The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty - a finite element analysis

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Title: The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty - a finite element analysis
Authors: Stoddart, J
Garner, A
Tuncer, M
Cobb, J
Van Arkel, RJ
Item Type: Journal Article
Abstract: Aims: To determine the risk of tibial eminence avulsion intraoperatively for bi-unicondylar knee arthroplasty (Bi-UKA) with consideration to the effect of implant positioning, overstuffing, and sex, compared to the risk for isolated medial UKA (UKA-M) and bi-cruciate retaining total knee arthroplasty (BCR-TKA). Methods: Two experimentally validated finite element models of tibia were implanted. Intraoperative loads were applied through the condyles, ACL, MCL and LCL, and the risk of fracture (ROF) was evaluated in the spine as the ratio of the 95th percentile maximum principal elastic strains over the tensile yield strain of proximal tibial bone. Results: Peak tensile strains occurred on the anterior portion of the medial sagittal cut in all simulations. Lateral translation of the medial implant in Bi-UKA had the largest increase in ROF of any of the implant positions (43%). Overstuffing the joint by 2mm had a much larger effect, resulting in a 6-fold increase in ROF. Bi-UKA had ~10% increased ROF compared to UKA-M for both the male and female models, though the smaller, less dense female model had a 1.5 times greater ROF compared to the male model. Removal of anterior bone akin to BCR-TKA doubled ROF compared to Bi-UKA. Conclusion: Tibial eminence avulsion fracture has a similar risk associated with Bi-UKA to UKA-M. The risk is higher for a smaller and less dense tibiae. To minimise risk, it is most important to avoid overstuffing the joint, followed by correctly positioning the medial implant, taking care not to narrow the bony island anteriorly.
Date of Acceptance: 24-May-2022
ISSN: 2046-3758
Publisher: The British Editorial Society of Bone & Joint Surgery
Journal / Book Title: Bone & Joint Research
Copyright Statement: This paper is embargoed until publication. Once published it will be available fully open access.
Keywords: 1103 Clinical Sciences
1106 Human Movement and Sports Sciences
Publication Status: Accepted
Embargo Date: publication subject to indefinite embargo
Appears in Collections:Mechanical Engineering