Skip to main content

Advertisement

SpringerLink
Log in

Posteromedial vertical capsulotomy selectively expands the intraoperative extension gap in cruciate-retaining total knee arthroplasty

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

Abstract

Purpose

Effective soft-tissue balancing procedures for expanding the extension gap (EG) are needed in cases of gap mismatch in total knee arthroplasty (TKA). A posteromedial vertical capsulotomy (PMVC) is performed to restore mobility in a knee with a flexion contracture. The purpose of this study was to evaluate the effectiveness and safety of PMVC for intraoperative gap adjustment in cruciate-retaining TKA.

Methods

A total of 120 consecutive knees undergoing cruciate-retaining TKA for varus osteoarthritis were examined. The EG and flexion gap (FG) with a trial femoral component were measured using spacer blocks before and after PMVC. PMVC was performed when the first FG was larger than the first EG by > 2 mm.

Results

Sixty-five knees underwent PMVC, and the mean EG significantly increased by 2.4 mm (p < 0.001). This increase was significantly larger than that of the FG by 2.0 mm (p < 0.001). The preoperative extension range of motion (ROM) was negatively correlated with the EG change after PMVC (r = − 0.39, p = 0.001). A receiver operating characteristic (ROC) curve indicated a preoperative extension ROM cut-off of -10° for predicting PMVC (sensitivity 72.3%, specificity 56.4%). No associated complications were observed during a minimum 2-year follow-up period, and there was no difference in the postoperative Knee Society Score between the PMVC and non-PMVC groups.

Conclusion

PMVC may be a useful soft-tissue treatment for gap adjustment with a selective EG expansion in TKA, especially in cases of a limited preoperative extension of − 10° or less.

Level of evidence

Therapeutic study, level III.

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

Similar content being viewed by others

Abbreviations

ΔFG-EG:

Difference between the FG and EG

EG:

Extension gap

FG:

Flexion gap

MCL:

Medial collateral ligament

PMVC:

Posteromedial vertical capsulotomy

ROC:

Receiver operating characteristic

ROM:

Range of motion

SF-36:

36-Item Short Form Survey

TKA:

Total knee arthroplasty

WOMAC:

Western Ontario and McMaster Universities Arthritis Index

References

  1. Azukizawa M, Kuriyama S, Nakamura S, Nishitani K, Lyman S, Morita Y, Furu M, Ito H, Matsuda S (2018) Intraoperative medial joint laxity in flexion decreases patient satisfaction after total knee arthroplasty. Arch Orthop Trauma Surg 138(8):1143–1150

    Article  PubMed  Google Scholar 

  2. Bellemans J, Vandenneucker H, Victor J, Vanlauwe J (2006) Flexion contracture in total knee arthroplasty. Clin Orthop Relat Res 452:78–82

    Article  PubMed  Google Scholar 

  3. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Article  Google Scholar 

  4. Kaneyama R, Higashi H, Oinuma K, Miura Y, Tamaki T, Shiratsuchi H (2019) Improvement of the gap adjustment in total knee arthroplasty using the posterior condylar pre-cut technique. J Knee Surg 32(10):1001–1007

    Article  PubMed  Google Scholar 

  5. Kaneyama R, Otsuka M, Shiratsuchi H, Oinuma K, Miura Y, Tamaki T (2014) Criteria for preserving posterior cruciate ligament depending on intra-operative gap measurement in total knee replacement. Bone Jt Res 3(4):95–100

    Article  CAS  Google Scholar 

  6. Kaneyama R, Shiratsuchi H, Oinuma K, Higashi H, Miura Y, Tamaki T (2016) Posteromedial vertical capsulotomy increases the medial extension gap in total knee arthroplasty. Orthop Proc 98-B(SUPP_2):90

    Google Scholar 

  7. Luyckx T, Vandenneucker H, Ing LS, Vereecke E, Ing AV, Victor J (2018) Raising the joint line in TKA is associated with mid-flexion laxity: a study in cadaver knees. Clin Orthop Relat Res 476(3):601–611

