In vivo kinematics of deep lunges and sit-to-stand activities in patients with bicruciate-retaining total knee arthroplasty

Aims The removal of the cruciate ligaments in total knee arthroplasty (TKA) has been suggested as a potential contributing factor to patient dissatisfaction, due to alteration of the in vivo biomechanics of the knee. Bicruciate retaining (BCR) TKA allows the preservation of the cruciate ligaments, thus offering the potential to reproduce healthy kinematics. The aim of this study was to compare in vivo kinematics between the operated and contralateral knee in patients who have undergone TKA with a contemporary BCR design. Methods A total of 29 patients who underwent unilateral BCR TKA were evaluated during single-leg deep lunges and sit-to-stand tests using a validated computer tomography and fluoroscopic imaging system. In vivo six-degrees of freedom (6DOF) kinematics were compared between the BCR TKA and the contralateral knee. Results During single-leg deep lunge, BCR TKAs showed significantly less mean posterior femoral translation (13 mm; standard deviation (SD) 4) during terminal flexion, compared with the contralateral knee (16.6 mm, SD 3.7; p = 0.001). Similarly, BCR TKAs showed significantly less mean femoral rollback (11.6 mm (SD 4.5) vs 14.4 mm (SD 4.6); p < 0.043) during sit-to-stand. BCR TKAs showed significantly reduced internal rotation during many parts of the strenuous flexion activities particularly during high-flexion lunge (4° (SD 5.6°) vs 6.5° (SD 6.1°); p = 0.051) and during sit-to-stand (4.5° (SD 6°) vs 6.9° (SD 6.3°); p = 0.048). Conclusion The contemporary design of BCR TKA showed asymmetrical flexion-extension and internal-external rotation, suggesting that the kinematics are not entirely reproduced during strenuous activities. Future studies are required to establish the importance of patient factors, component orientation and design, in optimizing kinematics in patients who undergo BCR TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):59–65.

Download Full-text

In Vivo Kinematics of Bicruciate-Retaining Total Knee Arthroplasty with Anatomical Articular Surface under High-Flexion Conditions

The Journal of Knee Surgery ◽

10.1055/s-0039-1696959 ◽

2019 ◽

Author(s):

Kenichi Kono ◽

Hiroshi Inui ◽

Tetsuya Tomita ◽

Takaharu Yamazaki ◽

Shuji Taketomi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Articular Surface ◽

High Flexion ◽

In Vivo Kinematics ◽

Significant Movement ◽

Medial Pivot ◽

Total Knee ◽

Bcr Tka

AbstractBicruciate-retaining total knee arthroplasty (BCR-TKA) recreates normal knee movement by preserving the anterior cruciate and posterior cruciate ligaments. However, in vivo kinematics of BCR-TKA with the anatomical articular surface remains unknown. The objective of this study was to evaluate in vivo kinematics of BCR-TKA with the anatomical articular surface during high-flexion activities. For this purpose, 17 knees after BCR-TKA with an anatomical articular surface were examined. Under fluoroscopy, each patient performed squatting and cross-legged sitting motions. To estimate the spatial position and orientation of the knee, a two-dimensional or three-dimensional registration technique was used. Rotation, varus-valgus angle, and anteroposterior translation of medial and lateral contact points of the femoral component relative to the tibial component were evaluated in each flexion angle. The results showed that from 80 to 110° of flexion, the femoral external rotation during squatting was significantly larger than that during cross-legged sitting. At maximum flexion, the knees during sitting indicated significantly more varus alignment than during squatting. During squatting, a medial pivot pattern was observed from minimum flexion to 10° flexion, with no significant movement beyond 10° of flexion. Conversely, during cross-legged sitting, no significant movement was detected from minimum flexion to 60° of flexion, with a medial pivot beyond 60° of flexion. Therefore, the knees showed relatively normal kinematics after BCR-TKA with an anatomical articular surface; however, it varied during high-flexion activities depending on the activity.

