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
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 arthr...
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| Published in | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 31; no. 9; pp. 3889 - 3897 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.09.2023
John Wiley & Sons, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0942-2056 1433-7347 1433-7347 |
| DOI | 10.1007/s00167-023-07342-x |
Cover
| 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 |
|---|---|
| AbstractList | 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.PURPOSETo 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.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.METHODSThirteen 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.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.RESULTSThe 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.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.CONCLUSIONSThe 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.III.LEVEL OF EVIDENCEIII. 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. 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. 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. 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. III. 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 PurposeTo 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.MethodsThirteen 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.ResultsThe 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.ConclusionsThe 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 evidenceIII |
| Author | Taketomi, Shuji D’Lima, Darryl D. Yamazaki, Takaharu Tanaka, Sakae Kono, Kenichi Inui, Hiroshi Tomita, Tetsuya Konda, Shoji |
| Author_xml | – sequence: 1 givenname: Kenichi orcidid: 0000-0001-8033-2037 surname: Kono fullname: Kono, Kenichi organization: Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo – sequence: 2 givenname: Hiroshi orcidid: 0000-0002-3605-2238 surname: Inui fullname: Inui, Hiroshi email: hiroshi_inui@yahoo.co.jp organization: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo – sequence: 3 givenname: Tetsuya orcidid: 0000-0001-5291-7185 surname: Tomita fullname: Tomita, Tetsuya organization: Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Master Course of Health Sciences, Graduate School of Health Sciences, Morinomiya University of Medical Sciences – sequence: 4 givenname: Takaharu surname: Yamazaki fullname: Yamazaki, Takaharu organization: Department of Information Systems, Faculty of Engineering, Saitama Institute of T1echnology – sequence: 5 givenname: Shoji orcidid: 0000-0002-8252-7281 surname: Konda fullname: Konda, Shoji organization: Department of Health and Sport Sciences, Osaka University Graduate School of Medicine – sequence: 6 givenname: Shuji orcidid: 0000-0002-4994-2504 surname: Taketomi fullname: Taketomi, Shuji organization: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo – sequence: 7 givenname: Sakae surname: Tanaka fullname: Tanaka, Sakae organization: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo – sequence: 8 givenname: Darryl D. surname: D’Lima fullname: D’Lima, Darryl D. organization: Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, Shiley Center for Orthopaedic Research & Education at Scripps Clinic |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36928366$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). |
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| Keywords | Ligament strain Collateral ligament force Bicruciate-retaining total knee arthroplasty TKA Knee flexion |
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| PublicationTitle | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