    Article  PubMed  PubMed Central  Google Scholar 

  8. Masuda S, Miyazawa S, Yuya K, Kamatski Y, Tomohito H, Yoshiki O, Yuki O, Furumatsu T, Ozaki T (2020) Posteromedial vertical capsulotomy selectively increases the extension gap in posterior stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 28(5):1419–1424

    Article  PubMed  Google Scholar 

  9. Matsuda S, Ito H (2015) Ligament balancing in total knee arthroplasty-Medial stabilizing technique. Asia Pac J Sports Med Arthrosc Rehabil Technol 2(4):108–113

    PubMed  PubMed Central  Google Scholar 

  10. Mihalko WM, Whiteside LA (2003) Bone resection and ligament treatment for flexion contracture in knee arthroplasty. Clin Orthop Relat Res 406:141–147

    Article  Google Scholar 

  11. Minoda Y, Sakawa A, Aihara M, Tada K, Kadoya Y, Kobayashi A (2007) Flexion gap preparation opens the extension gap in posterior cruciate ligament-retaining TKA. Knee Surg Sports Traumatol Arthrosc 15(11):1321–1325

    Article  PubMed  Google Scholar 

  12. Okamoto Y, Nakajima M, Jotoku T, Otsuki S, Neo M (2016) Capsular release around the intercondylar notch increases the extension gap in posterior-stabilized rotating-platform total knee arthroplasty. Knee 23(4):730–735

    Article  PubMed  Google Scholar 

  13. Scuderi GR, Kochhar T (2007) Management of flexion contracture in total knee arthroplasty. J Arthroplast 22(4 Suppl 1):20–24

    Article  Google Scholar 

  14. Stiehl JB, Heck DA (2015) How precise is computer-navigated gap assessment in TKA? Clin Orthop Relat Res 473(1):115–118

    Article  PubMed  Google Scholar 

  15. van Lieshout WAM, Valkering KP, Koenraadt KLM, van Etten-Jamaludin FS, Kerkhoffs GMMJ, van Geenen RCI (2019) The negative effect of joint line elevation after total knee arthroplasty on outcome. Knee Surg Sports Traumatol Arthrosc 27(5):1477–1486

    Article  PubMed  Google Scholar 

  16. Yercan HS, Ait Si Selmi T, Sugun TS, Neyret P (2005) Tibiofemoral instability in primary total knee replacement: a review, part 1: basic principles and classification. Knee 12(4):257–266

    Article  PubMed  Google Scholar 

  17. Yercan HS, Ait Si Selmi T, Sugun TS, Neyret P (2005) Tibiofemoral instability in primary total knee replacement: a review part 2: diagnosis, patient evaluation, and treatment. Knee 12(5):336–340

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chiba Aoba Municipal Hospital, 1273-2 Aobacho, Chuo-ku, Chiba, 260-0852, Japan

    Kensuke Yoshino, Hitoshi Watanabe & Masaaki Sakamoto

  2. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan

    Kensuke Yoshino & Seiji Ohtori

  3. Joint Replacement Center, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, 274-0822, Japan

    Ryutaku Kaneyama

  4. Knee Joint Reconstruction Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan

    Ryutaku Kaneyama

Authors
  1. Kensuke Yoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryutaku Kaneyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hitoshi Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masaaki Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seiji Ohtori
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study’s conception and design. Material preparation and data collection were performed by KY, HW, and MS. Data analysis was performed by KY and RK. The first draft of the manuscript was written by KY, and all authors commented on and revised previous versions of the manuscript; specifically, RK proofed the text as the developer of the surgical technique. All authors read and approved the final manuscript. SO revised and approved the final version of the manuscript as a graduate school advisor.

Corresponding author

Correspondence to Kensuke Yoshino.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest in association with this study.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. All study protocols were approved by the Institutional Review Board of Chiba Aoba Municipal Hospital.

Informed consent

All patients gave written informed consent before surgery.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshino, K., Kaneyama, R., Watanabe, H. et al. Posteromedial vertical capsulotomy selectively expands the intraoperative extension gap in cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 1347–1353 (2023). https://doi.org/10.1007/s00167-022-07015-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07015-1

Keywords

Search

Navigation