Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

2019 ◽  
Vol 33 (08) ◽  
pp. 798-803
Author(s):  
Yun Peng ◽  
Paul Arauz ◽  
Shuai An ◽  
Sakkadech Limmahakhun ◽  
Christian Klemt ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Tibial Slope ◽  
Component Alignment ◽  
Posterior Tibial ◽  
Patient Reported ◽  
Total Knee ◽  
Bcr Tka

AbstractThis is an experimental study. Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) retaining bicruciate retaining (BCR) total knee arthroplasty (TKA) have the potential to restore normal knee kinematics and thus improve patient outcome. Limited studies have examined the relationship between component alignment and patient-reported outcome measures (PROM). This study aims to determine (1) accurate three-dimensional (3D) component alignment of BCR TKA and (2) whether the component alignment of BCR TKA affects PROMs. The 3D modeling analysis was performed based on computed tomography images from 29 BCR TKAs. Component orientations were quantified for femoral and tibial components in the sagittal, axial, and coronal planes. The knee society scores (KSS) were collected preoperatively and postoperatively at 1-year follow-up. Multiple comparisons were performed to analyze the relationship between component alignment and patient outcomes. High variability was observed in the tibial component alignment (root–mean-square values: axial plane 6.6 degrees, sagittal plane 5.1 degrees, and coronal plane 4.0 degrees). At 1-year follow-up, significant improvement in KSS was noted in BCR TKA patients (p < 0.001). However, regression analysis adjusting for baseline KSS demonstrated the postoperative KSS was negatively associated with the posterior tibial slope (B [slope of the output of the regression analysis] = 2.597, p = 0.006). Patients with greater posterior tibial slopes were reported poorer postoperative functions at 1-year follow-up. Excessive posterior tibial slope may generate greater posterior force on the femur that leads to continuous overloading of the preserved ACL, suggesting optimal sagittal plane alignment of the tibial component may be important for the optimization of postoperative functions of BCR TKA patients.

Posterior Tibial Slope Increases Anterior Cruciate Ligament Stress in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematic Analysis

2020 ◽  
Author(s):  
Christian Klemt ◽  
Georges Bounajem ◽  
Venkatsaiakhil Tirumala ◽  
Liang Xiong ◽  
Ruben Oganesyan ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Weight Bearing ◽  
Knee Kinematics ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
Total Knee ◽  
Anterior Cruciate ◽  
Pl Bundle ◽  
Bcr Tka

AbstractThe study design involved here is experimental in nature. The resection of the anterior cruciate ligament (ACL) during conventional total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal in vivo knee kinematics. Bi-cruciate retaining (BCR) TKA designs allow the preservation of the ACL with the potential to restore native knee kinematics. This study aimed to investigate the effect of posterior tibial slope (PTS) on stress experienced by the ACL during weight bearing sit-to-stand (STS) and single-leg deep lunge. The ACL elongation patterns were measured in 30 unilateral BCR TKA patients during weight-bearing STS and single-leg deep lunge using a validated dual fluoroscopic tracking technique. The minimum normalized stress within the anteromedial (AM) and posterolateral (PL) bundle of the ACL during weight-bearing STS and single-leg deep lunge was found at a PTS of 3.7 degrees. The maximum AM and PL bundle stresses were observed at a PTS of 8.5 and 9.3 degrees, respectively during STS and at 8.4, and 9.1 degrees, respectively during single-leg deep lunge. There was a significant positive correlation between PTS and stress observed within the AM and PL bundle of the ACL during weight-bearing STS (R 2 = 0.37; p < 0.01; R2  = 0.36; p = 0.01) and single-leg deep lunge (R 2 = 0.42; p < 0.01; R 2 = 0.40; p < 0.01). The study demonstrates that PTS of operated BCR TKA knees has a significant impact on the stress experienced by the preserved ACL during weight-bearing STS and single-leg deep lunge. This suggests that avoiding excessive PTS may be one of the surgical implant alignment factors to consider during surgery to minimize increased loading of the preserved ACL.

DOES NAVIGATION TOTAL KNEE REPLACEMENT REALLY MAKE A DIFFERENCE?

