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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2016

01-10-2016 | Knee

Balancing UKA: overstuffing leads to high medial collateral ligament strains

Authors: Thomas J. Heyse, Bilal F. El-Zayat, Ronny De Corte, Lennart Scheys, Yan Chevalier, Susanne Fuchs-Winkelmann, Luc Labey

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2016

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Abstract

Purpose

Balancing unicondylar knee arthroplasty (UKA) is challenging. If not performed properly, it may lead to implant loosening or progression of osteoarthritis in the preserved compartment. This study was aimed to document the biomechanical effects of improper balancing. We hypothesised that overstuffing would lead to more valgus, higher strain in the medial collateral ligament (sMCL), and higher lateral contact force.

Methods

Six fresh-frozen cadaver specimens were mounted in a kinematic rig. Three motion patterns were applied with the native knee and following medial UKA (passive motion, open-chain extension, and squatting), while infrared cameras recorded the trajectories of markers attached to femur and tibia. Three inlay thicknesses were tested (8, 9, 10 mm).

Results

Overstuffed knees were in more valgus and showed less tibial rotation and higher strains in the sMCL (p < 0.05). Lateral contact forces were higher in some specimens and lower in others. Stiffening of the medial compartment by UKA, even well balanced, already leads to a knee more in valgus with a more stressed sMCL. Overstuffing increases these effects. Knees with a tight sMCL may even see lower lateral contact force. Biomechanics were closest to the native knee with understuffing.

Conclusion

The first two hypotheses were confirmed, but not the latter. This underlines the importance of optimal balancing. Overstuffing should certainly be avoided. Although kinematics is only slightly affected, contact forces and ligament strains are considerably changed and this might be of more clinical importance. It is advisable to use thinner inlays, if stability is not compromised.
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Metadata
Title
Balancing UKA: overstuffing leads to high medial collateral ligament strains
Authors
Thomas J. Heyse
Bilal F. El-Zayat
Ronny De Corte
Lennart Scheys
Yan Chevalier
Susanne Fuchs-Winkelmann
Luc Labey
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3848-5

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