Tibiofemoral instability in primary total knee replacement: A review, Part 1: Basic principles and classification

Gülabi, Deniz; Selmi, Tarik Aït Si; Sügün, Tahir Sadık; Neyret, Philippe

doi:10.1016/j.knee.2005.01.004

Cited by 97 publications

(70 citation statements)

References 60 publications

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“…Most publications indicate that PCL release substantially influences the joint-gap width. Authors of reviews state that sacrificing the PCL leads to an increased flexion gap [1,10]. Different companies, in their operating manuals, advise a reduced tibial slope to compensate for an increased flexion gap if the PCL is resected [11].…”

Section: Introductionmentioning

confidence: 99%

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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Section: Introductionmentioning

confidence: 99%

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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“…Moreover coronal plane alignment seen or measured intraoperatively during TKR is not necessarily the same as the deformity seen on standing long-leg radiograph either pre-or post-operatively [11]. Phenomenon of mid flexion instability is not uncommon [12]. Computer navigation has made it possible to monitor the kinematics throughout the range of flexion [13].…”

Section: /7mentioning

confidence: 99%

Effect of Traditional Sequential Medial Soft Tissue Release on Knee Kinematics and Alignment

Deep¹

2016

MOJOR

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Traditionally sequential medial soft tissue release is performed for balancing varus knees in total knee arthroplasty. Its effects on kinematics have been described in extension and 90° flexion in coronal plane but not through complete range of flexion. This study describes its effects on knee kinematics, throughout the range of motion of the knee, studied using a computer navigation system. Twelve cadaveric knees were studied. Femoro-Tibial-Mechanical-Angle (FTMA) was studied in extension, 0°, 15°, 30°, 45°, 60°, 90° and maximum flexion. Sequential medial release was performed in 7 steps, described by Luring et al. [1]. At each step FTMA was measured with and without varus and valgus stressing. A 10 Newton Meter (NM) moment was applied for varus and valgus stress.Most of the initial release steps had little effect on FTMA without force application, especially in the initial 60° of flexion. Application of varus force demonstrated very small changes. Even the application of valgus force demonstrated little change in initial arc of flexion until step 5 in the release was reached.Our study concludes that the present sequence of medial release may not be correct and should be investigated further to modify the sequence for sequential medial release for balancing in varus knees.

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“…It can be a consequence of surgical errors or poor implant design [9]. Mild instability can be misdiagnosed and confused with infection; however, this should always be ruled out before surgery (see section dedicated).…”

Section: Instabilitymentioning

confidence: 99%

“…The solution is the joint line distalization by using femoral distal augments. Joint line elevation should be avoided for flexion stiffness, patellar overstuffing, and midflexion instability [9,24,25].…”

Section: Extension Instabilitymentioning

confidence: 99%

Painful knee arthroplasty: current practice

Cottino

Rosso

Pastrone

et al. 2015

Curr Rev Musculoskelet Med

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Primary total knee arthroplasty is the treatment for end-stage arthritis of the knee; in the last years, it is becoming more common and reliable, due to technical and implant improvement. With larger implant rates, the overall complications will increase and pain is the most common sign of implant failure. Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis; if surgery is performed for the wrong reason, this will surely lead to a failure. In this paper, the authors revised the more common causes of failure that can have a painful onset proposing an approach for diagnosis and treatment.

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Tibiofemoral instability in primary total knee replacement: A review, Part 1: Basic principles and classification

Cited by 97 publications

References 60 publications

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

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

Effect of Traditional Sequential Medial Soft Tissue Release on Knee Kinematics and Alignment

Painful knee arthroplasty: current practice

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