2013 ◽  
Vol 16 (02) ◽  
pp. 1350007
Author(s):  
P. Motwani ◽  
A. Jariwala ◽  
N. Valentine
Keyword(s):  
Total Knee Replacement ◽  
Tibial Component ◽  
Sagittal Plane ◽  
Computer Navigation ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Background: Computer Navigation in Total Knee Replacement (TKR) has completed more than a decade since its inception. From that time, numerous studies have been done to see its effect on the variables of surgery and its outcome. Some studies have shown that it is definitely beneficial while others have negated its superiority over conventional techniques. This is an early outcome study on the results of navigation TKR in terms of alignment and clinical outcome at three years post-operatively. Methods: In the present study, 128 patients who had undergone navigation TKR (128 TKR) between January 2006 and November 2009 were included. The navigation system used was orthoPilot®. Patients were assessed post-operatively at one and three year using knee society score (KSS) and knee function score (KFS). All patients completed one year follow-up and 55 patients completed three year follow-up. From 128 patients, 40 navigated TKR patients operated between November 2007 and 2009 and were compared with 40 patients operated by conventional TKR operated between July 2007 and December 2008. Results: The mean KSS at 1 year post-operatively was 85.60 and at 3 years was 85.87. The mean KFS at 1 year post-operatively was 69.30 and at 3 years was 68.00. There was no statistically significant difference between navigation TKR and conventional TKR in terms of anatomical femoro-tibial alignment, femoral component alignment in coronal and sagittal plane and tibial component alignment in coronal plane. However, there was statistically significant difference between tibial component alignment in sagittal plane (p = 0.000) between both the groups. Conclusion: Computer navigation TKR affords a possibility to place both the femoral and tibial component very precisely without the risk of any greater axis deviation from ideal value. It helps in reducing the outliers in alignment of the limb and that of component and that improves the overall implant survival for a long time post-operatively.

scholarly journals Patient-Reported Outcomes with Tibial Baseplate Position and PCL Status in Conforming Total Knee Arthroplast

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Joseph A. Madden, BS ◽  
Payton K. Arnold, MS ◽  
Evan R. Deckard, BSE ◽  
R. Michael Meneghini, MD
Keyword(s):  
Tibial Slope ◽  
Activity Level ◽  
Posterior Tibial Slope ◽  
Consecutive Series ◽  
Posterior Tibial ◽  
Primary Tkas ◽  
Measurement Protocol ◽  
Patient Reported ◽  
Total Knee ◽  
Climbing Stairs

Background and Hypothesis: Anteroposterior (AP) tibial baseplate position, posterior tibial slope, and posterior cruciate ligament (PCL) status in total knee arthroplasty (TKA) undoubtedly affect kinematic patterns. Further, few studies document patient-reported outcome measures (PROMS) in conforming polyethylene TKA with these varying parameters. The purpose of this study was to correlate PROMS with the interaction of AP tibial baseplate position, tibial slope, and PCL status in a consecutive series of primary TKAs with conforming polyethylene. We hypothesized that pain, function, and satisfaction may correlate with a combination of these three parameters. Experimental Design or Project Methods: 589 consecutive primary TKAs of a single implant design performed by a single surgeon between January 2016 and October 2018 were retrospectively reviewed. AP tibial baseplate position (relative to the middle of the tibial canal) and posterior tibial slope measurements were performed on 4-week postoperative sagittal view radiographs with a standardized measurement protocol by two independent blinded raters. Validated PROMS related to activity level, pain, and function were evaluated at minimum one-year. Results: Analyses indicated differences based on ≥8mm vs. <8mm of posterior distance of the tibial baseplate from the tibial canal and whether or not the PCL was released. Four analysis groups (PCL-preserved <8mm, PCL-preserved ≥8mm, PCL-resected <8mm, and PCL-resected ≥8mm) did not differ by demographics/covariates (p≥0.150), tibial slope (p≥0.132), or preoperative PROMS (p≥0.088). The PCL-released <8mm group achieved clinically meaningful higher absolute (92.0) and delta (42.0) median KOOS Jr. scores, higher satisfaction (96.3%), and the greatest reduction in pain while climbing stairs (-7.0) although some findings lacked statistical significance. Conclusion and Potential Impact: In conforming polyethylene TKAs, releasing the PCL in combination with AP tibial baseplate placement <8mm from the tibial canal may eliminate kinematic conflict between the PCL and tibial baseplate leading to improved satisfaction, function, and pain while climbing stairs.

