Patient-specific musculoskeletal models as a framework for comparing ACL function in unicompartmental versus bicruciate retaining arthroplasty

2021 ◽  
pp. 095441192110118
Author(s):  
Qida Zhang ◽  
Zhenxian Chen ◽  
Zhongmin Jin ◽  
Orhun K Muratoglu ◽  
Kartik M Varadarajan
Keyword(s):  
Knee Arthroplasty ◽  
Gait Cycle ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Patient Specific ◽  
Knee Biomechanics ◽  
Subject Specific ◽  
Total Knee ◽  
The Subject ◽  
Anterior Cruciate

Unicompartmental knee arthroplasty has been shown to provide superior functional outcomes compared to total knee arthroplasty and have motivated development of advanced implant designs including bicruciate retaining knee arthroplasty. However, few validated frameworks are available to directly compare the effect of implant design and surgical techniques on ligament function and joint kinematics. In the present study, the subject-specific lower extremity models were developed based on musculoskeletal modeling framework using force-dependent kinematics method, and validated against in vivo telemetric data. The experiment data of two subjects who underwent TKA were obtained from the SimTK “Grand Challenge Competition” repository, and integrated into the subject-specific lower extremity model. Five walking gait trials and three different knee implant models for each subject were used as partial inputs for the model to predict knee biomechanics for unicompartmental, bicruciate retaining, and total knee arthroplasty. The results showed no significant differences in the tibiofemoral contact forces or angular kinematic parameters between three groups. However, unicompartmental knee arthroplasty demonstrated significantly more posterior tibial location between 0% and 40% of the gait cycle ( p < 0.017). Significant differences in range of tibiofemoral anterior/posterior translation and medial/lateral translation were also observed between unicompartmental and bicruciate retaining arthroplasty ( p < 0.017). Peak values of anterior cruciate ligament forces differed between unicompartmental and bicruciate retaining arthroplasty from 10% to 30% of the gait cycle. Findings of this study indicate that unicompartmental and bicruciate retaining arthroplasty do not have identical biomechanics and point to the complementary role of anterior cruciate ligament and articular geometry in guiding knee function. Further, the patient-specific musculoskeletal model developed provides a reliable framework for assessing new implant designs, and effect of surgical techniques on knee biomechanics following arthroplasty.

Quantifying Achievable Levels of Improvement in Knee Joint Biomechanics During Gait After Total Knee Arthroplasty Relative to Osteoarthritis Severity

2020 ◽  
pp. 1-9
Author(s):  
Jereme B. Outerleys ◽  
Michael J. Dunbar ◽  
Glen Richardson ◽  
Cheryl L. Hubley-Kozey ◽  
Janie L. Astephen Wilson
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Frontal Plane ◽  
Knee Adduction Moment ◽  
Patient Specific ◽  
Knee Biomechanics ◽  
Knee Oa ◽  
Joint Biomechanics ◽  
Total Knee

Total knee arthroplasty (TKA) surgery improves knee joint kinematics and kinetics during gait for most patients, but a lack of evidence exists for the level and incidence of improvement that is achieved. The objective of this study was to quantify patient-specific improvements in knee biomechanics relative to osteoarthritis (OA) severity levels. Seventy-two patients underwent 3-dimensional (3D) gait analysis before and 1 year after TKA surgery, as well as 72 asymptomatic adults and 72 with moderate knee OA. A combination of principal component analysis and discriminant analyses were used to categorize knee joint biomechanics for patients before and after surgery relative to asymptomatic, moderate, and severe OA. Post-TKA, 63% were categorized with knee biomechanics consistent with moderate OA, 29% with severe OA, and 8% asymptomatic. The magnitude and pattern of the knee adduction moment and angle (frontal plane features) were the most significant contributors in discriminating between pre-TKA and post-TKA knee biomechanics. Standard of care TKA improves knee biomechanics during gait to levels most consistent with moderate knee OA and predominately targets frontal plane features. These results provide evidence for the level of improvement in knee biomechanics that can be expected following surgery and highlight the biomechanics most targeted by surgery.

scholarly journals Comparative evaluation of posterior cruciate ligament in total knee arthroplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769097 ◽  
Author(s):  
Yuan Ma ◽  
Wei-Jia Chen ◽  
Ryuji Nagamine
Keyword(s):  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Varus Deformity ◽  
Full Extension ◽  
Balance Technique ◽  
Total Knee ◽  
Anterior Cruciate ◽  
Distraction Force

