The effect of anteroposterior laxity on the range of movement and knee function following a cruciate-retaining total knee replacement

Seon, Jong Keun; Park, S. J.; Yoon, Taek Rim; Lee, K. B.; Moon, Eun Sun; Song, Eun Kyoo

doi:10.1302/0301-620x.92b8.23980

Cited by 20 publications

(36 citation statements)

References 24 publications

(53 reference statements)

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“…A single‐radius design oriented along the trans‐epicondylar axis may reproduce the natural knee kinematics19 and maintain isometry of the MCL. Clinical studies8, 20 found that functional scores were reduced only when AP laxity exceeded 10 mm, which is greater than in this experiment, and is related to ligament laxity rather than a relatively small change in implant geometry, between single and multi‐radius femoral components. More knowledge of TKA function could be gained by further experiments, in which component positions, ligament tensions and loading conditions are varied 12, 13.…”

Section: Discussioncontrasting

confidence: 45%

“…A geometrical analysis (that remains unconfirmed by experimental measurement) suggested that the multi‐radius geometry may tend to tense the sMCL in mid‐flexion more than the single‐radius design. Taking this with clinical evidence7, 8, 20 suggests that mid‐range instability relates to ligament laxity, which may not be recognized during surgery.…”

Section: Discussionmentioning

confidence: 98%

“…However, there may sometimes be an intermediate arc of flexion where the ligaments are more slack, leading to “mid‐range instability” with the multi‐radius prostheses 6, 7. This instability may occur with both posterior cruciate ligament‐retaining and posterior cruciate‐sacrificing designs 8, 9. The use of a “single‐radius” femoral component has been proposed to ensure consistent tension in the collateral ligaments throughout the functional range of movement.…”

mentioning

confidence: 99%

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The kinematics and stability of single‐radius versus multi‐radius femoral components related to Mid‐range instability after TKA

Stoddard

Deehan

Bull

et al. 2012

Journal Orthopaedic Research

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There continues to be some dissatisfaction with the function of total knee arthroplasties (TKA). ''Mid-range instability'' has been linked to multi-radius femoral components allowing transient ligament slackness and instability during knee flexion. Singleradius designs have been introduced to avoid this. We compared the kinematics and stability of eight natural knees versus multi-radius and single-radius TKAs in vitro. The loading conditions imposed across the range of active knee extension were anterior-posterior drawer forces, internal-external rotation torques, and varus-valgus moments. Significant differences were not found between the biomechanical behavior of the two TKAs. Both were significantly different from the natural knee in allowing greater anterior drawer laxity near extension, probably caused by excision of the anterior cruciate ligament, but no difference occurred beyond 308 flexion. No differences were found for any of the other degrees-of-freedom of movement. A geometric analysis suggested that the multi-radius design may tense the MCL more than the single-radius in mid-flexion, contrary to expectation. These kinematic and stability tests did not find mid-range instability of the knees, and so they could not demonstrate enhanced mid-range stability of the single-radius TKA over the older multi-radius implant. This suggests that mid-range instability may relate to unrecognized ligament laxity during surgery, rather than being inherent to a specific feature of implant design. ß

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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The kinematics and stability of single‐radius versus multi‐radius femoral components related to Mid‐range instability after TKA

Stoddard

Deehan

Bull

et al. 2012

Journal Orthopaedic Research

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“…Furthermore, soft tissue laxity may negatively infl uence outcome in patients receiving a minimally constrained knee design, such as cruciate retaining knees. 9,10 Patients with fi bromyalgia may also develop end-stage knee arthritis and eventually require total knee arthroplasty (TKA). Currently, no data on the results of TKA in patients with fi bromyalgia have been published.…”

mentioning

confidence: 99%

Primary Total Knee Arthroplasty in Patients With Fibromyalgia

D’Apuzzo¹,

Cabanela²,

Trousdale³

et al. 2012

Orthopedics

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No data on the results of total knee arthroplasty (TKA) in patients with fibromyalgia have been published. The purposes of this study were to review a cohort of patients with fibromyalgia undergoing TKA to determine the level of postoperative pain and satisfaction with the surgery, the incidence of postoperative surgical complications, and revision rates and their relationship to TKA design. One hundred ten patients with fibromyalgia (141 knees) who underwent primary TKA between 1990 and 2001 were studied. The average age was 64 years (range, 39-86 years), and the average follow-up was 7 years (range, 2-16 years). Forty-five knees were cruciate retaining, and 96 had a posterior stabilized design. Clinical outcome was assessed using the Knee Society Knee Score and satisfaction regarding the results of the procedure. Postoperative surgical complications and reoperations were obtained from the registry. Sixty-two patients (44%) continued with some pain after TKA. Eighty-five patients (82%) were satisfied with the results. The most common complications were arthrofibrosis and symptomatic instability. The revision rate was 6% (8 knees). Survivorship free from revision at 7 years was 89% for cruciate retaining knees and 98% for posterior stabilized knees. Patients with fibromyalgia undergoing primary TKA have a high prevalence of complications and pain. Despite continued pain, the majority of patients were satisfied with the results and reported improvements after TKA. This data should be used to counsel patients with fibromyalgia preoperatively regarding limited goals with respect to pain relief and suggests that a multimodal individualized treatment program may be necessary to achieve optimal outcomes in patients with fibromyalgia.

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“…[7][8][9] However, Seon et al, 10 in their assessment of 42 TKRs, have suggested that a moderate amount (5 mm to 10 mm) of sagittal movement may provide ideal function and ROM, compared, for instance, with a TKR that is too tight (< 5 mm) or lax (> 10 mm) when assessed for AP translation. 9,11 The objective of our study was to correlate post-operative AP movement in patients with a CR TKR with ROM and function two years post-operatively.…”

mentioning

confidence: 99%

Evaluation of the relationship between anteroposterior translation of a posterior cruciate ligament-retaining total knee replacement and functional outcome

Seah

Pang

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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The success of total knee replacement (TKR) depends on optimal soft-tissue balancing, among many other factors. The objective of this study is to correlate post-operative anteroposterior (AP) translation of a posterior cruciate ligament-retaining TKR with clinical outcome at two years. In total 100 patients were divided into three groups based on their AP translation as measured by the KT-1000 arthrometer. Group 1 patients had AP translation < 5 mm, Group 2 had AP translation from 5 mm to 10 mm, and Group 3 had AP translation > 10 mm. Outcome assessment included range of movement of the knee, the presence of flexion contractures, hyperextension, knee mechanical axes and functional outcome using the Knee Society score, Oxford knee score and the Short-Form 36 questionnaire. At two years, patients in Group 2 reported significantly better Oxford knee scores than the other groups (p = 0.045). A positive correlation between range of movement and AP translation was noted, with patients in group 3 having the greatest range of movement (mean flexion: 117.9° (106° to 130°)) (p < 0.001). However, significantly more patients in Group 3 developed hyperextension > 10° (p = 0.01). In this study, the best outcome for cruciate-ligament retaining TKR was achieved in patients with an AP translation of 5 mm to 10 mm.

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The effect of anteroposterior laxity on the range of movement and knee function following a cruciate-retaining total knee replacement

Cited by 20 publications

References 24 publications

The kinematics and stability of single‐radius versus multi‐radius femoral components related to Mid‐range instability after TKA

The kinematics and stability of single‐radius versus multi‐radius femoral components related to Mid‐range instability after TKA

Primary Total Knee Arthroplasty in Patients With Fibromyalgia

Evaluation of the relationship between anteroposterior translation of a posterior cruciate ligament-retaining total knee replacement and functional outcome

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