Download Full-text

Comparison of in vivo kinematics of total knee arthroplasty between cruciate retaining and cruciate substituting insert

Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology ◽

10.1016/j.asmart.2021.10.002 ◽

2021 ◽

Vol 26 ◽

pp. 47-52

Author(s):

Keiji Iwamoto ◽

Takaharu Yamazaki ◽

Kazuomi Sugamoto ◽

Tetsuya Tomita

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cruciate Retaining ◽

In Vivo Kinematics ◽

Total Knee

Download Full-text

Bicruciate-retaining total knee arthroplasty reproduces in vivo kinematics of normal knees to a lower extent than unicompartmental knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05754-2 ◽

2019 ◽

Vol 28 (9) ◽

pp. 3007-3015 ◽

Cited By ~ 3

Author(s):

Kenichi Kono ◽

Hiroshi Inui ◽

Tetsuya Tomita ◽

Takaharu Yamazaki ◽

Shuji Taketomi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

In Vivo Kinematics ◽

Unicompartmental Knee ◽

Lower Extent ◽

Total Knee

Download Full-text

In vivo kinematics and kinetics of a bi-cruciate substituting total knee arthroplasty: A combined fluoroscopic and gait analysis study

Journal of Orthopaedic Research® ◽

10.1002/jor.20941 ◽

2009 ◽

Vol 27 (12) ◽

pp. 1569-1575 ◽

Cited By ~ 51

Author(s):

Fabio Catani ◽

Andrea Ensini ◽

Claudio Belvedere ◽

Alessandro Feliciangeli ◽

Maria Grazia Benedetti ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Gait Analysis ◽

Knee Arthroplasty ◽

Analysis Study ◽

In Vivo Kinematics ◽

Total Knee ◽

Kinetics Of ◽

Kinematics And Kinetics

Download Full-text

In Vivo Kinematic Analysis of Bicruciate-retaining Total Knee Arthroplasty Focused on Function of the ACL

10.21203/rs.3.rs-180548/v1 ◽

2021 ◽

Author(s):

Kosei Ishigaki ◽

Hideyuki Aoki ◽

Ryo Takamatsu ◽

Yuji Nishiwaki ◽

Hiroshi Takahashi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Kinematic Analysis ◽

Tibial Component ◽

Lateral Translation ◽

In Vivo Kinetics ◽

Total Knee ◽

Bcr Tka

Abstract Background: The utility of a bi-cruciate retaining total knee arthroplasty (BCR-TKA) is uncertain. In this study, we performed an in vivo kinematic analysis of squat motion on level ground and on a downward slope in patients treated with BCR-TKA to examine the value of anterior cruciate ligament (ACL) preservation.Methods: The subjects were ten valgus knees that underwent TKA (BCR: 5 knees, CR: 5 knees) at our hospital. We evaluated in vivo kinematics of the knee using fluoroscopy and investigated the femoral component translation relative to the tibial component from extension to maximum flexion, and the rotation angle between the components under the two conditions. Statistical analysis was conducted by Mann-Whitney U test to compare the rotational angle, the location of lateral and medial contact points per flexion angle. Differences in these parameters between the BCR and CR groups across the flexion angles were compared by repeated measures ANOVA.Results: Rotation of the femoral component to the tibial component occurred gradually as flexion continued. On level ground, lateral rotation at 0° to 120° flexion was 14.5±1.95° in the BCR group and 7.9±0.47° in the CR group. Medial translation was 4.1±1.73mm in the BCR group and 2.5±1.64mm in the CR group, and lateral translation was 13.2±1.6mm in the BCR group and 7.1±1.74mm in the CR group. On a forward slope, lateral rotation was 12.7±1.45° in the BCR group and 7.57±0.47° in the CR group. Medial translation was 5.87±1.78mm in the BCR and 2.9±0.81mm in the CR, and lateral translation was 13.6±1.84mm in the BCR and 7.4±0.96mm in the CR.Conclusion: An in vivo kinetics analysis of deep flexion motion was conducted on level ground and on a forward slope to stress the ACL. Under both conditions, kinetics close to screw home movement were found in the BCR group and rotation was significantly larger than that in the CR group. The medial contact point between components was located significantly more anterior in the BCR group. In conclusion, BCR-TKA was found to have in vivo kinetics close to those of a normal knee, in comparison with CR-TKA.

Download Full-text