scholarly journals Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

2019 ◽  
Vol 33 (03) ◽  
pp. 284-293 ◽  
Author(s):  
Kyoung-Tak Kang ◽  
Yong-Gon Koh ◽  
Ji Hoon Nam ◽  
Sae Kwang Kwon ◽  
Kwan Kyu Park
Keyword(s):  
Stance Phase ◽  
Lateral Collateral Ligament ◽  
Contact Stresses ◽  
Kinematic Alignment ◽  
Collateral Ligament ◽  
Cruciate Retaining ◽  
Lateral Contact ◽  
Lateral Collateral Ligaments ◽  
Total Knee ◽  
Maximum Contact

AbstractKinematic alignment (KA), which co-aligns the rotational axes of the components with three kinematic axes of the knee by aligning the components to the prearthritic joint lines, has been a recently introduced surgical technique. However, whether KA and cruciate retaining (CR) implants provide better biomechanical function during activities than mechanical alignment (MA) in posterior stabilized (PS) implants is unclear. We evaluated the biomechanical functions during the stance phase gait and deep knee bend, with a computer simulation and measured forces in the medial and lateral collateral ligaments and medial and lateral contact stresses in the polyethylene insert and patellar button. The forces on the medial collateral ligament in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions, whereas those on the lateral collateral ligament did not show any difference between the two surgical alignment techniques in the stance phase gait condition. The maximum contact stresses on the medial PE inserts in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions. However, the maximum contact stresses on the lateral PE inserts and the patellar button did not differ between MA and KA. The biomechanical function was superior in KA TKA than in MA TKA, and KA was more effective in CR TKA. This comparison could be used as a reference by surgeons to reduce the failure rates by using KA TKA instead of MA TKA.

scholarly journals Effect of Post-Cam Design for Normal Knee Joint Kinematic, Ligament, and Quadriceps Force in Patient-Specific Posterior-Stabilized Total Knee Arthroplasty by Using Finite Element Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Yong-Gon Koh ◽  
Juhyun Son ◽  
Oh-Ryong Kwon ◽  
Sae Kwang Kwon ◽  
Kyoung-Tak Kang
Keyword(s):  
Lateral Collateral Ligament ◽  
Posterior Stabilized ◽  
Collateral Ligament ◽  
Element Analysis ◽  
Normal Knee ◽  
Cam Design ◽  
Knee Mechanics ◽  
Total Knee ◽  
Quadriceps Force ◽  
Femoral Rollback

The purpose of this study is to investigate post-cam design via finite element analysis to evaluate the most normal-like knee mechanics. We developed five different three-dimensional computational models of customized posterior-stabilized (PS) total knee arthroplasty (TKA) involving identical surfaces with the exception of the post-cam geometry. They include flat-and-flat, curve-and-curve (concave), curve-and-curve (concave and convex), helical, and asymmetrical post-cam designs. We compared the kinematics, collateral ligament force, and quadriceps force in the customized PS-TKA with five different post-cam designs and conventional PS-TKA to those of a normal knee under deep-knee-bend conditions. The results indicated that femoral rollback in curve-and-curve (concave) post-cam design exhibited the most normal-like knee kinematics, although the internal rotation was the closest to that of a normal knee in the helical post-cam design. The curve-and-curve (concave) post-cam design showed a femoral rollback of 4.4 mm less than the normal knee, and the helical post-cam design showed an internal rotation of 5.6° less than the normal knee. Lateral collateral ligament and quadriceps forces in curve-and-curve (concave) post-cam design, and medial collateral ligament forces in helical post-cam design were the closest to that of a normal knee. The curve-and-curve (concave) post-cam design showed 20% greater lateral collateral ligament force than normal knee, and helical post-cam design showed medial collateral ligament force 14% greater than normal knee. The results revealed the variation in each design that provided the most normal-like biomechanical effect. The present biomechanical data are expected to provide useful information to improve post-cam design to restore normal-like knee mechanics in customized PS-TKA.

scholarly journals Gait Kinematics of Patients with Lateral Collateral Ligament Injuries of Ankle

2020 ◽  
Author(s):  
Bin Zheng ◽  
Xin Liu ◽  
Dezheng Zhang ◽  
Qinwei Guo ◽  
Zhongshi Zhang
Keyword(s):  
Stance Phase ◽  
Lateral Collateral Ligament ◽  
Measurement Model ◽  
Swing Phase ◽  
Foot And Ankle ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Control Subjects ◽  
Computer Aided ◽  
Aided Diagnosis

