scholarly journals Relationship between posterior tibial slope and anterior tibial translation in bicruciate and cruciate retaining TKA

Author(s):  
Mitsuhiro Nakamura ◽  
Yoshinori Soda
2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
D. C. Kieser ◽  
E. Savage ◽  
P. Sharplin

Case. A 55-year-old male with a chronic isolated grade 3 PCL injury who demonstrates a positive quadriceps active test without activating his quadriceps musculature. Conclusion. Gravity and hamstring contraction posteriorly translate the tibia into a subluxed position. Subsequent gastrocnemius contraction with the knee flexed causes an anterior tibial translation by virtue of the mass enlargement of the gastrocnemius muscular bulk, the string of a bow effect, and the anterior origin of the gastrocnemius in relation to the posterior border of the subluxed tibia aided by the normal posterior tibial slope.


2021 ◽  
Vol 49 (4) ◽  
pp. 928-934
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Tracey Bastrom ◽  
James D. Bomar ◽  
Andrew T. Pennock ◽  
...  

Background: Incompetence of the anterior cruciate ligament (ACL) confers knee laxity in the sagittal and axial planes that is measurable with clinical examination and diagnostic imaging. Hypothesis: An ACL-deficient knee will produce a more vertical orientation of the lateral collateral ligament (LCL), allowing for the entire length of the LCL to be visualized on a single coronal slice (coronal LCL sign) on magnetic resonance imaging. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Charts were retrospectively reviewed from April 2009 to December 2017 for all patients treated with ACL reconstruction (constituting the ACL-deficient cohort). A control cohort was separately identified consisting of patients with a normal ACL and no pathology involving the collateral ligaments or posterior cruciate ligament. Patients were excluded for follow-up <2 years, incomplete imaging, and age >19 years. Tibial translation and femorotibial rotation were measured on magnetic resonance images, and posterior tibial slope was measured on a lateral radiograph of the knee. Imaging was reviewed for the presence of the coronal LCL sign. Results: The 153 patients included in the ACL-deficient cohort had significantly greater displacement than the 70 control patients regarding anterior translation (5.8 vs 0.3 mm, respectively; P < .001) and internal rotation (5.2° vs −2.4°, P < .001). Posterior tibial slope was not significantly different. The coronal LCL sign was present in a greater percentage of ACL-deficient knees than intact ACL controls (68.6% vs 18.6%, P < .001). The presence of the coronal LCL sign was associated with greater anterior tibial translation (7.2 vs 0.2 mm, P < .001) and internal tibial rotation (7.5° vs –2.4°, P = .074) but not posterior tibial slope (7.9° vs 7.9°, P = .973) as compared with its absence. Multivariate analysis revealed that the coronal LCL sign was significantly associated with an ACL tear (odds ratio, 12.8; P < .001). Conclusion: Our study provides further evidence that there is significantly more anterior translation and internal rotation of the tibia in the ACL-deficient knee and proves our hypothesis that the coronal LCL sign correlates with the presence of an ACL tear. This coronal LCL sign may be of utility for identifying ACL tears and anticipating the extent of axial and sagittal deformity.


2018 ◽  
Vol 33 (12) ◽  
pp. 3778-3782.e1 ◽  
Author(s):  
Toshitaka Fujito ◽  
Tetsuya Tomita ◽  
Takaharu Yamazaki ◽  
Kosaku Oda ◽  
Hideki Yoshikawa ◽  
...  

Orthopedics ◽  
2019 ◽  
Vol 43 (1) ◽  
pp. e21-e26
Author(s):  
James L. Howard ◽  
Mina W. Morcos ◽  
Brent A. Lanting ◽  
Lyndsay E. Somerville ◽  
James P. McAuley

2001 ◽  
Vol 29 (6) ◽  
pp. 771-776 ◽  
Author(s):  
Jürgen Höher ◽  
Akihiro Kanamori ◽  
Jennifer Zeminski ◽  
Freddie H. Fu ◽  
Savio L-Y. Woo

Ten cadaveric knees (donor ages, 36 to 66 years) were tested at full extension, 15°, 30°, and 90° of flexion under a 134-N anterior tibial load. In each knee, the kinematics as well as in situ force in the graft were compared when the graft was fixed with the tibia in four different positions: full knee extension while the surgeon applied a posterior tibial load (Position 1), 30° of flexion with the tibia at the neutral position of the intact knee (Position 2), 30° of flexion with a 67-N posterior tibial load (Position 3), and 30° of flexion with a 134-N posterior tibial load (Position 4). For Positions 1 and 2, the anterior tibial translation and the in situ forces were up to 60% greater and 36% smaller, respectively, than that of the intact knee. For Position 3, knee kinematics and in situ forces were closest to those observed in the intact knee. For Position 4, anterior tibial translation was significantly decreased by up to 2 mm and the in situ force increased up to 31 N. These results suggest that the position of the tibia during graft fixation is an important consideration for the biomechanical performance of an anterior cruciate ligament-reconstructed knee.


2019 ◽  
Vol 47 (2) ◽  
pp. 285-295 ◽  
Author(s):  
Alberto Grassi ◽  
Luca Macchiarola ◽  
Francisco Urrizola Barrientos ◽  
Juan Pablo Zicaro ◽  
Matias Costa Paz ◽  
...  

Background: Tibiofemoral anatomic parameters, such as tibial slope, femoral condyle shape, and anterior tibial subluxation, have been suggested to increase the risk of anterior cruciate ligament (ACL) reconstruction failure. However, such features have never been assessed among patients experiencing multiple failures of ACL reconstruction. Purpose: To compare the knee anatomic features of patients experiencing a single failure of ACL reconstruction with those experiencing multiple failures or with intact ACL reconstruction. Study: Case-control study; Level of evidence, 3. Methods: Twenty-six patients who experienced failure of revision ACL reconstruction were included in the multiple-failure group. These patients were matched to a group of 25 patients with failure of primary ACL reconstruction and to a control group of 40 patients who underwent primary ACL reconstruction with no failure at a minimum follow-up of 24 months. On magnetic resonance imaging (MRI), the following parameters were evaluated: ratio between the height and depth of the lateral and medial femoral condyles, the lateral and medial tibial plateau slopes, and anterior subluxation of the lateral and medial tibial plateaus with respect to the femoral condyle. The presence of a meniscal lesion during each procedure was evaluated as well. Anatomic, demographic, and surgical characteristics were compared among the 3 groups. Results: The patients in the multiple-failure group had significantly higher values of lateral tibial plateau slope ( P < .001), medial tibial plateau slope ( P < .001), lateral tibial plateau subluxation ( P < .001), medial tibial plateau subluxation ( P < .001), and lateral femoral condyle height/depth ratio ( P = .038) as compared with the control group and the failed ACL reconstruction group. Moreover, a significant direct correlation was found between posterior tibial slope and anterior tibial subluxation for the lateral ( r = 0.325, P = .017) and medial ( r = 0.421, P < .001) compartments. An increased anterior tibial subluxation of 2 to 3 mm was present in patients with a meniscal defect at the time of the MRI as compared with patients who had an intact meniscus for both the lateral and the medial compartments. Conclusion: A steep posterior tibial slope and an increased depth of the lateral femoral condyle represent a common finding among patients who experience multiple ACL failures. Moreover, higher values of anterior subluxation were found among patients with repeated failure and those with a medial or lateral meniscal defect.


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