| PublicationTitleAbbrev | Knee Surg Sports Traumatol Arthrosc |
| PublicationTitleAlternate | Knee Surg Sports Traumatol Arthrosc |
| PublicationYear | 2023 |
| Publisher | Springer Berlin Heidelberg John Wiley & Sons, Inc |
| Publisher_xml | – name: Springer Berlin Heidelberg – name: John Wiley & Sons, Inc |
| References | Kono, Inui, Tomita, Yamazaki, Taketomi, Tanaka (CR11) 2020; 28 Park, Hosseini, Tsai, Kwon, Li (CR26) 2015; 48 Heyse, Slane, Peersman, Dirckx, van de Vyver, Dworschak (CR5) 2017; 25 Pritchett (CR28) 2015; 473 Tsai, Liow, Li, Arauz, Peng, Klemt (CR35) 2019; 37 Innocenti, Bori, Paszicsnyek (CR7) 2022; 142 Kono, Inui, Tomita, Yamazaki, Konda, Taketomi (CR10) 2021; 11 Angerame, Holst, Jennings, Komistek, Dennis (CR1) 2019; 34 Nagai, Muratsu, Takeoka, Tsubosaka, Kuroda, Matsumoto (CR20) 2017; 32 Okada, Teramoto, Takagi, Yamakawa, Sakakibara, Shoji (CR24) 2018; 100 Shelburne, Kim, Sterett, Pandy (CR32) 2011; 29 Pritchett (CR29) 2011; 26 Ritter, Harty, Davis, Meding, Berend (CR30) 2003; 85 Halewood, Traynor, Bellemans, Victor, Amis (CR4) 2015; 30 Moro-oka, Muenchinger, Canciani, Banks (CR19) 2007; 15 Kittl, Robinson, Raschke, Olbrich, Frank, Glasbrenner (CR9) 2021; 29 Nakahara, Okazaki, Mizu-Uchi, Hamai, Tashiro, Matsuda (CR21) 2015; 20 Noble, Conditt, Cook, Mathis (CR23) 2006; 452 Faul, Erdfelder, Buchner, Lang (CR3) 2009; 41 Ritter, Lutgring, Davis, Berend (CR31) 2008; 90 Yamazaki, Watanabe, Nakajima, Sugamoto, Tomita, Yoshikawa (CR36) 2004; 23 Migaud, De Ladoucette, Dohin, Cloutier, Gougeon, Duquennoy (CR18) 1996; 82 Lee, Seon, Shin, Kim, Jeon (CR17) 2008; 7 Nakamura, Takeuchi, Sawaguchi, Ishikawa, Saito, Goldhahn (CR22) 2011; 16 Kono, Inui, Tomita, Yamazaki, Taketomi, Tanaka (CR12) 2021; 34 Pandy, Sasaki, Kim (CR25) 1998; 1 Hosseini Nasab, Smith, Schutz, Postolka, List, Taylor (CR6) 2019; 7 Shelburne, Pandy (CR33) 1997; 30 Kono, Tomita, Futai, Yamazaki, Tanaka, Yoshikawa (CR14) 2018; 100 Jenny, Jenny (CR8) 1998; 118 Kuriyama, Ishikawa, Furu, Ito, Matsuda (CR15) 2014; 32 Blankevoort, Huiskes (CR2) 1991; 113 Stiehl, Komistek, Cloutier, Dennis (CR34) 2000; 15 Lavoie, Denis, Chergui, Al-Shakfa, Sabouret (CR16) 2022 Kono, Konda, Yamazaki, Tanaka, Sugamoto, Tomita (CR13) 2020; 21 Pritchett (CR27) 1996; 11 e_1_2_11_31_2 e_1_2_11_30_2 Migaud H (e_1_2_11_19_2) 1996; 82 e_1_2_11_13_2 e_1_2_11_35_2 e_1_2_11_12_2 e_1_2_11_34_2 e_1_2_11_11_2 e_1_2_11_33_2 e_1_2_11_10_2 e_1_2_11_32_2 e_1_2_11_6_2 e_1_2_11_28_2 e_1_2_11_5_2 e_1_2_11_27_2 e_1_2_11_4_2 e_1_2_11_26_2 e_1_2_11_3_2 e_1_2_11_25_2 e_1_2_11_2_2 e_1_2_11_29_2 e_1_2_11_20_2 e_1_2_11_24_2 e_1_2_11_9_2 e_1_2_11_23_2 e_1_2_11_8_2 e_1_2_11_22_2 e_1_2_11_7_2 e_1_2_11_21_2 e_1_2_11_17_2 e_1_2_11_16_2 e_1_2_11_15_2 e_1_2_11_14_2 e_1_2_11_36_2 e_1_2_11_37_2 e_1_2_11_18_2 |
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To analyse the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on the tensile force of the collateral ligaments during two deep knee... 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... PurposeTo analyse the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on the tensile force of the collateral ligaments during two deep knee... |
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| SubjectTerms | Arthroplasty (knee) Fluoroscopy In vivo methods and tests Joint replacement surgery Joints (anatomy) Kinematics Knee Ligaments Mathematical analysis Medicine Medicine & Public Health Orthopaedic implants Orthopedics Osteoarthritis Sports Medicine Surgery Variance analysis |
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| Title | 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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