Is the Use of Spreaders an Accurate Method for Ligament Balancing?

Ferreira, M C; Franciozi, Carlos Eduardo da Silveira; Kubota, Marcelo Seiji; Priore, Ricardo D.; Ingham, Sheila Jean McNeill; Abdalla, René Jorge

doi:10.1016/j.arth.2017.01.055

Cited by 17 publications

(6 citation statements)

References 22 publications

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“…1c) used to define full extension and flexion at 90° rectangular space as previously described [1]. Following this, symmetrical tension is applied to the joint line in extension using the ligament tensor [9]. This symmetrical tensioning was able to identify any residual varus/valgus deformity and could determine the magnitude of the gap.…”

Section: Methodsmentioning

confidence: 99%

A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state

Manning

Blain

Longstaff

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose A balanced knee arthroplasty should optimise survivorship and performance. Equilibration of medial and lateral femorotibial load requires guided judicious pericapsular ligament release. The null hypothesis was that there would be no difference between use of a tensiometer device and a remote load sensor final load transfer across the joint through functional arc of motion. Methods A cadaveric study, using eight knees, was performed to define the impact of an established gap distraction device against load sensor-aimed soft tissue release in a TKA setting. Using validated measures of laxity in six degrees of freedom and true real-time load sensing four states were examined: native knee, TKA using spacer blocks (TKA), TKA with soft tissue release aided by a monogram tensiometer (TKA-T) and finally where load across the tibiofemoral articulation remains unbalanced final soft tissue release using a sensor device (TKA-OS). Results The laxity pattern was equivalent for TKA-T and TKA-OS. However, in only four of these seven knees despite the tensiometer confirming equivalence of rectangular flexion–extension gap dimensions and centralisation of collateral ligament distraction, there remained a > 15lb medial to lateral load difference for at least one point of the flexion arc. This was corrected by further final soft tissue release guided by the OS sensor device in the final three knees. Conclusion Tensiometer-guided soft tissue release at two points of flexion failed to achieve balance for three out of seven knee arthroplasty procedures. Sensor technology guided final soft tissue balancing to equilibrate load across the joint through full arc of motion. This work argues for the role of continuous sensor readings to guide the soft tissue balancing during total knee arthroplasty.

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Section: Methodsmentioning

confidence: 99%

A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state

Manning

Blain

Longstaff

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…Ligament balancing is essential during TKA and especially difficult to assess and to manage. Experienced surgeons traditionally obtain soft tissue balance using their own subjective “feeling” rather than a scientific perspective [ 25 , 26 , 27 , 28 ]. The ligament balancing “feeling” is affected by many factors such as patient obesity, gender, generalized laxity, degree of joint contracture, surgical experience, and even the surgeon’s daily condition [ 29 , 30 ].…”

Section: Sensors In Tkamentioning

confidence: 99%

New Technologies in Knee Arthroplasty: Current Concepts

Batailler

Swan

Sappey‐Marinier

et al. 2020

JCM

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Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. Despite good survival rates, up to 20% of TKA patients remain dissatisfied. Recently, promising new technologies have been developed in knee arthroplasty, and could improve the functional outcomes. The aim of this paper was to present some new technologies in TKA, their current concepts, their advantages, and limitations. The patient-specific instrumentations can allow an improvement of implant positioning and limb alignment, but no difference is found for functional outcomes. The customized implants are conceived to reproduce the native knee anatomy and to reproduce its biomechanics. The sensors have to aim to give objective data on ligaments balancing during TKA. Few studies are published on the results at mid-term of these two devices currently. The accelerometers are smart tools developed to improve the TKA alignment. Their benefits remain yet controversial. The robotic-assisted systems allow an accurate and reproducible bone preparation due to a robotic interface, with a 3D surgical planning, based on preoperative 3D imaging or not. This promising system, nevertheless, has some limits. The new technologies in TKA are very attractive and have constantly evolved. Nevertheless, some limitations persist and could be improved by artificial intelligence and predictive modeling.

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“…However, when using a spring-loaded ligament balancer, Matsui et al applied a force of 120 N in both gaps, whereas Ferreira et al applied 100 N upon extension and 80 N upon flexion 25,26 . As the soft tissue balance has been reported to change under these varying forces 27 , it is necessary to find the optimal force for evaluating joint gaps.…”

Section: Discussionmentioning

confidence: 99%

Optimal Distraction Force for Evaluating Tibiofemoral Joint Gaps in Posterior Stabilized Total Knee Arthroplasty

et al. 2021

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Background: Obtaining well-balanced soft tissues is important to achieve natural knee kinematics after total knee arthroplasty (TKA). In conventional procedures, soft tissue balance is evaluated with spacer blocks or lamina spreaders. However, the evaluation depends on the surgeons' experience and is not quantitative. This study aims to measure the mechanical properties of knee soft tissue with a new ligament balancer and to determine the optimal distraction force for evaluating tibiofemoral joint gaps in TKA.Methods: This study included 30 consecutive patients with medial knee osteoarthritis who were scheduled to undergo posterior stabilized TKA. The mean age of patients was 73 ± 9.6 years at the time of surgery, and the mean hip-knee-ankle angle was 13.1 ± 6.5°in varus. After distal femoral and proximal tibial resections, the tibiofemoral joint gaps under several distraction forces were measured in extension and at 90°flexion. The load-displacement curves in extension and flexion were drawn with these data, and the stability range, which was defined as the shift range from the toe region to the linear region in the curves, was calculated. Results:The stability ranges were 160 Newtons (N) in extension and 140 N in flexion.Conclusions: These displacement forces were considered optimal for evaluating tibiofemoral joint gaps during surgery and ensuring knee stability after TKA.

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Is the Use of Spreaders an Accurate Method for Ligament Balancing?

Cited by 17 publications

References 22 publications

A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state

A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state

New Technologies in Knee Arthroplasty: Current Concepts

Optimal Distraction Force for Evaluating Tibiofemoral Joint Gaps in Posterior Stabilized Total Knee Arthroplasty

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