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Bicruciate-retaining total knee arthroplasty procedure reduced tensile force in the middle and posterior components of lateral collateral ligament during deep knee flexion activities with no effect on tensile force of the medial collateral ligament

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To analyse the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on the tensile force of the collateral ligaments during two deep knee flexion activities, cross-leg sitting and squatting.

Methods

Thirteen patients (15 knees) treated using bicruciate-retaining total knee arthroplasty (BCR-TKA) for knee joint osteoarthritis were analysed. Knee joint kinematics during cross-leg sitting (open-chain flexion) and squatting (closed-chain flexion) were evaluated through fluoroscopy. The tensile force was calculated in vivo based on the change in the distance between the femoral and tibial attachment areas for the anterior, middle, and posterior components of the superficial (sMCL) and deep (dMCL) medial collateral ligament and the lateral collateral ligament (LCL). Differences in the calculated tensile forces of the collateral ligaments were evaluated using repeated measures of analysis of variance, with post hoc pairwise comparison (Bonferroni test). Statistical significance was set at P ≤ 0.05.

Results

The correction of the coronal alignment was related to the surgical technique, not to the implant design. No significant change in the tensile force in all three components of the sMCL from pre- to post-TKA (n.s.) was observed. For dMCL, a pre- to post-TKA change in the tensile force was observed only for the anterior dMCL component (p = 0.03). No change was observed in the tensile force of the anterior LCL with increasing flexion, with no difference in pre- to post-TKA and between activities (n.s.). In contrast, tensile force in the middle LCL slightly decreased with increasing flexion during squatting, pre- and post-TKA. After surgery, lower forces were generated at 40° of flexion (p = 0.04). Tensile force in the posterior LCL was higher in extension than flexion, which remained high in the extension post-TKA. However, after surgery, lower tensile forces were generated at 10° (p = 0.04) and 40° (p = 0.04) of flexion.

Conclusions

The in vivo change in tensile forces of the collateral ligaments of the knee before and after BCR-TKA can inform the development of appropriate ligament balancing strategies to facilitate recovery of deep knee flexion activities after TKA, as well as for continued improvement of BCR-TKA designs.

Level of evidence

III

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Data availability

The data that support the findings of the current study are available from the corresponding author [HI] upon reasonable request. The data are not publicly available.

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Acknowledgements

The authors thank Ryota Yamagami, Kohei Kawaguchi, Tomofumi Kage and Takahiro Arakawa for their assistance in this study.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, La Jolla, CA, USA

    Kenichi Kono & Darryl D. D’Lima

  2. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kenichi Kono, Hiroshi Inui, Shuji Taketomi & Sakae Tanaka

  3. Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Tetsuya Tomita

  4. Master Course of Health Sciences, Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan

    Tetsuya Tomita

  5. Department of Information Systems, Faculty of Engineering, Saitama Institute of T1echnology, Fukaya, Saitama, Japan

    Takaharu Yamazaki

  6. Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Shoji Konda

  7. Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA

    Darryl D. D’Lima

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  1. Kenichi Kono
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Contributions

KK contributed to the formal analysis, investigation, and writing of the manuscript. HI and SK carried out data curation and conceived the study. TY provided technical assistance. TT, ST, RY, KK, ST, and DD provided general support. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hiroshi Inui.

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The authors declare that they have no conflicts of interest.

Ethical approval

All participants provided informed consent for the surgery and our evaluation of the tensile force for the collateral ligaments after BCR TKA.

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Kono, K., Inui, H., Tomita, T. et al. Bicruciate-retaining total knee arthroplasty procedure reduced tensile force in the middle and posterior components of lateral collateral ligament during deep knee flexion activities with no effect on tensile force of the medial collateral ligament. Knee Surg Sports Traumatol Arthrosc 31, 3889–3897 (2023). https://doi.org/10.1007/s00167-023-07342-x

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