Abstract Background Lateral collateral ligament (LCL) injuries of ankle are a common problem in sports medicine. The purpose of this study is to evaluate the walking kinematics in patients with LCL injuries of ankle for examining how ankle ligament injuries affect foot and ankle motion. The results will serve in precision assessment and computer-aided diagnosis. Methods Kinematics of walking were assessed by the Heidelberg Foot Measurement Model (HFMM) in 6 adults (3 patients, 3 control subjects). We hypothesized that patients with ligament injury will: present a shorter stance phase, but longer swing phase; be observed with an increasing number of shank and foot adjustments during the stance phase; reduce velocity of foot during the early swing phase with an increasing variation. Velocity profiles and micro-adjustment of knee, ankle, and foot were calculated during different gait phases and compared between two different subject groups by independent-sample t-test with 95% confidence intervals and standard error of measurements. Results In the gait cycle, 1 st rocker phase was 2.09% shorter (p < 0.001) and 2 nd rocker phase was 1.54% longer (p = 0.009) in patients than in controls. Compared to control subjects, the patients showed 89.1 mm shorter stride length (p<0.001), 0.10s slower stride (p<0.001) and 1.57 more complex micro-adjustments in 2 nd rocker phase than in other rocker/swing phases during natural walking (p=0.017). The mean velocity of knee (6.05 mm/10 -2 s vs. 4.74 mm/10 -2 s), ankle (0.85 mm/10 -2 s vs. 0.52 mm/10 -2 s), midfoot (0.79 mm/10 -2 s vs. 0.48 mm/10 -2 s) and forefoot (1.72 mm/10 -2 s vs. 0.97 mm/10 -2 s) in 2 nd rocker was significantly higher in patients (p<0.001). Conclusion Our findings revealed the human motion compensatory mechanism. Patients with ligament injuries need more musculoskeletal adjustments to keeping body balance than control subjects. Precise descriptions of the kinematics are crucial for clinical assessment before and after surgical management. These results will also provide a foundation for computer-aided diagnosis in the future. Key Terms ankle ligaments, gait analysis, Heidelberg Foot Measurement Model, foot and ankle kinematics, phase/rocker, physical therapy/rehabilitation.

scholarly journals The Influence of Medial Collateral Ligament and Lateral Collateral Ligament Pie Crusting in Primary Total Knee Arthroplasty on Patient Reported Outcomes

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ethan Cornwell ◽  
Evan R. Deckard ◽  
Kevin A. Sonn ◽  
R. Michael Meneghini
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Lateral Collateral Ligament ◽  
Activity Level ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Study Results ◽  
Patient Reported ◽  
Total Knee

Background and Hypothesis: Pie-crusting of the collateral ligaments can help achieve balanced gaps in total knee arthroplasty (TKA) in knees with varus or valgus deformity. However, the effect of this technique on patient-reported outcome measures (PROMs) is unknown.  The purpose of this study was to compare PROMs following primary TKA for patients with and without medial collateral ligament (MCL) or lateral collateral ligament (LCL) pie-crusting. Experimental Design or Project Methods: We retrospectively reviewed 1,305 primary TKAs. Intraoperative MCL or LCL pie-crusting was documented in all operative reports and recorded. Prospectively collected preoperative, 4-month postoperative, and minimum 1-year postoperative PROMs related to overall knee health, pain during functional activities, activity level, and overall satisfaction were compiled and compared between patients with and without MCL or LCL pie-crusting.  Medians were evaluated with Kruskal-Wallis test adjusted for ties. Results: The cohort was 67% female with mean age 66 years and BMI 34.0 kg/m2. MCL or LCL pie-crusting was performed in 13.0% of the cohort.  There were no intraoperative or postoperative ruptures of the MCL or LCL. 6.3% of conforming bearing TKAs required a collateral ligament pie crusting versus 21.5% of standard bearing TKA (p<0.001). No significant differences were found in preoperative, 4-month, minimum 1-year, or change from preoperative baseline to minimum 1-year PROMs with and without pie-crusting of the collateral ligaments (p≥0.095).  However, the LCL pie-crusting group had slightly better PROMs at minimum 1-year. Conclusion and Potential Impact: These study results corroborate existing literature that pie-crusting of collateral ligaments is safe and effective to achieve a balanced TKA.  Additionally, no significant outcome differences were found between groups with and without MCL or LCL pie-crusting. However, LCL pie-crusting for valgus knee correction had slightly better PROMs.  Interestingly, conforming bearings may impart enhanced stability and mitigate the need for pie-crusting ligament releases in TKA.

scholarly journals The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Lateral Collateral Ligament ◽  
Lower Limbs ◽  
Lateral Femoral Condyle ◽  
Popliteus Tendon ◽  
Femoral Bone ◽  
Collateral Ligament ◽  
Bone Resection ◽  
Total Knee ◽  
Resection Area

