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Archives of Orthopaedic and Trauma Surgery

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01-06-2022 | Knee Arthroplasty

Functional stability: an experimental knee joint cadaveric study on collateral ligaments tension

Authors: Bernardo Innocenti, Edoardo Bori, Thomas Paszicsnyek

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2022

Abstract

Introduction

Applying proper tension to collateral ligaments during total knee arthroplasty surgery is fundamental to achieve optimal implant performance: low tension could lead to joint instability, over-tensioning leads to pain and stiffness. A “functional stability” must be defined and achieved during surgery to guarantee optimal results. In this study, an experimental cadaveric activity was performed to measure the minimum tension required to achieve knee functional stability.

Materials and methods

Ten knee specimens were investigated; femur and tibia were fixed in specifically designed fixtures and clamped to a loading frame; constant displacement rate was applied and resulting tension force was measured. Joint stability was determined as the slope change in the force/displacement curve, representing the activation of both collateral ligaments elastic region; the tension required to reach joint functional stability is then the span between ligaments toe region and this point. Intact, ACL (anterior cruciate ligament)-resected and ACL & PCL (posterior cruciate ligament)-resected knees were tested. The test was performed at different flexion angles; each configuration was analyzed three times.

Results

Results demonstrated an overall tension of 40–50 N to be enough to reach stability in intact knees. Similar values are sufficient in ACL-resected knees, while significantly higher tension is required (up to 60 N) after cruciate ligaments resection. The tension required was slightly higher at 60° of flexion.

Conclusion

Results agree with other experimental studies, showing that the tensions required to stabilize a knee joint are lower than the ones applied nowadays via surgical tensioners.

To reach functional stability, surgeons should consider such results intraoperatively and avoid ligament laxity or over-tension.

Gustke K, Golladay G, Roche M et al (2014) Increased satisfaction after total knee replacement using sensor-guided technology. Bone Joint J 96-B(10):1333PubMedCrossRef

Sharkey P, Hozack W, Rothman R et al (2002) Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13 (Insall award paper)CrossRef

Sharkey P, Lichstein P, Shen C et al (2014) Why are total knee arthroplasties failing today—has anything changed after 10 years? J Arthroplasty 29(9):1774–1778PubMedCrossRef

Delport H, Labey L, Corte RD et al (2013) Collateral ligament strains during knee joint laxity evaluation before and after TKA. Clin Biomech 28(7):777–782CrossRef

Dhurve K, Scholes C, El-Tawil S et al (2017) Multifactorial analysis of dissatisfaction after primary total knee replacement. Knee 24(4):856–862PubMedCrossRef

Freisinger G, Hutter E, Lewis J et al (2017) Relationships between varus–valgus laxity of the severely osteoarthritic knee and gait, instability, clinical performance, and function. J Orthop Res 35(8):1644–1652PubMedCrossRef

Wright T (2017) Joint stability in total knee arthroplasty: what is the target for a stable knee? J Am Acad Orthop Surg 25:S25–S28PubMedCrossRef

Del Gaizo D, Della VC (2011) Instability in primary total knee arthroplasty. Orthopedics 34:e519–e521PubMed

Parratte S, Pagnano M (2008) Instability after total knee arthroplasty. J Bone Joint Surg Am 90:184–194PubMed

10.

Burstein T, Wright A. (1994). Fundamentals of orthopaedic biomechanics. Baltimore MD, Wolters Kluwer/Lippincott Williams & Wilkins. p. 63

11.

Belvedere C, Leardini A, Catani F et al (2017) In vivo kinematics of knee replacement during daily living activities: condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses. J Orthop Res 35(7):1396–1403PubMedCrossRef

12.

Incavo S, Mullins E, Coughlin K et al (2004) Tibio-femoral kinematic analysis of kneeling after total knee arthroplasty. J Arthroplasty 19:906–910PubMedCrossRef

13.

Catani F, Innocenti B, Belvedere C et al (2010) The Mark Coventry Award: articular contact estimation in TKA using in vivo kinematics and finite element analysis. Clin Orthop Relat Res 468:19–28PubMedCrossRef

14.

Butler D (1989) Anterior cruciate ligament: its normal response and replacement. J Orthop Res 7(6):910–921PubMedCrossRef

15.

Zitnay J, Weiss J (2018) Load transfer, damage, and failure in ligaments and tendons. J Orthop Res 36:3093–3104PubMedPubMedCentralCrossRef

16.

Li X, Liu B, Deng B, Zhang S (1996) Normal six-degree-of-freedom motions of knee joint during level walking. J Biomech Eng 118(2):258–261PubMedCrossRef

17.

Vince K, Abdeen A, Sugimori T (2006) The unstable total knee arthroplasty: causes and cures. J Arthroplasty 21(4 Suppl 1):44–49PubMedCrossRef

18.

Manrique J, Gomez M, Parvizi J (2015) Stiffness after total knee arthroplasty. J Knee Surg 28(2):119–126PubMedCrossRef

19.

Victor J (2017) Optimising position and stability in total knee arthroplasty. EFORT Open Rev 2(5):215–220PubMedPubMedCentralCrossRef

20.

Sambatakakis A, Attfield S, Newton G (1993) Quantification of soft-tissue imbalance in condylar knee arthroplasty. J Biomed Eng 15(4):339–343PubMedCrossRef

21.

