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The medial constrained insert restores native knee rotational kinematics after bicruciate-retaining total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to test the hypothesis that the medial constrained insert would reproduce the native knee kinematics after bicruciate-retaining (BCR) total knee arthroplasty (TKA).

Methods

Using an image-free navigation system in six fresh-frozen whole-body cadavers, the rotation angle of the tibia at minimum flexion, at 10° intervals from 0° to 130° flexion, and at maximum flexion during manual passive knee flexion was assessed. The data was collected in native knees, in BCR TKA using a normal flat insert (BCR-XP), and in BCR TKA using a more constrained insert in the medial side (BCR-AS). The differences in the rotation angle of the tibia were statistically evaluated.

Results

The rotation angles of the tibia in BCR-XP were significantly different from those of the native knees both in the early flexion phase (p = 0.002 at minimum knee flexion, p = 0.002 at 0°, p = 0.041 at 10°, p = 0.009 at 20°, p = 0.026 at 30°) and in the late flexion phase (p = 0.015 at 130°, p = 0.015 at maximum knee flexion), whereas the rotational angles of the tibia in BCR-AS were similar to those of the native knee.

Conclusion

This study shows that the rotational kinematics of the native knee is reproduced after BCR TKA with the medial constrained insert. Surgeons and implant designers should be aware that constraint of the medial side in BCR TKA is a crucial factor for restoration of native kinematics which may lead to better clinical outcome.

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Abbreviations

TKA:

Total knee arthroplasty

UKA:

Unicompartmental arthroplasty

ACL:

Anterior cruciate ligament

PCL:

Posterior cruciate ligament

BCR:

Bicruciate-retaining

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Funding

This study was funded by the Grant of The Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine, 2016.

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Authors and Affiliations

  1. Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan

    Keizo Wada, Daisuke Hamada, Tomoya Takasago, Akihiro Nitta, Tomohiro Goto, Ichiro Tonogai & Koichi Sairyo

  2. Department of Anatomy and Cell Biology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan

    Yoshihiro Tsuruo

Authors
  1. Keizo Wada
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  2. Daisuke Hamada
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  3. Tomoya Takasago
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  4. Akihiro Nitta
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  5. Tomohiro Goto
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  6. Ichiro Tonogai
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  7. Yoshihiro Tsuruo
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  8. Koichi Sairyo
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Contributions

KW carried out the kinematic measurements, performed the statistical analysis, and drafted the manuscript. DH participated in the design of the study and performed the TKA surgery as the surgeon. TT and AN assisted in performing the TKA surgery and kinematic measurements. IT and YT coordinated this study. TG and KS helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daisuke Hamada.

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Conflict of interest

This study received grant from Grant of The Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine, 2016.

Ethical approval

This study was approved by the institutional review board (IRB) of Tokushima University Hospital (approval no. 2068), and was performed in accordance with the 1964 Helsinki Declaration and its later amendments.

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Wada, K., Hamada, D., Takasago, T. et al. The medial constrained insert restores native knee rotational kinematics after bicruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 1621–1627 (2019). https://doi.org/10.1007/s00167-018-5249-z

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