Lateral soft-tissue structures contribute to cruciate-retaining total knee arthroplasty stability.
File(s)
Author(s)
Type
Journal Article
Abstract
Little information is available to surgeons regarding how the lateral structures prevent instability in the replaced knee. The aim of this study was to quantify the lateral soft‐tissue contributions to stability following cruciate‐retaining total knee arthroplasty (CR TKA). Nine cadaveric knees were tested in a robotic system at full extension, 30°, 60°, and 90° flexion angles. In both native and CR implanted states, ±90 N anterior–posterior force, ±8 Nm varus–valgus, and ±5 Nm internal–external torque were applied. The anterolateral structures (ALS, including the iliotibial band), the lateral collateral ligament (LCL), the popliteus tendon complex (Pop T), and the posterior cruciate ligament (PCL) were transected and their relative contributions to stabilizing the applied loads were quantified. The LCL was found to be the primary restraint to varus laxity (an average 56% across all flexion angles), and was significant in internal–external rotational stability (28% and 26%, respectively) and anterior drawer (16%). The ALS restrained 25% of internal rotation, while the PCL was significant in posterior drawer only at 60° and 90° flexion. The Pop T was not found to be significant in any tests. Therefore, the LCL was confirmed as the major lateral structure in CR TKA stability throughout the arc of flexion and deficiency could present a complex rotational laxity that cannot be overcome by the other passive lateral structures or the PCL. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1902–1909, 2017.
Date Issued
2016-11-09
Date Acceptance
2016-11-03
Citation
Journal of Orthopaedic Science, 2016, 35, pp.1902-1909
ISSN
0949-2658
Publisher
Springer Verlag (Germany)
Start Page
1902
End Page
1909
Journal / Book Title
Journal of Orthopaedic Science
Volume
35
Copyright Statement
© 2016 Springer-Verlag. The final publication is available at Springer via https://dx.doi.org/10.1002/jor.23477
Sponsor
Wellcome Trust
Grant Number
WT 098269/Z/12/Z
Subjects
Science & Technology
Life Sciences & Biomedicine
Orthopedics
total knee arthroplasty
stability
lateral collateral ligament
biomechanics
LIGAMENT-DEFICIENT KNEE
MEDIAL COLLATERAL LIGAMENT
IN-SITU FORCES
POPLITEUS TENDON
POSTEROLATERAL STRUCTURES
ANTEROLATERAL LIGAMENT
POPLITEOFIBULAR LIGAMENT
ILIOTIBIAL BAND
FAILING TODAY
LAXITY
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee
Female
Humans
Joint Instability
Knee Joint
Male
Middle Aged
Rotation
0903 Biomedical Engineering
1103 Clinical Sciences
1106 Human Movement And Sports Science
Publication Status
Published