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

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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Posterior tibial slope and femoral sizing affect posterior cruciate ligament tension in posterior cruciate-retaining total knee arthroplasty

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2015.05.006 ◽

2015 ◽

Vol 30 (7) ◽

pp. 676-681 ◽

Cited By ~ 11

Author(s):

Shinichi Kuriyama ◽

Masahiro Ishikawa ◽

Shinichiro Nakamura ◽

Moritoshi Furu ◽

Hiromu Ito ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Posterior Cruciate Ligament ◽

Knee Arthroplasty ◽

Cruciate Ligament ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Cruciate Retaining ◽

Posterior Tibial ◽

Ligament Tension ◽

Total Knee

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

The Journal of Arthroplasty ◽

10.1016/s0883-5403(96)80167-7 ◽

1996 ◽

Vol 11 (1) ◽

pp. 99-103 ◽

Cited By ~ 62

Author(s):

Robert Singerman ◽

John C. Dean ◽

Hector D. Pagan ◽

Victor M. Goldberg

Keyword(s):

Total Knee Arthroplasty ◽

Posterior Cruciate Ligament ◽

Knee Arthroplasty ◽

Cruciate Ligament ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Posterior Tibial ◽

Total Knee

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Effect of Posterior Femoral Condylar Offset and Posterior Tibial Slope on Maximal Flexion Angle of the Knee in Posterior Cruciate Ligament Sacrificing Total Knee Arthroplasty

Knee Surgery and Related Research ◽

10.5792/ksrr.2013.25.2.54 ◽

2013 ◽

Vol 25 (2) ◽

pp. 54-59 ◽

Cited By ~ 24

Author(s):

Jong-Heon Kim

Keyword(s):

Total Knee Arthroplasty ◽

Posterior Cruciate Ligament ◽

Knee Arthroplasty ◽

Cruciate Ligament ◽

Tibial Slope ◽

Flexion Angle ◽

Posterior Tibial Slope ◽

Posterior Tibial ◽

Total Knee

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The Medial Tibial Plateau Can Be Used as a Direct Anatomical Reference for the Posterior Tibial Slope in Medial Unicompartmental Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0041-1740384 ◽

2021 ◽

Author(s):

Shigeshi Mori ◽

Masao Akagi ◽

Akihiro Moritake ◽

Ichiro Tsukamoto ◽

Kotaro Yamagishi ◽

...

Keyword(s):

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Tibial Plateau ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Posterior Tibial ◽

Medial Unicompartmental Knee Arthroplasty ◽

The Mean ◽

Ct Data ◽

The Individual

AbstractThere has been no consensus about how to determine the individual posterior tibial slope (PTS) intraoperatively. The purpose of this study was to investigate whether the tibial plateau could be used as a reference for reproducing individual PTS during medial unicompartmental knee arthroplasty (UKA). Preoperative computed tomography (CT) data from 48 lower limbs for medial UKA were imported into a three-dimensional planning software. Digitally reconstructed radiographs were created from the CT data as the lateral knee plain radiographs and the radiographic PTS angle was measured. Then, the PTS angles on the medial one-quarter and the center of the MTP (¼ and ½ MTP, respectively), and that on the medial tibial eminence (TE) were measured on the sagittal multiplanar reconstruction image. Finally, 20 lateral knee radiographs with an arthroscopic probe placed on the ¼ and the ½ MTP were obtained intraoperatively, and the angle between the axis of the probe and the tangent line of the plateau was measured. The mean radiographic PTS angle was 7.9 ± 3.0 degrees (range: 1.7–13.6 degrees). The mean PTS angles on the ¼ MTP, the ½ MTP, and the TE were 8.1 ± 3.0 degrees (1.2–13.4 degrees), 9.1 ± 3.0 degrees (1.4–14.7 degrees), and 9.9 ± 3.1 degrees (3.1–15.7 degrees), respectively. The PTS angles on the ¼ MTP and the ½ MTP were strongly correlated with the radiographic PTS angle (r =0.87 and 0.80, respectively, p < 0.001). A statistically significant difference was observed between the mean angle of the radiographic PTS and the PTS on the TE (p < 0.01). The mean angle between the axis of the probe and the tangent line of the tibial plateau was −0.4 ± 0.9 degrees (−2.3–1.3 degrees) on the ¼ MTP and −0.1 ± 0.7 degrees (−1.5–1.2 degrees) on the ½ MTP, respectively. An area from the medial one-quarter to the center of the MTP could be used as an anatomical reference for the individual PTS.

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