Tibial Slope Strongly Influences Knee Stability After Posterior Cruciate Ligament Reconstruction: A Prospective 5- to 15-Year Follow-up

2016 ◽  
Vol 45 (2) ◽  
pp. 355-361 ◽  
Author(s):  
Clemens Gwinner ◽  
Andreas Weiler ◽  
Manoussos Roider ◽  
Frederik M. Schaefer ◽  
Tobias M. Jung
Keyword(s):  
Posterior Cruciate Ligament ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Posterolateral Corner ◽  
Knee Stability ◽  
Pcl Reconstruction ◽  
The Mean ◽  
Tibial Translation

Background: The reported failure rate after posterior cruciate ligament (PCL) reconstruction remains high. Previous studies have shown that the tibial slope (TS) influences sagittal plane laxity. Consequently, alterations of TS might have an effect on postoperative knee stability after PCL reconstruction. Hypothesis: We hypothesized that flattening of TS is associated with increased posterior laxity after PCL reconstruction. Study Design: Cohort study; Level of evidence 3. Methods: This study consisted of 48 patients who underwent PCL reconstruction in a single-surgeon series. Eight patients underwent an isolated PCL reconstruction, 27 patients underwent an additional posterolateral corner reconstruction, and 13 patients underwent a combined reconstruction of the PCL, anterior cruciate ligament, and posterolateral corner. Three blinded observers measured TS and the side-to-side difference (SSD) of posterior tibial translation (PTT) before and after PCL reconstruction using standardized stress radiographs. The minimum follow-up was 5 years. Results: At a mean follow-up of 103 months (range, 65-187), the mean SSD of PTT was significantly reduced (10.9 ± 2.9 vs 4.9 ± 4.3 mm; P < .0001). The mean TS was 8.0° ± 3.7° (range, 1°-14.3°) for the operated knee and 7.9° ± 3.2° (range, 2°-15.3°) for the contralateral knee. There was a statistically significant correlation between TS and PTT ( r = −0.77 and R2 = 0.59; P < .0001). In addition, there was a significant correlation between TS and the postoperative reduction of PTT ( r = 0.74 and R2 = 0.55; P < .0001). Subgrouping according to the number of operated ligaments showed no significant differences regarding TS or the mean reduction of PTT. Conclusion: Flattening of TS is associated with a significantly higher remaining PTT as well as a lower reduction of PTT. Notably, these results are irrespective of sex and number of ligaments addressed. Thus, isolated soft tissue procedures in PCL deficiency may only incompletely address posterior knee instability in patients with flattening of the posterior slope.

Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases

2019 ◽  
Vol 47 (2) ◽  
pp. 296-302 ◽  
Author(s):  
Andrew S. Bernhardson ◽  
Zachary S. Aman ◽  
Grant J. Dornan ◽  
Bryson R. Kemler ◽  
Hunter W. Storaci ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Relationship ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Acl Graft ◽  
Posterior Tibial ◽  
Axially Loaded ◽  
Anterior Cruciate

Background: Previous work has reported that increased tibial slope is directly correlated with increased anterior tibial translation, possibly predisposing patients to higher rates of anterior cruciate ligament (ACL) tears and causing higher rates of ACL graft failures over the long term. However, the effect of changes in sagittal plane tibial slope on ACL reconstruction (ACLR) graft force has not been well defined. Purpose/Hypothesis: The purpose of this study was to quantify the effect of changes in sagittal plane tibial slope on ACLR graft force at varying knee flexion angles. Our null hypothesis was that changing the sagittal plane tibial slope would not affect force on the ACL graft. Study Design: Controlled laboratory study. Methods: Ten male fresh-frozen cadaveric knees had a posterior tibial osteotomy performed and an external fixator placed for testing and accurate slope adjustment. Following ACLR, specimens were compressed with a 200-N axial load at flexion angles of 0°, 15°, 30°, 45°, and 60°, and the graft loads were recorded through a force transducer clamped to the graft. Tibial slope was varied between −2° and 20° of posterior slope at 2° increments under these test conditions. Results: ACL graft force in the loaded testing state increased linearly as slope increased. This effect was independent of flexion angle. The final model utilized a 2-factor linear mixed-effects regression model and noted a significant, highly positive, and linear relationship between tibial slope and ACL graft force in axially loaded knees at all flexion angles tested (slope coefficient = 0.92, SE = 0.08, P < .001). Significantly higher graft force was also observed at 0° of flexion as compared with all other flexion angles for the loaded condition (all P < .001). Conclusion: The authors found that tibial slope had a strong linear relationship to the amount of graft force experienced by an ACL graft in axially loaded knees. Thus, a flatter tibial slope had significantly less loading of ACL grafts, while steeper slopes increased ACL graft loading. Our biomechanical findings support recent clinical evidence of increased ACL graft failure with steeper tibial slope secondary to increased graft loading. Clinical Relevance: Evaluation of the effect of increasing tibial slope on ACL graft force can guide surgeons when deciding if a slope-decreasing proximal tibial osteotomy should be performed before a revision ACLR. Overall, as slope increases, ACL graft force increases, and in our study, flatter slopes had lower ACL graft forces and were protective of the ACLR graft.

