Flexion—Extension Gap Changes During Total Knee Arthroplasty – <i>Effect of Posterior Cruciate Ligament and Posterior Osteophytes Removal</i>

Baldini, Andrea; Scuderi, G R; Aglietti, Paolo; Chalnick, David; Insall, J N

doi:10.1055/s-0030-1248201

Cited by 59 publications

(28 citation statements)

References 12 publications

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“…Resecting the PCL in general led to an increase in gap height with flexion, as expected from previous reports [4,18,25]. PCL resection caused the tibia to drop with respect to the femur in flexion, opening up the medial and lateral compartments and generally loosening the knee.…”

Section: Discussionsupporting

confidence: 85%

Ligament Tension in the ACL-deficient Knee: Assessment of Medial and Lateral Gaps

Mayman

Plaskos

Kendoff

et al. 2009

Clin Orthop Relat Res

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Obtaining symmetric and balanced gaps under equilateral loads is a common goal in posterior cruciate ligament (PCL)-retaining and -sacrificing TKAs. Owing to limitations in existing surgical tensors, however, tensing knee ligaments with standardized and symmetric loads has been possible only with the patella subluxated or everted. We therefore determined the influences of (1) patellar eversion versus complete reduction, (2) PCL resection, and (3) load magnitude on gap symmetry and balance in the anterior cruciate ligament (ACL)-deficient knee. We used a novel computer-controlled tensioner to measure gaps in 10 cadavers with an applied force of 50 N, 75 N, and 100 N per side. Gap data were acquired at 0 masculine, 30 masculine, 60 masculine, 90 masculine, and 120 masculine flexion with the patella reduced and everted and with the PCL intact and resected. Everting the patella tightened the medial and lateral flexion gaps between 90 masculine and 120 masculine by 0.7 mm to 2.7 mm. PCL resection increased gaps from 30 degrees to 120 degrees by 1 mm to 3 mm. Increasing the force from 50 N to 100 N increased the mean gap by 0.5 mm. Everting the patella and resecting the PCL influenced gap balance and symmetry. Surgeons should be aware of how these conditions affect gaps during assessment and balancing.

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Section: Discussionsupporting

confidence: 85%

Ligament Tension in the ACL-deficient Knee: Assessment of Medial and Lateral Gaps

Mayman

Plaskos

Kendoff

et al. 2009

Clin Orthop Relat Res

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“…The latter two studies included no information on how many patients reacted with a relevant flexion-gap increase. Baldini and coworkers reported on 50 patients with varus and valgus deformity and found a symmetrical effect from the PCL release of 1.3 mm on the joint gap in extension and 90°flexion [12]. A flexion-gap increase >2 mm was measured in 26% of patients.…”

Section: Discussionmentioning

confidence: 97%

“…In this context, we investigated high flexion grades and found that the biggest joint-gap increase was between 110°and 140°. To our knowledge, all other studies focused only on the joint gap between full extension and 90° [9,12,13,[16][17][18][19][20][21]. The proven increase in high flexion grades might be the reason for the higher range of motion that was frequently detected after posterior stabilised prostheses in comparison with posterior cruciateretaining prostheses [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…However, at that point of the procedure, the flexion/extension gap ratio has already been determined by the femoral distal and posterior resections. In contrast to this operative strategy, some studies indicate no effects of PCL release on the flexion/extension gap ratio [12,13]. Therefore, it may be a better alternative to release the PCL prior to the femoral resections.…”

Section: Introductionmentioning

confidence: 99%

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Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable?

Schnurr

Eysel

König

2011

International Orthopaedics (SICOT)

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Purpose It is broadly supposed that in total knee arthroplasty, the flexion/extension gap ratio is increased after resection of the posterior cruciate ligament (PCL). However, studies are rare and results are inconsistent. Therefore, this study was conducted to determine whether PCL release regularly increases the flexion gap. Methods Data from 50 consecutive posterior stabilised knee prostheses were analysed retrospectively. Using imageless computer navigation, the joint-gap width was measured over the entire range of motion before and after PCL release. Results PCL release had no effect on the extension gap, but it increased the flexion gap significantly. An increase of >3 mm occurred in 36% of patients and of >5 mm in 12%. No clinically relevant effect (<2 mm) was found in 44% of patients. Conclusion PCL release increased the flexion/extension gap ratio on average, but the individual effect could not be predicted. Therefore, we recommend PCL release before the femoral resections are performed, as this step mainly determines the ratio between extension and flexion gap.

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“…Nonetheless, it remains unsettled how wide, in proportion to the prosthetic components, the gaps should be distracted. Baldini et al 29 propose that for the majority of osteoarthritic (OA) knees undergoing posterior stabilized TKA, PCL removal and re-establishment of the posterior recess does not require additional consideration for gap balancing. This may be partially relevant for the posterior stabilized concept, which perhaps compensates for some gap differences.…”

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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Flexion—Extension Gap Changes During Total Knee Arthroplasty – Effect of Posterior Cruciate Ligament and Posterior Osteophytes Removal

Cited by 59 publications

References 12 publications

Ligament Tension in the ACL-deficient Knee: Assessment of Medial and Lateral Gaps

Ligament Tension in the ACL-deficient Knee: Assessment of Medial and Lateral Gaps

Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable?

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

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