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

Abstract

We 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.

Cruciate ligament force of knees following mobile-bearing unicompartmental knee arthroplasty is larger than the preoperative value

“…According to a study, the ACL force in the postoperative knees was greater than the force in the preoperative knees following BCR-TKA; this is similar to our present findings 19 . Okada et al demonstrated that the in situ ACL force against 100 N of anterior force in BCR-TKA knees was statistically comparable with that of intact knees at all flexion angles 10 .…”

“…Although there was no significant difference in the PCL force in BCR-TKA 19 , the PCL force in the postoperative UKA knees was larger than that in the preoperative knees. Tsai et al have reported that the PCL in BCR-TKA was significantly overstretched in deep flexion positions, resonating with a previous posterior cruciate-retaining TKA study 16 , which reported overstretching of the PCL in PCR-TKA during deep flexion and attributed this to reduced femoral rollback 24 .…”

Bicruciate-Retaining Total Knee Arthroplasty: State of the Art for the Younger and Active Population? A Systematic Review and Future Prospective

“…In addition, while preoperatively ACL forces correlated highly with AP translation of the femur during squatting, postoperatively only posterior cruciate ligament (PCL) forces correlated with AP translation of the lateral femoral condyle during squatting. These findings indicate that kinematic changes correlate with changes in cruciate ligament forces, thus underlining the lack of achieving native kinematics [48]. This has been supported by a validated computer tomography and fluoroscopic imaging system in 29 patients who underwent unilateral BCR-TKA.…”

“…Although kinematic studies found advantages of BCR-TKA, its design does not achieve native knee function, as forces to the ACL may be increased and posterior femoral translation and internal rotation decreased. In addition, sagittal plane motion and tibiofemoral articular contact characteristics including pivoting patterns were not fully restored [25,[48][49][50]. Nevertheless, kinematic analyses suggest superior static balance ability on a single-leg test of BCR-TKA compared to PS-TKA and UKA designs [51], and that compared to the CR-TKA design, ACL retention may lead to improved muscle recruitment during (downhill) walking and increased neuromuscular control Recently, a BCS-TKA design was introduced which uses a dual-post-cam mechanism as a substitute for the ACL and PCL, with due to the design provides guidance for axial rotation and posterior translation.…”

Bicruciate-retaining total knee arthroplasty procedure reduced tensile force in the middle and posterior components of lateral collateral ligament during deep knee flexion activities with no effect on tensile force of the medial collateral ligament

“…A previous study demonstrated that knee joint kinematics after BCR‐TKA differed depending on the type of high‐flexion activity performed [12]. Furthermore, it is known that the tensile force of the ACL is higher during a closed kinetic chain (CKC) and deep knee bend is higher than knee flexion in open‐kinetic chain (OKC) high [10]. However, whether the tensile force in the collateral ligaments of the knee differs after BCR‐TKA from those in intact knees during high knee flexion activities remains unknown.…”