Influence of posterior tibial slope on three-dimensional femorotibial alignment under weightbearing conditions in healthy Japanese elderly people

2021 ◽  
pp. 1-12
Author(s):  
Ryota Katsumi ◽  
Takashi Sato ◽  
Tomoharu Mochizuki ◽  
Satoshi Watanabe ◽  
Osamu Tanifuji ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
External Rotation ◽  
Weight Bearing ◽  
Linear Regression Analysis ◽  
Three Dimensional ◽  
Tibial Slope ◽  
Rotational Alignment ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Japanese Elderly

BACKGROUND: Assessment of three-dimensional (3D) femorotibial alignment is essential for successful knee osteoarthritis treatment in the elderly. The complex morphology of the posterior tibial slope (PTS) might have an influence on sagittal and rotational alignment and the positional relationship between the femur and tibia in the anterior–posterior (AP) direction under weight-bearing conditions. OBJECTIVE: This study aimed to clarify the association between the PTS and 3D femorotibial alignment under weight-bearing conditions in healthy Japanese elderly individuals. METHODS: We investigated the 3D femorotibial alignment of 110 lower extremities of 55 healthy individuals (26 women, 29 men, mean age: 70 ± 6 years). Using our previously reported 3D-to-2D image registration technique, we evaluated the 3D hip-knee-ankle angle (3DHKA) in the sagittal plane, rotational alignment, and the distance between the femoral and tibial origins in the AP direction (tibial AP position) as femorotibial alignment parameters under weight-bearing conditions. We assessed the medial and lateral PTS and their angular difference (PTS difference) as PTS parameters. Stepwise multiple linear regression analysis was performed using PTS parameters and other possible confounders (age, sex, height, and weight) as the independent variables and femorotibial alignment parameters as the dependent variable. RESULTS: Weight (𝛽 = 0.393, p < 0.001) and lateral PTS (𝛽 = 0.298, p < 0.001) were the predictors associated with 3DHKA in the sagittal plane. Lateral PTS (𝛽 = 0.304, p = 0.001) was the only predictor associated with the tibial AP position. Sex (𝛽 = −0.282, p = 0.002) and PTS difference (𝛽 = −0.231, p = 0.012) were associated with rotational alignment. CONCLUSIONS: We found that a steeper lateral PTS resulted in a more flexed knee and anterior tibia. The PTS difference was positively correlated with tibial external rotation. Our data could be used as the standard reference for realignment surgery to ensure PTS is appropriately maintained.

Change in Posterior Tibial Slope in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: A Case Series With a Mean 9 Years’ Follow-up

2021 ◽  
pp. 036354652199709
Author(s):  
R. Kyle Martin ◽  
Guri R. Ekås ◽  
JūratėŠaltytė Benth ◽  
Nicholas Kennedy ◽  
Gilbert Moatshe ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Skeletally Immature ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
The Mean ◽  
Injured Knee

Background: Increased lateral posterior tibial slope (LPTS) is associated with increased rates of anterior cruciate ligament (ACL) injury and failure of ACL reconstruction. It is unknown if ACL deficiency influences the developing proximal tibial physis and slope in skeletally immature patients through anterior tibial subluxation and abnormal force transmission. Purpose: To assess the natural history of LPTS in skeletally immature patients with an ACL-injured knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 participants from a previous study on nonoperative management of ACL injury in skeletally immature patients were included. During the initial study, bilateral knee magnetic resonance imaging (MRI) was performed within 1 year of enrollment and again at final follow-up. All patients were younger than 13 years at the time of enrollment, and final follow-up occurred a mean 10 years after the injury. MRI scans were retrospectively reviewed by 2 reviewers to determine bilateral LPTS for each patient and each time point. Linear mixed models were used to assess LPTS differences between knees, change over time, and association with operational status. Subgroup analyses were performed for patients who remained nonoperated throughout the study. Results: A total of 22 patients had ACL reconstruction before final follow-up and 16 remained nonoperated. In the entire study population, the mean LPTS was higher in the injured knee than in the contralateral knee at final follow-up by 2.0° ( P < .001; 95% CI, 1.3°–2.6°). The mean LPTS increased significantly in the injured knee by 0.9° ( P = .042; 95% CI, 0.03°–1.7°), while the mean LPTS decreased in the contralateral knee by 0.4° ( P = .363; 95% CI, –0.8° to 0.4°). A significant difference in LPTS was also observed in the nonoperated subgroup. No significant association was observed between LPTS and operational status. Conclusion: Lateral posterior tibial slope increased more in the ACL-injured knee than in the contralateral uninjured knee in a group of skeletally immature patients. Lateral posterior tibial slope at baseline was not associated with the need for surgical reconstruction over the study period.

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