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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2017

Open Access 01-06-2017 | Knee

Popliteus impingement after TKA may occur with well-sized prostheses

Authors: Michel P. Bonnin, Arnoud de Kok, Matthias Verstraete, Tom Van Hoof, Catherine Van der Straten, Mo Saffarini, Jan Victor

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2017

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Abstract

Purpose

To determine the mechanisms and extents of popliteus impingements before and after TKA and to investigate the influence of implant sizing. The hypotheses were that (1) popliteus impingements after TKA may occur at both the tibia and the femur, and (2) even with an apparently well-sized prosthesis, popliteal tracking during knee flexion is modified compared to the preoperative situation.

Methods

The location of the popliteus in three cadaver knees was measured using computed tomography, before and after implantation of plastic TKA replicas, by injecting the tendon with radiopaque liquid. The pre- and post-operative positions of the popliteus were compared from full extension to deep flexion using normosized, oversized, and undersized implants (one size increments).

Results

At the tibia, TKA caused the popliteus to translate posteriorly, mostly in full extension: 4.1 ± 2 mm for normosized implants, and 15.8 ± 3 mm with oversized implants, but no translations were observed when using undersized implants. At the femur, TKA caused the popliteus to translate laterally at deeper flexion angles, peaking between 80° and 120°: 2 ± 0.4 mm for normosized implants and 2.6 ± 0.5 mm with oversized implants. Three-dimensional analysis revealed prosthetic overhang at the posterosuperior corner of normosized and oversized femoral components (respectively, up to 2.9 mm and 6.6 mm).

Conclusions

A well-sized tibial component modifies popliteal tracking, while an undersized tibial component maintains more physiologic patterns. Oversizing shifts the popliteus considerably throughout the full arc of motion. This study suggests that both femoro- and tibio-popliteus impingements could play a role in residual pain and stiffness after TKA.
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Metadata
Title
Popliteus impingement after TKA may occur with well-sized prostheses
Authors
Michel P. Bonnin
Arnoud de Kok
Matthias Verstraete
Tom Van Hoof
Catherine Van der Straten
Mo Saffarini
Jan Victor
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4330-8

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