Skip to main content
SpringerLink
Log in

A new spacer-guided, PCL balancing technique for cruciate-retaining total knee replacement

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The goal of this study was to investigate whether a new posterior cruciate ligament (PCL) balancing approach with a spacer technique during total knee arthroplasty (TKA) reproduced the correct tibiofemoral contact point (CP) location. It was hypothesized that it should be possible to adequately balance the PCL with this geometrical technique, obtaining correct position and stability of the medial femoral condyle, independent of insert shape.

Methods

Nine fresh-frozen full-leg cadaver specimens were used. After native testing, prototype components of a new PCL-retaining implant were implanted using navigation and a bone-referencing technique. After finishing the bone cuts, the spacer technique was used to ascertain balancing of the PCL and the tibial cut was corrected if necessary. Passive and squat motions were performed before and after TKA using a dynamic knee simulator while tibiofemoral kinematics were recorded using six infrared cameras. CPs (native and implant) were calculated as the projections of the femoral condylar centres on the horizontal plane of the tibia.

Results

The spacer technique resulted in correct PCL balancing in all specimens. The kinematic patterns of native and replaced knees showed no statistically significant differences in passive and squat motions. The medial CP after TKA was at the same position as in the native knee. No paradoxical sliding forward was seen after TKA, supporting our hypothesis.

Conclusions

The spacer technique can be applied by surgeons during PCL-retaining TKA and will lead to good PCL balancing, indicated by a correct CP, no lift-off in flexion and no posterior sag.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Banks S, Bellemans J, Nozaki H, Whiteside LA, Harman M, Hodge WA (2003) Knee motions during maximum flexion in fixed and mobile-bearing arthroplasties. Clin Orthop Relat Res 410:131–138

    Article  PubMed  Google Scholar 

  2. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84:50–53

    Article  CAS  PubMed  Google Scholar 

  3. Catani F, Innocenti B, Belvedere C, Labey L, Ensini A, Leardini A (2010) The mark coventry award: articular contact estimation in TKA using in vivo kinematics and finite element analysis. Clin Orthop Relat Res 468:19–28

    Article  PubMed  Google Scholar 

  4. de Jong RJ, Heesterbeek PJ, Wymenga AB (2010) A new measurement technique for the tibiofemoral contact point in normal knees and knees with TKR. Knee Surg Sports Traumatol Arthrosc 18:388–393

    Article  PubMed  Google Scholar 

  5. Freeman MA, Pinskerova V (2003) The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res 410:35–43

    Article  PubMed  Google Scholar 

  6. Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am 69:233–242

    CAS  PubMed  Google Scholar 

  7. Heesterbeek P, Keijsers N, Jacobs W, Verdonschot N, Wymenga A (2010) Posterior cruciate ligament recruitment affects antero-posterior translation during flexion gap distraction in total knee replacement. An intraoperative study involving 50 patients. Acta Orthop 81:471–477

    Article  PubMed  Google Scholar 

  8. Kim H, Pelker RR, Gibson DH, Irving JF, Lynch JK (1997) Rollback in posterior cruciate ligament-retaining total knee arthroplasty. A radiographic analysis. J Arthroplast 12:553–561

    Article  CAS  Google Scholar 

  9. Kurtz SM, Villarraga ML, Herr MP, Bergstrom JS, Rimnac CM, Edidin AA (2002) Thermomechanical behavior of virgin and highly crosslinked ultra-high molecular weight polyethylene used in total joint replacements. Biomaterials 23:3681–3697

    Article  CAS  PubMed  Google Scholar 

  10. Liabaud B, Patrick DA Jr, Geller JA (2013) Is the posterior cruciate ligament destabilized after the tibial cut in a cruciate retaining total knee replacement? An anatomical study. Knee. doi:S0968-0160(13)00022-7

  11. Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R (2012) Intraoperative soft tissue balance reflects minimum 5-year midterm outcomes in cruciate-retaining and posterior-stabilized total knee arthroplasty. J Arthroplast 27:1723–1730

