scholarly journals Both Intraoperative Medial and Lateral Soft Tissue Balances Influence Intraoperative Rotational Knee Kinematics in Bi-Cruciate Stabilized Total Knee Arthroplasty: A Retrospective Investigation.

2021 ◽  
Author(s):  
Kentaro Takagi ◽  
Hiroshi Inui ◽  
Shuji Taketomi ◽  
Ryota Yamagami ◽  
Kenichi Kono ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Internal Rotation ◽  
Knee Arthroplasty ◽  
Knee Kinematics ◽  
Joint Laxity ◽  
Angular Difference ◽  
Tibial Internal Rotation ◽  
Maximum Flexion ◽  
Total Knee

Abstract BackgroundTibial internal rotation following total knee arthroplasty (TKA) is important in achieving favorable postoperative clinical outcomes. Studies have reported the effect of intraoperative soft tissue balance on tibial internal rotation in conventional TKA, however, its effect on bi-cruciate stabilized (BCS) TKA has not reported enough. Furthermore, although studies have shown that both medial and lateral soft tissue balances are important for a good tibial internal rotation, no studies have evaluated the effects of soft tissue balance at medial or lateral compartments separately on tibial internal rotation in BCS TKA. The purpose of this study was to clarify the relationship between medial or lateral component gaps and rotational knee kinematics in BCS TKA.MethodsOne hundred fifty-eight knees that underwent BCS TKA were included in this study. They were divided into two groups according to the medial or lateral joint laxities, which was defined as the value of component gap minus the selected thickness of the tibial component at 30°, 60°, and 90° flexion, respectively: Group M-stable (medial joint laxity, ≤2 mm) or Group M-loose (medial joint laxity, ≥3 mm) and Group L-stable (lateral joint laxity, ≤3 mm) or Group L-loose (lateral joint laxity, ≥4 mm). The intraoperative rotational knee kinematics was compared between Group M-stable and Group M-loose or between Group L-stable and Group L-loose at each angle, respectively.ResultsThe rotational angular difference between 30° flexion and maximum flexion was significantly larger in Group M-stable at 30° flexion than that in Group M-loose at 30° flexion. The rotational angular difference between 60° flexion and maximum flexion was significantly larger in Group L-loose at 60° flexion than that in Group L-stable at 60° flexion. The rotational angular difference between 60° flexion and maximum flexion was significantly larger in Group L-loose at 90° flexion than that in Group L-stable at 90° flexion.ConclusionSurgeons should pay attention to the importance of medial joint stability at midflexion and lateral joint laxities at midflexion and 90° flexion on a good tibial internal rotation from midflexion to deep flexion in BCS TKA.

scholarly journals Both intraoperative medial and lateral soft tissue balances influence intraoperative rotational knee kinematics in bi-cruciate stabilized total knee arthroplasty: A retrospective investigation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kentaro Takagi ◽  
Hiroshi Inui ◽  
Shuji Taketomi ◽  
Ryota Yamagami ◽  
Kenichi Kono ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Rotation ◽  
Knee Kinematics ◽  
Joint Laxity ◽  
Tibial Internal Rotation ◽  
Maximum Flexion ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
Group D

Abstract Background Tibial internal rotation following total knee arthroplasty (TKA) is important in achieving favorable postoperative clinical outcomes. Studies have reported the effect of intraoperative soft tissue balance on tibial internal rotation in conventional TKA, no studies have evaluated the effects of soft tissue balance at medial or lateral compartments separately on tibial internal rotation in bi-cruciate stabilized (BCS) TKA. The purpose of this study was to clarify the relationship between medial or lateral component gaps and rotational knee kinematics in BCS TKA. Methods One hundred fifty-eight knees that underwent BCS TKA were included in this study. The intraoperative medial and lateral joint laxities which was defined as the value of component gap minus the thickness of the tibial component were firstly divided into two groups, respectively: Group M-stable (medial joint laxity, ≤ 2 mm) or Group M-loose (medial joint laxity, ≥ 3 mm) and Group L-stable (lateral joint laxity, ≤ 3 mm) or Group L-loose (lateral joint laxity, ≥ 4 mm). And finally, the knees enrolled in this study were divided into four groups based on the combination of Group M and Group L: Group A (M-stable and L-stable), Group B (M-stable and L-loose), Group C (M-loose and L-stable), and Group D (M-loose and L-loose). The intraoperative rotational knee kinematics were compared between the four Groups at 0°, 30°, 60°, and 90° flexion, respectively. Results The rotational angular difference between 0° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group A at 30° flexion (*p < 0.05). The rotational angular difference between 30° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group D at 30° flexion (*p < 0.05). The rotational angular differences between 30° or 90° flexion and maximum flexion in Group B at 60° flexion were significantly larger than those in Group A at 60° flexion (*p < 0.05). Conclusion Surgeons should pay attention to the importance of medial joint stability at midflexion and lateral joint laxities at midflexion and 90° flexion on a good tibial internal rotation in BCS TKA.

Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review

2017 ◽  
Vol 26 (6) ◽  
pp. 1636-1644 ◽  
Author(s):  
Alfredo Schiavone Panni ◽  
Francesco Ascione ◽  
Marco Rossini ◽  
Adriano Braile ◽  
Katia Corona ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Internal Rotation ◽  
Knee Arthroplasty ◽  
Tibial Internal Rotation ◽  
Total Knee

Semimembranosus Release Reduces Tibial Internal Rotation and Flexion Angle in Cruciate-Retaining Total Knee Arthroplasty

2015 ◽  
Vol 30 (9) ◽  
pp. 1537-1541 ◽  
Author(s):  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
Hirotsugu Muratsu ◽  
Takehiko Matsushita ◽  
Ryosuke Kuroda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Internal Rotation ◽  
Knee Arthroplasty ◽  
Flexion Angle ◽  
Cruciate Retaining ◽  
Tibial Internal Rotation ◽  
Total Knee

Intraoperative Soft Tissue Balance/Kinematics and Clinical Evaluation of Modified Kinematically versus Mechanically Aligned Total Knee Arthroplasty

2019 ◽  
Vol 33 (08) ◽  
pp. 777-784 ◽  
Author(s):  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
Kazunari Ishida ◽  
Yuichi Kuroda ◽  
Masanori Tsubosaka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Soft Tissue Balance ◽  
Cruciate Retaining ◽  
Tibial Internal Rotation ◽  
Tibial Cut ◽  
Total Knee

AbstractRecently, kinematically aligned total knee arthroplasty has been found to achieve better clinical outcomes than mechanically aligned TKA. Despite the good clinical outcomes that are reported at short- to mid-term follow-up, intraoperative variables that are associated with a better outcome have not been measured. Therefore, this study was conducted to compare intraoperative kinematics/soft tissue balance and the clinical outcomes of patients who underwent modified kinematically (restricted tibial cut) or mechanically aligned total knee arthroplasty. Sixty cruciate-retaining total knee arthroplasties (30 modified kinematically [3-degree varus and 7-degree posterior slope in tibial cut] and 30 mechanically aligned) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative kinematics assessed by the navigation system and soft tissue balance assessed by an offset-type tensor were compared between the groups. One year postoperatively, the range of motion and 2011 Knee Society scores were compared between the groups. Kinematic assessment exhibited that tibial internal rotation during flexion was significantly maintained in the kinematic compared with the mechanical group (p < 0.05). Varus/valgus ligament balance at 90 and 120 degrees of flexion significantly maintained lateral laxity in the kinematic compared with the mechanical group (p < 0.05). Improvement of flexion angles, functional activity scores, and patient satisfaction were significantly better in the kinematic than in the mechanical group (p < 0.05). Modified kinematically aligned cruciate-retaining total knee arthroplasty maintained more tibial internal rotation and lateral laxity during flexion than mechanically aligned total knee arthroplasty; thus, the former may result in better clinical outcomes.

scholarly journals Rotational Soft-Tissue Balance Is Highly Correlated with Rotational Kinematics in Total Knee Arthroplasty

2021 ◽  
Author(s):  
Tomofumi Kinoshita ◽  
Kazunori Hino ◽  
Tatsuhiko Kutsuna ◽  
Kunihiko Watamori ◽  
Hiromasa Miura
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Knee Kinematics ◽  
Soft Tissue Balance ◽  
Posterior Stabilized ◽  
Cruciate Retaining ◽  
Rotational Kinematics ◽  
Total Knee

AbstractRecovery of normal knee kinematics is critical for improving functional outcomes and patient satisfaction after total knee arthroplasty (TKA). The kinematics pattern after TKA varies from case to case, and it remains unclear how to reproduce normal knee kinematics. The present study aimed to evaluate rotational knee kinematics and soft-tissue balance using a navigation system and to assess the influence of intraoperative soft-tissue balance on the rotational knee kinematics. We evaluated 81 osteoarthritic knees treated with TKA using a posterior stabilized (50 knees) or cruciate retaining (31 knees) prosthesis. Rotational kinematics were assessed at 0, 30, 45, 60, and 90 degrees flexion angles by using a computer-assisted navigation system. Correlation between femorotibial rotational position and measured soft tissue balance was assessed by using Spearman's rank correlation coefficient. Rotational soft-tissue balance (the median angle of rotational stress) was significantly correlated with rotational kinematics (rotational axis of the femur relative to the tibia throughout the range of motion) at all measured angles after TKA. The correlation coefficients between the median angle of rotational stress and rotational kinematics were 0.97, 0.80, 0.74, 0.71, and 0.70 at 0, 30, 45, 60, and 90 degrees of flexion, respectively (p-values <0.0001 in all measured angles). The correlation coefficient increased as the knee approached full extension. Our findings suggest that soft-tissue balance is a key factor for rotational kinematics, following both cruciate-retaining and posterior-stabilized TKA.

Is Soft Tissue Laxity Associated with Tissue Metal Concentrations after Total Knee Arthroplasty?

2018 ◽  
Vol 28 (2) ◽  
pp. 79-85
Author(s):  
Meredith Perkins ◽  
Julie Lowell ◽  
Christina Arnholt ◽  
Daniel MacDonald ◽  
Anita L. Kerkhof ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Metal Concentrations ◽  
Soft Tissue Laxity ◽  
Total Knee

scholarly journals Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Takashi Kobayashi ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Varus Deformity ◽  
Varus Knee ◽  
Before And After ◽  
Knee Deformity ◽  
Varus Stress ◽  
Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

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