scholarly journals Diagnostic Algorithm in Patients with Flexion Instability after Cruciate-Retaining Total Knee Arthroplasty: A Case Report

2021 ◽  
Vol 11 (3) ◽  
pp. 687-693
Author(s):  
Lukas B. Moser ◽  
Ponnaian Prabhakar ◽  
Silvan Hess ◽  
Michael T. Hirschmann
Keyword(s):  
Total Knee Arthroplasty ◽  
Case Report ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Diagnostic Algorithm ◽  
Tracer Uptake ◽  
Cruciate Retaining ◽  
Total Knee ◽  
Dynamic Examination ◽  
Anterior Posterior

A posterior flexion instability due to insufficiency of the posterior cruciate ligament (PCL) in cruciate retaining (CR) total knee arthroplasty (TKA) is an important but underdiagnosed problem. We hereby suggest a diagnostic algorithm, as demonstrated by a case report of a male patient suffering from anterior knee pain and instability after CR TKA. Clinical examination was followed by standard anterior–posterior and lateral radiographs. Stress radiographs in 30° and 90° posterior drawer position enabled a dynamic examination of the instability. SPECT/CT was used to determine the TKA component position in all planes and investigate bone tracer uptake (BTU) patterns. At revision surgery, an absent PCL after CR TKA was noted and a semi-constrained TKA was implanted.

scholarly journals Obliteration of Intercondylar Notch Mimicking Flexion-Extension Gap Imbalance in a Cruciate Retaining Total Knee Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Harun Resit Gungor ◽  
Esat Kiter ◽  
Semih Akkaya ◽  
Nusret Ok ◽  
Cagdas Yorukoglu
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Period ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Early Postoperative Period ◽  
Intercondylar Notch ◽  
Cruciate Retaining ◽  
Flexion Extension ◽  
Total Knee

Following total knee arthroplasty (TKA), the most frequent cause of extension deficit and limitation of range of motion in early postoperative period is related to improper tensioning of soft tissues and failure to balance extension and flexion gaps. If a cruciate retaining (CR) prosthesis is the planned implant, then attention should be given to balancing the posterior cruciate ligament (PCL), and any factor that alters this balance may also cause deterioration of knee balance in postoperative period. Here, we report on an unusual case referred from another hospital because of continuous pain and restriction of knee motion in early postoperative period following CR-designed TKA that was initially thought to be due to flexion-extension imbalance. However, during the revision procedure, extruded cement to the intercondylar notch was found to be both mechanically blocking terminal extension and limiting flexion by possible mechanism of irritation of the synovial nerve endings around the stretched anterior fibers of PCL during flexion. This case was successfully treated by removal of extruded cement from intercondylar notch to decompress PCL, polyethylene exchange, and secondary patellar resurfacing.

scholarly journals A Surgical Reduction Technique for Posterior Cruciate Ligament Avulsion Fracture in Total Knee Arthroplasty: A Comparison Study

2020 ◽  
Author(s):  
Wei Lin ◽  
Jinghui Niu ◽  
Yike Dai ◽  
Huaxing Zhang ◽  
Jing Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Cruciate Retaining ◽  
Total Knee ◽  
The Mean ◽  
Pcl Avulsion

Abstract Background: Posterior cruciate ligament (PCL) avulsion fracture of tibia is an uncommon but serious complication during primary cruciate retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.Methods: From January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of tibia in primary cruciate-retaining TKA were included in study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA but no PCL avulsion fracture occurred. Range of motion of the knee and Knee Society Scores were assessed. The forgotten joint score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.Results: In our series, the incidence of PCL avulsion fracture was 4.6%. There was no significant differences with regard to preoperative or postoperative range of motion of the knee (p > 0.05). At the final follow-up of 4 years, the mean clinical scores of study and control groups were 92.4±2.7 and 93.6±1.9, respectively (p > 0.05). The mean functional scores were 85.1±1.8 and 87.1±1.2, respectively (p > 0.05). There was no significant statistical difference with regard to forgotten joint score (p > 0.05). Conclusions: The incidence of PCL avulsion fracture of tibia is relatively high. Older age and female gender were two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with high-strength line can achieve good stability and function of the knee.

scholarly journals A Surgical Reduction Technique for Posterior Cruciate Ligament Avulsion Fracture in Total Knee Arthroplasty: A Comparison Study

2020 ◽  
Author(s):  
Wei Lin ◽  
Jinghui Niu ◽  
Yike Dai ◽  
Huaxing Zhang ◽  
Jing Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Cruciate Retaining ◽  
Total Knee ◽  
Pcl Avulsion

Abstract Background: Posterior cruciate ligament (PCL) avulsion fracture of tibia is an uncommon but serious complication during primary cruciate retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.Methods: From January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of tibia in primary cruciate-retaining TKA were included in study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA but no PCL avulsion fracture occurred. Range of motion of the knee and Knee Society Scores were assessed. The forgotten joint score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.Results: In our series, the incidence of PCL avulsion fracture was 4.6%. There was no significant differences (p > 0.05) with regard to preoperative or postoperative range of motion of the knee, final 4 year mean clinical score in study and control groups 92.4 ± 2.7 and 93.6 ± 1.9, respectively, and mean functional scores of 85.1 ± 1.8 and 87.1 ± 1.2, respectively.Conclusions: The incidence of PCL avulsion fracture of tibia is relatively high. Older age and female gender were two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with high-strength line can achieve good stability and function of the knee.

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.

scholarly journals A Surgical Reduction Technique for Posterior Cruciate Ligament Avulsion Fracture in Total Knee Arthroplasty: A Comparison Study

2020 ◽  
Author(s):  
Wei Lin ◽  
Jinghui Niu ◽  
Yike Dai ◽  
Huaxing Zhang ◽  
Jing Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Cruciate Retaining ◽  
Total Knee ◽  
The Mean ◽  
Pcl Avulsion

Abstract Background: Posterior cruciate ligament (PCL) avulsion fracture of tibia is an uncommon but serious complication during primary cruciate retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.Methods: From January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of tibia in primary cruciate-retaining TKA were included in study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA but no PCL avulsion fracture occurred. Range of motion of the knee and Knee Society Scores were assessed. The forgotten joint score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.Results: In our series, the incidence of PCL avulsion fracture was 4.6%. There was no significant differences with regard to preoperative or postoperative range of motion of the knee (p > 0.05). At the final follow-up of 4 years, the mean clinical scores of study and control groups were 92.4±2.7 and 93.6±1.9, respectively (p > 0.05). The mean functional scores were 85.1±1.8 and 87.1±1.2, respectively (p > 0.05). There was no significant statistical difference with regard to forgotten joint score (p > 0.05). Conclusions: The incidence of PCL avulsion fracture of tibia is relatively high. Older age and female gender were two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with high-strength line can achieve good stability and function of the knee.

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