The influence of patella height on soft tissue balance in cruciate-retaining and posterior-stabilised total knee arthroplasty

Nishizawa, Yuichiro; Matsumoto, Tomoyuki; Kubo, Seiji; Muratsu, Hirotsugu; Matsushita, Takehiko; Oka, Shiro; Ishida, Kazunari; Matsuzaki, Takashi; Nishida, Kotaro; Akisue, Toshihiro; Kuroda, Ryosuke; Kurosaka, Masahiro

doi:10.1007/s00264-012-1749-5

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…We also checked references and used citation tracking. Recently published have meta-analyses found and included only between 8 and 12 articles as compared to our 21 ( Luo et al 2012 , Bercik et al 2013 , Li et al 2014 ), while we excluded several RCTs because of the follow-up being less than 1 year ( Swanik et al 2004 , Ishii et al 2008 , Nishizawa et al 2013 , Cankaya et al 2014 ). Since our study was performed according to the Cochrane guidelines, an elaborate and systematic assessment of quality of evidence and risk of bias was performed.…”

Section: Discussionmentioning

confidence: 99%

Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

Verra¹,

Boom²,

Jacobs³

et al. 2014

Acta Orthopaedica

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Background and purpose To retain or to sacrifice the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) remains a matter of discussion. In this systematic review, we wanted to find differences in functional and clinical outcome between the 2 methods.Methods We conducted a systematic review and meta-analysis including all randomized controlled trials (RCTs) and quasi-RCTs that have compared PCL retention with PCL sacrifice in TKA with a minimum of 1-year follow-up. Primary outcome was range of motion. Secondary outcomes were knee pain and clinical scoring systems that were preferably validated. Quality of evidence was graded using the GRADE approach. All outcomes available for data pooling were used for meta-analysis.Results 20 studies involving 1,877 patients and 2,347 knees were included. In meta-analysis, the postoperative flexion angle had a mean difference of 2 degrees (95% CI: 0.23–4.0; p = 0.03) and the KSS functional score was 2.4 points higher in favor of PCL sacrifice (95% CI: 0.41–4.3; p = 0.02). There were no statistically significant differences regarding other measured clinical outcomes such as WOMAC, KSS pain, clinical and overall score, HSS score, SF-12, radiolucencies, femoro-tibial angle, and tibial slope. The quality of the studies varied considerably. Risk of bias in most studies was unclear; 5 were judged to have a low risk of bias and 5 to have a high risk of bias.Interpretation We found no clinically relevant differences between retention and sacrifice of the PCL in TKA, in terms of functional and clinical outcomes. The quality of the studies ranged from moderate to low. Based on the current evidence, no recommendation can be made as to whether to retain or to sacrifice the PCL.

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Section: Discussionmentioning

confidence: 99%

Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

Verra¹,

Boom²,

Jacobs³

et al. 2014

Acta Orthopaedica

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“…Several reports have emphasized that patellar height is an important factor in uencing intraoperative soft tissue balance at high exion angles, especially in PS TKA [19]. The primary function of the PCL is to resist posterior tibial translation.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have showed that patellar height is an important factor influencing intraoperative soft tissue balance at high flexion angles, especially in PS‐TKA. 24 The primary function of PCL is to resist posterior tibial translation. 25 It also acts to maintain a stable joint gap between the femur and tibia beyond 90° flexion.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Factors Predicting the Preservation of the Posterior Cruciate Ligament in Total Knee Arthroplasty

Wang

Zhang

Lin

et al. 2022

Orthopaedic Surgery

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Objective Predicting the successful preservation of posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) is an important step for preoperative planning to secure the satisfactory outcomes. We aimed to examine the preoperative factors predicting the successful preservation of the PCL in cruciate‐retaining TKA and the outcome of sacrificing the PCL. Methods In this retrospective study, we analyzed TKAs consecutively performed by a single surgeon between January 2019 and August 2021 who had been preoperatively planned to undergo implantation of cruciate‐retaining (CR) prostheses. The outcome of the current study was whether the PCL was retained or sacrificed. Anterior‐stabilized (AS) tibial bearings when the PCL was sacrificed as needed were used intraoperatively. Age, sex, body mass index (BMI), and preoperative diagnosis from the patients' medical records were obtained. The medial‐lateral width of epicondyle (MLW), the medial posterior condyle height (MPCH), the lateral posterior condyle height (LPCH), the ratio of MLW and MPCH, the ratio of MLW and LPCH, the Insall–Salvati index, and the severity of the varus or valgus deformity were measured using preoperative radiographs. Univariate and multivariate regression were fitted to assess the association of these factors with the successful retention of PCL. To examine the influence of sacrifice of the PCL on the surgical procedure, the size of the tibial and femoral components, the thickness of the polyethylene insert, and the rate of patella replacement between the CR group and AS group were also compared using t tests or chi‐square tests. Results Among 307 TKAs included, PCL was sacrificed with concurrent use of AS prostheses in 89 (29.0%) procedures. Knees with rheumatoid arthritis (P < 0.01), lower Insall–Salvati index (P < 0.01), and more severe varus deformity (P = 0.011) were at a higher risk of sacrificing the PCL intraoperatively. There was no significant difference in age, sex, BMI, MLW, MPCH, LPCH, ratio of MLW and MPCH, ratio of MLW and LPCH, size of the tibial and femoral components, or replacement of the patella between the CR and AS groups. Converting from CR to AS was associated with a higher risk of using a thicker polyethylene insert (P < 0.01). Conclusion Rheumatoid arthritis, lower Insall–Salvati index, and more severe varus deformity were associated with an increased risk of sacrificing the PCL in TKAs planned to undergo implantation CR prostheses. Converting to AS tibial bearing may result in a thicker polyethylene insert. These factors should be carefully considered for the appropriate selection of prosthesis type preoperatively.

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“…Nishizawa et al . reported that the patellar height influenced the soft-tissue balance and was positively correlated with the joint component gap at greater flexion angles (90° and 135°) in PS-TKA, but the PCL was an important factor influencing the flexion soft-tissue balance in CR-TKA [ 16 ]. In the present study, there was no significant correlation between the flexion gap (with and without the trial component) and the posterior tibial slope angle or patellar height.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component

et al. 2021

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Background In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap. Methods This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component. Results The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°). Conclusions In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.

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The influence of patella height on soft tissue balance in cruciate-retaining and posterior-stabilised total knee arthroplasty

Cited by 11 publications

References 23 publications

Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty

Preoperative Factors Predicting the Preservation of the Posterior Cruciate Ligament in Total Knee Arthroplasty

Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component

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