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Knee joint laxity is restored in a bi-cruciate retaining TKA-design

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The goal is to evaluate the passive stability of a bicruciate retaining, cruciate retaining and bicruciate substituting TKA design in relation to the native knee stability in terms of the laxity envelope. A bicruciate retaining knee prosthesis was hypothesized to offer a closer to normal knee stability in vitro.

Methods

Fourteen cadaveric knee specimens have been tested under passive conditions with and without external loads, involving a varus/valgus and an external/internal rotational torque, distraction/compression force and an anteroposterior shear force. Subsequently, the native knee, bicruciate retaining, cruciate retaining and finally a bicruciate substituting total knee arthroplasty were tested.

Results

Through the range of motion, the width of the varus/valgus and internal/external laxity envelope for the native knee and the bicruciate retaining knee were almost equivalent, whereas the cruciate retaining and the bicruciate substituting knee displayed less laxity and more joint distraction. In all prosthetic knees, an equal anteroposterior laxity was seen for the lateral and medial side whereas in the native knee, a difference in laxity was seen between the stable medial side and the more mobile lateral side.

Conclusion

Bicruciate retaining knee prostheses can restore normal laxity and thus have the potential to offer more normal knee function. Restoration of natural peri-articular soft-tissue tension is clinically important because of its obvious effects on joint stability and range of motion. Furthermore, the results of this study could help to establish the ideal ligament tension and laxity in more conventional implants by approaching the normal values for passive knee evaluation as presented here.

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References

  1. Arnout N, Vanlommel L, Vanlommel J, Luyckx JP, Labey L, Innocenti B, Victor J, Bellemans J (2015) Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior stabilised total knee designs. Knee Surg Sports Traumatol Arthrosc 23(11):3343–3353

    Article  CAS  Google Scholar 

  2. Blankevoort L, Huiskens R, De Lange A (1988) The envelope of passive knee joint motion. J Biomech 21:705–720

    Article  CAS  Google Scholar 

  3. Butler DL, Noyes FR, Groos ES (1980) Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am 62(2):259–270

    Article  CAS  Google Scholar 

  4. Delport P, Labey L, De Corte R, Innocenti B, Vander Sloten J, Bellemans J (2013) Collateral ligament strains during knee joint laxity evaluation before and after TKA. Clin Biomech 28(7):777–782

    Article  Google Scholar 

  5. Font-Rodriguez DE, Scuderi GR, Insall JN (1997) Survivorship of cemented total knee arthroplasty. Clin Orthop Rel Res 345:79–86

    Article  Google Scholar 

  6. Goh GS, Liow MH, Bin Abd Razak HR, Tay DK, Lo NN, Yeo SJ (2017) Patient reported outcomes, Quality of life and satisfaction Rates in Young Patients Aged 50 years of younger after total knee arthroplasty. J Arthroplasty 32(2):419–425

    Article  Google Scholar 

  7. Grood ES, Suntay W (1983) A joint coordinate system for the clinical description of three dimensional motions: application to the knee. J Biomech Eng 105:136–144

    Article  CAS  Google Scholar 

  8. Halewood C, Traynor A, Bellemans J, Victor J, Amis A (2015) Anteroposterior laxity after bicruciate-retaining total knee arthroplasty is closer to the native knee than ACL-resecting TKA: a biomechanical cadaver study. J Arthroplasty 30(12):2315–2319

    Article  Google Scholar 

  9. Hamada D, Wada K, Tkasago T, Goto T, Nitta A, Higashino K, Fukui Y, Sairyo K (2018) Native rotational knee kinematics are lost in bicruciate-retaining total knee arthroplasty when the tibial component is replaced. Knee Surg Sports Traumatol Arthrosc 26(11):329–3256

    Article  Google Scholar 

  10. Hashemi J, Chandrashekar N, Gill B, Beynnon B, Slauterbeck J, Schutt R, Mansouri H, Dabezies E (2008) The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Joint Surg Am 90(12):2724–2734

    Article  Google Scholar 

  11. Haynes J, Sassoon A, Nam D, Schultz L, Keeney J (2017) Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty. Knee 24(3):663–669

    Article  Google Scholar 

  12. Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y (2001) Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop Relat Res 391:210–217

    Article  Google Scholar 

  13. Liddle AD, Pandit H, Judge A, Murray D (2015) Patient reported outcomes following total and unicompartimental knee replacement: a study of 14,076 matched patients from the National Joint Register for England and Wales. Bone Joint J 97-B:793–801

    Article  CAS  Google Scholar 

  14. Lo J, Muller O, Dilger T, Wulker N, Wuntschel M (2011) Translational and rotational knee joint stability in anterior and posterior cruciate—retaining knee arthroplasty. Knee 18(6):491–495

    Article  Google Scholar 

  15. Lutzner J, Hubel U, Kirschner S et al (2011) Long term results in total knee arthroplasty a meta- analysis of revision rates and functional outcome. Chirurg 82:618–624

    Article  CAS  Google Scholar 

  16. Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW (2012) Unicompartimental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Rel Res 470(1):84–90

    Article  Google Scholar 

  17. Mills O, Hull M (1991) Rotational flexibility of the human knee due t o varus/valgus and axial moments in vivo. J Biomech 24(8):673–690

    Article  CAS  Google Scholar 

  18. Moro-oka TA, Muenchinger M, Canciani JP, Banks SA (2007) Comparing in vivo kinematics of anterior and posterior cruciate retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 15(1):93–101

