-pivot CR-TKA but not to symmetric CR-TKA.

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Effects of Posterior Cruciate Ligament Resection on the Tibiofemoral Joint Gap

Cited by 132 publications

References 12 publications

Measurement of knee joint gaps without bone resection: “Physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes

Measurement of knee joint gaps without bone resection: “Physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes

Joint Gap Changes with Patellar Tendon Strain and Patellar Position During TKA

Does a Modified Gap-balancing Technique Result in Medial-pivot Knee Kinematics in Cruciate-retaining Total Knee Arthroplasty?: A Pilot Study

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