Decreased posterior tibial slope increases strain in the posterior cruciate ligament following total knee arthroplasty

AbstractThe posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the preoperative and postoperative PTS, ROM, visual analog scale pain scale, Western Ontario and McMaster University Index (WOMAC), Hospital for Special Surgery Knee Score, Knee Society Score, and Forgotten Joint Score (FJS). The association of the absolute change in PTS with ROM and clinical scores was analyzed using correlation analysis and multiple regression analysis. As a result, the mean PTS and mean ROM changed from 9.6 ± 3.4 and 120.1 ± 15.4 degrees preoperatively to 2.0 ± 1.3 and 128.4 ± 9.3 degrees postoperatively, and the mean PTS change was 7.6 ± 3.5 degrees. The PTS change had no statistically significant association with the postoperative ROM and clinical scoring systems, although it did have a weak positive correlation with WOMAC function, No 10 (difficulty in rising from sitting) (correlation coefficient = 0.342, p = 0.041), and moderate positive correlation with the FJS, No. 6 (awareness when climbing stairs) (correlation coefficient = 0.470, p = 0.001). The authors concluded that the amount of change in PTS did not affect the postoperative ROM and clinical scores, although proximal tibial resection with a constant target of PTS resulted in individually different changes in the PTS after PS TKA,

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Influence of Posterior Tibial Slope on Kinematics After Cruciate-Retaining Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.07.029 ◽

2018 ◽

Vol 33 (12) ◽

pp. 3778-3782.e1 ◽

Cited By ~ 4

Author(s):

Toshitaka Fujito ◽

Tetsuya Tomita ◽

Takaharu Yamazaki ◽

Kosaku Oda ◽

Hideki Yoshikawa ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Cruciate Retaining ◽

Posterior Tibial ◽

Total Knee

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Reproducing the Native Posterior Tibial Slope in Cruciate-Retaining Total Knee Arthroplasty: Technique and Clinical Implications

Orthopedics ◽

10.3928/01477447-20191122-06 ◽

2019 ◽

Vol 43 (1) ◽

pp. e21-e26

Author(s):

James L. Howard ◽

Mina W. Morcos ◽

Brent A. Lanting ◽

Lyndsay E. Somerville ◽

James P. McAuley

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Clinical Implications ◽

Cruciate Retaining ◽

Posterior Tibial ◽

Total Knee

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Biomechanical effect of tibial slope on the stability of medial unicompartmental knee arthroplasty in posterior cruciate ligament-deficient knees

Bone and Joint Research ◽

10.1302/2046-3758.99.bjr-2020-0128.r1 ◽

2020 ◽

Vol 9 (9) ◽

pp. 593-600 ◽

Cited By ~ 1

Author(s):

Jin-Ah Lee ◽

Yong-Gon Koh ◽

Paul Shinil Kim ◽

Ki Won Kang ◽

Yoon Hae Kwak ◽

...

Keyword(s):

Articular Cartilage ◽

Posterior Cruciate Ligament ◽

Contact Stress ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Cruciate Ligament ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

High Flexion ◽

Posterior Tibial

Aims Unicompartmental knee arthroplasty (UKA) has become a popular method of treating knee localized osteoarthritis (OA). Additionally, the posterior cruciate ligament (PCL) is essential to maintaining the physiological kinematics and functions of the knee joint. Considering these factors, the purpose of this study was to investigate the biomechanical effects on PCL-deficient knees in medial UKA. Methods Computational simulations of five subject-specific models were performed for intact and PCL-deficient UKA with tibial slopes. Anteroposterior (AP) kinematics and contact stresses of the patellofemoral (PF) joint and the articular cartilage were evaluated under the deep-knee-bend condition. Results As compared to intact UKA, there was no significant difference in AP translation in PCL-deficient UKA with a low flexion angle, but AP translation significantly increased in the PCL-deficient UKA with high flexion angles. Additionally, the increased AP translation became decreased as the posterior tibial slope increased. The contact stress in the PF joint and the articular cartilage significantly increased in the PCL-deficient UKA, as compared to the intact UKA. Additionally, the increased posterior tibial slope resulted in a significant decrease in the contact stress on PF joint but significantly increased the contact stresses on the articular cartilage. Conclusion Our results showed that the posterior stability for low flexion activities in PCL-deficient UKA remained unaffected; however, the posterior stability for high flexion activities was affected. This indicates that a functional PCL is required to ensure normal stability in UKA. Additionally, posterior stability and PF joint may reduce the overall risk of progressive OA by increasing the posterior tibial slope. However, the excessive posterior tibial slope must be avoided. Cite this article: Bone Joint Res 2020;9(9):593–600.

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