    Article  Google Scholar 

  19. Mugnai R, Digennaro V, Ensini A, Leardini A, Catani F (2014) Can TKA affect the clinical outcome? Comparison between to guided-motion systems. Knee Surg Sports Traumatol Arthrosc 22(3):581–589

    Article  Google Scholar 

  20. Noble P, Conditt M, Cook K et al (2006) The John insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Rel Res 452:35–43

    Article  Google Scholar 

  21. Porter M, Borrof M, Gregg P et al (2013) 10th annual report 2013-National joint registry of England, Wales and Northern Ireland. https://www.njrcentre.org.uk/njrcentre/Portals0/Documents/England/Reports/10th_annual_report/NJR. Accessed 25 Sept 2013

  22. Pritchett JW (2015) Bicruciate-retaining total knee replacement provides satisfactory function and implant survivorship at 23 years. Clin Orthop Relat Res 473(7):2327–2333

    Article  Google Scholar 

  23. Sabouret P, Lavoie F, Cloutier JM (2013) Total knee replacement with retention of both cruciate ligaments: a 22-year follow-up study. Bone Joint J 95-B(7):917–922

    Article  CAS  Google Scholar 

  24. Schnurr C, Eysel P, Konig D (2012) Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable? Int Orthop 36(1):83–88

    Article  Google Scholar 

  25. Scott C, Howie C, Mac Donald D et al (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92(9):1253–1258

    Article  CAS  Google Scholar 

  26. Sharkey P, Hozack W, Rothmann R, Shastri S, Jacoby S (2002) Insall Award Paper. Why are total knee arthroplasties failing today? Clin Orthop Rel Res 404:7–13

    Article  Google Scholar 

  27. Verstraete M, Arnout N, De Baets P, Vancouillie T, Van Hoof T, Victor J (2017) Real time kinematic evaluation of the knee: kinematics using enriched computed tomography data. CAOS Int, Aachen

    Google Scholar 

  28. Verstraete M, Meere P, Salvadore G, Victor J, Walker P (2017) Contact forces in the tibiofemoral joint from soft tissue tensions: implications to soft tissue balancing in total knee arthroplasty. J Biomech 58:195–202

    Article  Google Scholar 

  29. Verstraete M, Victor J (2015) Possibilities and limitations of novel in-vitro knee simulator. J Biomech 48(12):3377–3382

    Article  Google Scholar 

  30. Verstraete M, Willemot L, Van Onsem S, Stevens C, Arnout N, Victor J (2016) 3D printed guides for controlled alignment in biomechanical tests. J Biomech 49(3):484–487

    Article  Google Scholar 

  31. Victor J, Labey L, Wong P, Innocenti B, Bellemans JJ (2010) The influence of muscle load on tibiofemoral knee kinematics. Orthop Res 28(4):419–428

    Google Scholar 

  32. Victor J, Van Doninck D, Labey L, Innocenti B, Parizel P, Bellemans J (2009) How precise can bony landmarks be determined on a CT scan of the knee? Knee 16(5):358–365

    Article  CAS  Google Scholar 

  33. Wada K, Hamada D, Takasago T, Nitta A, Goto T, Tonogai I, Tsuruo Y, Sairyo K (2018) The medial constrained insert restores native knee rotational kinematics after bicruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5249-z

    Article  PubMed  Google Scholar 

  34. Wunschel M, Lo J, Dilger T, Wulker N, Muller O (2011) Influence of bi- and tri-compartmental knee arthroplasty on the kinematics of the knee joint. BMC Musculoskelet Disord 27(12):29

    Article  Google Scholar 

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Acknowledgements

The authors want to thank the Research Foundation Flanders (FWO) for the financial support through Grant number 12N5117N. The help from Dr. De Schepper (Department of Biostatistics of Ghent University) in establishing the general linear models is also acknowledged. The authors also acknowledge the financial support of Smith&Nephew Inc. through an unrestricted research grant.

Funding

The institution (department of orthopaedics, University hospital Ghent) has received funding from Smith and Nephew (research grant). The work was performed at the University of Ghent and the university hospital of Ghent, Belgium.

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Authors and Affiliations

  1. University Hospital Ghent, Corneel Heymanslaan 10, 9000, Gent, Belgium

    N. Arnout, J. Victor, H. Vermue & L. Pringels

  2. Ghent University, Gent, Belgium

    N. Arnout, J. Victor, H. Vermue, L. Pringels & M. A. Verstraete

  3. ZOL, Schiepse Bos 6, 3600, Genk, Belgium

    J. Bellemans

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  1. N. Arnout
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  6. M. A. Verstraete
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Correspondence to N. Arnout.

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Conflict of interest

Nele Arnout, Matthias Verstraeten and Hannes Vermue and Lauren Pringels have no conflict of interest, Jan Victor and Johan Bellemans have recieved consultancy fees and royalties from Smith and Nephew.

Ethical approval

This study was apporved by the institutional review board (IRB) by the university of Ghent ethical committee (B670201421989) and was performed in accordance to the 1964 Helsinki Declaration and its amendments.

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Arnout, N., Victor, J., Vermue, H. et al. Knee joint laxity is restored in a bi-cruciate retaining TKA-design. Knee Surg Sports Traumatol Arthrosc 28, 2863–2871 (2020). https://doi.org/10.1007/s00167-019-05639-4

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  • DOI: https://doi.org/10.1007/s00167-019-05639-4

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