Introduction: It has been realized that for osteoarthritis (OA) knee with varus deformity, posterior cruciate ligament (PCL) release resulted in the increase of the flexion gap without significant effect on the extension gap. While the effect of release on gap angle is still obscure. On the other hand, gap distance and varus angle measured under different distraction forces suggest different patterns. Objectives: In the current study, mechanical gap balance in displacement and angular alternation of extension and flexion gaps will be evaluated, with PCL fully retained or resected under different distracting forces in varus knees. Methods: Fifty cases with medial OA undergoing posterior-stabilized (PS) total knee arthroplasty (TKA) were included in the study. PCL of all the cases were identified intact before resection. After distal femoral and proximal tibial cuts were initially performed and anterior cruciate ligament was excised, joint gap angle and distance in full extension and at 90° flexion were obtained by means of a tensioning device with 10, 20 and 30 inch-pounds (in-lbf) of distraction force. The gap angle and distance were measured three times at each step. After the excision of PCL, the same measurement was performed. Results: Both the distance and the varus angles of the knee gap enlarged accordingly with the augment of distraction forces at both extension and flexion with or without PCL resection. As to the gap distance, it remained the same after PCL resection at extension; while at flexion, the gap distance significantly ( p < 0.001) enlarged – 1.2, 1.6 and 1.9 mm – under 10, 20 and 30 in-lbf, respectively, after PCL resection. As to the varus angles, it significantly ( p < .050) decreased 0.6°, 0.3° and 0.4° at extension; while at flexion, the varus angles decreased 0° (not significant), 0.6° ( p < 0.050) and 1.1° ( p < 0.001) with 10, 20 and 30 in-lbf, respectively, after PCL resection. Conclusion: Our study indicated that the sacrifice of PCL will decrease the varus deformity at both extension and flexion, but with the exception under low distraction force at flexion. A proper distraction tension is of great importance in gap balancing during TKA. Sufficient attention of varus differences should be paid to the gap balance technique when choosing from different techniques, PCL-retained TKA or PCL-sacrificed TKA, as well as and an appropriate distract tension during measurement.

Leveraging subject-specific musculoskeletal modeling to assess effect of anterior cruciate ligament retaining total knee arthroplasty during walking gait

2020 ◽  
Vol 234 (12) ◽  
pp. 1445-1456 ◽  
Author(s):  
Qida Zhang ◽  
Zhenxian Chen ◽  
Zhifeng Zhang ◽  
Zhongmin Jin ◽  
Orhun K Muratoglu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Anterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Musculoskeletal Modeling ◽  
Cruciate Retaining ◽  
Walking Gait ◽  
Total Knee ◽  
Anterior Cruciate

Bi-cruciate retaining total knee arthroplasty has several potential advantages including improved anteroposterior knee stability compared to contemporary posterior cruciate-retaining total knee arthroplasty. However, few studies have explored whether there is significant differences of knee biomechanics following bi-cruciate retaining total knee arthroplasty compared to posterior cruciate-retaining total knee arthroplasty. In the present study, subject-specific lower extremity musculoskeletal multi-body dynamics models for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty were developed based on the musculoskeletal modeling framework using force-dependent kinematics method and validated against in vivo telemetric data. The experiment data of two subjects who underwent total knee arthroplasty were obtained for the SimTK “Grand Challenge Competition” repository, and integrated into the musculoskeletal model. Five walking gait trials for each subject were used as partial inputs for the model to predict the knee biomechanics for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty. The results revealed significantly greater range of anterior/posterior tibiofemoral translation, and significantly more posterior tibial location during the early phase of gait and more anterior tibial location during the late phase of gait were found in bi-cruciate retaining total knee arthroplasty without anterior cruciate ligament when compared to the bi-cruciate retaining total knee arthroplasty. No significant differences in tibiofemoral contact forces, rotations, translations, and ligament forces between bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty during normal walking gait, albeit slight differences in range of tibiofemoral internal/external rotation and anterior/posterior translation were observed. The present study revealed that anterior cruciate ligament retention has a positive effect on restoring normal knee kinematics in bi-cruciate retaining total knee arthroplasty. Preservation of anterior cruciate ligament in total knee arthroplasty and knee implant designs interplay each other and both contribute to restoring normal knee kinematics in different types of total knee arthroplasty. Further evaluation of more demanding activities and subject data from patients with bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty via musculoskeletal modeling may better highlight the role of the anterior cruciate ligament and its stabilizing influence.

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