    Article  Google Scholar 

  12. Mihalko WM, Krackow KA (1999) Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop Relat Res 360:243–250

    Article  PubMed  Google Scholar 

  13. Most E, Li G, Sultan PG, Park SE, Rubash HE (2005) Kinematic analysis of conventional and high-flexion cruciate-retaining total knee arthroplasties an in vitro investigation. J Arthroplast 20:529–535

    Article  Google Scholar 

  14. Nakagawa S, Johal P, Pinskerova V, Komatsu T, Sosna A, Williams A, Freeman MA (2004) The posterior cruciate ligament during flexion of the normal knee. J Bone Joint Surg Br 86:450–456

    Article  CAS  PubMed  Google Scholar 

  15. Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res 356:39–46

    Article  PubMed  Google Scholar 

  16. Pianigiani S, Chevalier Y, Labey L, Pascale V, Innocenti B (2012) Tibio-femoral kinematics in different total knee arthroplasty designs during a loaded squat: a numerical sensitivity study. J Biomech 45:2315–2323

    Article  PubMed  Google Scholar 

  17. Pinskerova V, Johal P, Nakagawa S, Sosna A, Williams A, Gedroyc W, Freeman MA (2004) Does the femur roll-back with flexion? J Bone Joint Surg Br 86:925–931

    Article  CAS  PubMed  Google Scholar 

  18. Pruitt LA (2005) Deformation, yielding, fracture and fatigue behavior of conventional and highly cross-linked ultra high molecular weight polyethylene. Biomaterials 26:905–915

    Article  CAS  PubMed  Google Scholar 

  19. Romero J, Stahelin T, Binkert C, Pfirrmann C, Hodler J, Kessler O (2007) The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplast 22:235–240

    Article  Google Scholar 

  20. Schuster AJ, von Roll AL, Pfluger D, Wyss T (2011) Anteroposterior stability after posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1113–1120

    Article  CAS  PubMed  Google Scholar 

  21. Swany MR, Scott RD (1993) Posterior polyethylene wear in posterior cruciate ligament-retaining total knee arthroplasty. A case study. J Arthroplast 8:439–446

    Article  CAS  Google Scholar 

  22. Victor J, Van GF, Vander SJ, Parizel PM, Somville J, Bellemans J (2009) An experimental model for kinematic analysis of the knee. J Bone Joint Surg Am 91(Suppl 6):150–163

    Article  PubMed  Google Scholar 

  23. Wilson DR, Apreleva MV, Eichler MJ, Harrold FR (2003) Accuracy and repeatability of a pressure measurement system in the patellofemoral joint. J Biomech 36:1909–1915

    Article  CAS  PubMed  Google Scholar 

  24. Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M (2005) In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplast 20:777–783

    Article  Google Scholar 

Download references

Acknowledgments

We thank Ronny De Corte from the European Centre for Knee Research for his help in preparation, implantation and measurements of the specimen. Specimen and materials used in this study were kindly arranged by the ECKR. Three authors were employees of Smith and Nephew at the time of the study. The first and the last author did not receive any personal finances from Smith and Nephew. The study was partly financed by Smith and Nephew.

Author information

Author notes

  1. L. Labey

    Present address: Mobilab, Thomas More University College, Geel, Belgium

  2. B. Innocenti

    Present address: BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Brussels, Belgium

Authors and Affiliations

  1. Department of Research, Sint Maartenskliniek, Postbox 9011, 6500 GM, Nijmegen, The Netherlands

    P. J. C. Heesterbeek

  2. European Centre for Knee Research, Smith & Nephew, Leuven, Belgium

    L. Labey, P. Wong & B. Innocenti

  3. Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands

    A. B. Wymenga

Authors
  1. P. J. C. Heesterbeek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Labey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Innocenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. B. Wymenga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. J. C. Heesterbeek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heesterbeek, P.J.C., Labey, L., Wong, P. et al. A new spacer-guided, PCL balancing technique for cruciate-retaining total knee replacement. Knee Surg Sports Traumatol Arthrosc 22, 650–659 (2014). https://doi.org/10.1007/s00167-013-2660-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2660-3

Keywords

Search

Navigation