Insall J, Easley M (2001) Surgical techniques and instrumentation in total knee arthroplasty. In: Insall JN, Scott WN (eds) Surgery of the Knee. Vol 3. New York, p. 1553–1620.

22.

Whiteside L (2003) Tensioners: dangerous toys in the operating room. Whiteside Orthop 26(9):963–965CrossRef

23.

Booth R (2003) Tensioners: essential for accurate performance of TKA. Orthopedics 26(9):962–964PubMedCrossRef

24.

Basselot F, Gicquel T, Common H et al (2016) Are ligament-tensioning devices interchangeable? A study of femoral rotation. Orthop Traumatol Surg Res 102(4 Suppl):S213–S219PubMedCrossRef

25.

Elmallah R, Mistry J, Cherian J et al (2016) Can we really “feel” a balanced total knee arthroplasty? J Arthroplasty 31(9):102–105PubMedCrossRef

26.

Wilson W, Deakin A, Payne A et al (2012) Comparative analysis of the structural properties of the collateral ligaments of the human knee. J Orthop Sports Phys 42(4):345–351CrossRef

27.

Van Dommelen JA, Ivarsson BJ, Jolandan MM et al (2005) Characterization of the rate-dependent mechanical properties and failure of human knee ligaments. SAE Trans. 80–90

28.

Völlner F, Fischer J, Weber M et al (2019) Weakening of the knee ligament complex due to sequential medial release in total knee arthroplasty. Arch Orthop Trauma Surg 139(7):999–1006PubMedCrossRef

29.

Bland J, Altman D (1995) Multiple significance tests: the Bonferroni method. BMJ 310:170PubMedPubMedCentralCrossRef

30.

Manning W, Blain A, Longstaff L, Deehan DJ (2018) A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state. Knee Surg Sports Traumatol Arthrosc 27(7):2238–2250PubMedPubMedCentralCrossRef

31.

Nowakowski A, Majewski M, Müller-Gerbl M, Valderrabano V (2012) Measurement of knee joint gaps without bone resection: “physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes. J Ortoph Res 30:522–527CrossRef

32.

Ramappa M (2015) Midflexion instability in primary total knee replacement: a review. SICOT J 1:24PubMedPubMedCentralCrossRef

33.

Kawamura H, Bourne R (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 6(3):248–252PubMedCrossRef

34.

Shelburne K, Torry M, Pandy M (2005) Muscle, ligament, and joint-contact forces at the knee during walking. Med Sci Sports Exerc 37:1948–1956PubMedCrossRef

35.

Noyes F (2009) The function of the human anterior cruciate ligament and analysis of single- and double-bundle graft reconstructions. Sports Health 1(1):66–75PubMedPubMedCentralCrossRef

36.

Yagi M, Wong E, Kanamori A et al (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30(5):660–666PubMedCrossRef

37.

Amis A, Bull A, Gupte C et al (2003) Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sport Tr A 11(5):271–281CrossRef

38.

Veltri D, Deng X, Torzilli P et al (1995) The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study. Am J Sports Med 23:436–443PubMedCrossRef

39.

Toutoungi D, Lu T, Leardini A et al (2000) Cruciate ligament forces in the human knee during rehabilitation exercises. Clin Biomech 15:176–187CrossRef

40.

Nasab Hosseini S, Smith C, Schütz P et al (2019) Elongation patterns of the collateral ligaments after total knee arthroplasty are dominated by the knee flexion angle. Front Bioeng Biotechnol 7:323CrossRef

41.

Robinson J, Bull A, Amis A (2005) Structural properties of the medial collateral ligament complex of the human knee. J Biomech 38:1067–1074PubMedCrossRef

42.

Sugita T, Amis A (2001) Anatomic and biomechanical study of the lateral collateral and popliteofibular ligaments. Am J Sports Med 29:466–472PubMedCrossRef

43.

Wijdicks C, Ewart D, Nuckley D et al (2010) Structural properties of the primary medial knee ligaments. Am J Sport Med 38(8):1638–1646CrossRef

44.

Victor J, Labey L, Wong P, Innocenti B, Bellemans J (2010) The influence of muscle load on tibiofemoral knee kinematics. J Orthop Res 28(4):419–428PubMed

45.

Innocenti B, Larrieu J, Lambert P, Pianigiani S (2017) Automatic characterization of soft tissues material properties during mechanical tests. Muscles Ligaments Tendons J 7:529–537PubMedCrossRef

46.

Delport H, Labey L, Innocenti B et al (2015) Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments. Knee Surg Sport Tr A 23(8):2159–2169CrossRef

47.

Kowalczewski J, Labey L, Chevalier Y et al (2015) Does joint line elevation after revision knee arthroplasty affect tibio-femoral kinematics, contact pressure or collateral ligament lengths? An in vitro analysis. Arch Med Sci 2:311–318CrossRef

Title: Functional stability: an experimental knee joint cadaveric study on collateral ligaments tension
Authors: Bernardo Innocenti
Edoardo Bori
Thomas Paszicsnyek
Publication date: 01-06-2022
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03966-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Functional stability: an experimental knee joint cadaveric study on collateral ligaments tension

Abstract

Introduction

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

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