Abstract Background The popliteus tendon (PT) or lateral collateral ligament (LCL) stabilizes the postero-lateral aspects of the knees. When surgeons perform total knee arthroplasty (TKA), PT and LCL iatrogenic injuries are a risk because the femoral attachments are relatively close to the femoral bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model.Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used (average age: 80.3). Whole length lower limbs were resected from the pelvis. All the surrounding soft tissue except the PT, knee ligaments and meniscus were removed from the limb. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a 1.5 mm K-wire. Computed tomography (CT) scanning of the whole lower limb was then performed. The CT data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image of the femur, the shortest length between each footprint and the bone resection area were calculated.Results PT and LCL footprint were detected in all knees. The area of the PT and LCL footprints was 38.7±17.7mm2 and 58.0±24.6mm2, respectively. The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm, respectively. The length between most distal and most posterior point of the lateral femoral condyle and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm, respectively. Under TKA simulation, the shortest length between the PT footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 4.3±2.5mm and 3.2±2.9mm, respectively. The shortest length between the LCL footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 7.2±2.3mm and 5.6±2.1mm, respectively. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knees, respectively.Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. To prevent postero-lateral instability in TKA, careful attention is needed to avoid damage to the PT and LCL during surgical procedures.

The Function of the Short Lateral Collateral Ligaments of the Canine Tarsus: A Cadaveric Study

2019 ◽  
Vol 55 (5) ◽  
pp. 220-225
Author(s):  
Riccarda Schuenemann ◽  
Sandra Bogisch
Keyword(s):  
External Rotation ◽  
Lateral Collateral Ligament ◽  
Cadaveric Study ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Clinical Behavior ◽  
Before And After ◽  
Lateral Subluxation ◽  
Lateral Collateral Ligaments ◽  
K Wires

ABSTRACT Information on the clinical behavior and treatment of cases with an isolated rupture of the short collateral ligaments of the canine tarsus is sparse and contradictory in the veterinary literature. Our objective was to evaluate the function of the short lateral collateral ligaments (SLCLs) of the tarsocrural joint in 90° flexion. Eight canine cadaveric limbs were tested for internal/external rotation and valgus/varus before and after transection of one or both SLCLs. In one group, the fibulocalcaneal ligament was transected first, followed by the fibulotalar. In the second group, the order of ligament transection was reversed. Angular changes between two k-wires were measured and compared. External rotation increased significantly after transection of one or both SLCLs (P = .009 and P &lt; .0005), as did varus (P = .021 and P = .001). Lateral subluxation was only possible when both SLCLs were cut. Unlike the long lateral collateral ligament, which stabilizes against deviation toward medial, both SLCLs are major stabilizers against subluxation toward lateral. This important difference must be considered in clinical patients with isolated rupture of the SLCLs.

In Vitro Kinematic Analysis of Single Axis Radius Posterior-Substituting Total Knee Arthroplasty

2020 ◽  
Author(s):  
Paul Arauz ◽  
Yun Peng ◽  
Tiffany Castillo ◽  
Christian Klemt ◽  
Young-Min Kwon
Keyword(s):  
Knee Flexion ◽  
Knee Kinematics ◽  
Lateral Collateral Ligament ◽  
Collateral Ligament ◽  
Flexion Extension ◽  
Healthy Knee ◽  
Joint Biomechanics ◽  
Total Knee ◽  
Intact Knee

AbstractThis is an experimental study. As current posterior-substituting (PS) total knee arthroplasties have been reported to incompletely restore intrinsic joint biomechanics of the healthy knee, the recently designed single axis radius PS knee system was introduced to increase posterior femoral translation and promote ligament isometry. As there is a paucity of data available regarding its ability to replicate healthy knee biomechanics, this study aimed to assess joint and articular contact kinematics as well as ligament isometry of the contemporary single axis radius PS knee system. Implant kinematics were measured from 11 cadaveric knees using an in vitro robotic testing system. In addition, medial collateral ligament (MCL) and lateral collateral ligament (LCL) forces were quantified under simulated functional loads during knee flexion for the contemporary PS knee system. Posterior femoral translation between the intact knee and the single axis radius PS knee system differed significantly (p < 0.05) at 60, 90, and 120 degrees of flexion. The LCL force at 60 degrees (9.06 ± 2.81 N) was significantly lower (p < 0.05) than those at 30, 90, and 120 degrees of flexion, while MCL forces did not differ significantly throughout the range of tested flexion angles. The results from this study suggest that although the contemporary single axis radius PS knee system has the potential to mimic the intact knee kinematics under muscle loading during flexion extension due to its design features, single axis radius PS knee system did not fully replicate posterior femoral translation and ligament isometry of the healthy knee during knee flexion.

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