An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty

Title: An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty
Author(s): Athwal, KK
El Daou, H
Inderhaug, E
Manning, W
Davies, AJ
Deehan, DJ
Amis, AA
Item Type: Journal Article
Abstract: Purpose The aim of this study was to quantify the medial soft tissue contributions to stability following constrained condylar (CC) total knee arthroplasty (TKA) and determine whether a medial reconstruction could restore stability to a soft tissue-deficient, CC-TKA knee. Methods Eight cadaveric knees were mounted in a robotic system and tested at 0°, 30°, 60°, and 90° of flexion with ±50 N anterior–posterior force, ±8 Nm varus–valgus, and ±5 Nm internal–external torque. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were transected and their relative contributions to stabilising the applied loads were quantified. After complete medial soft tissue transection, a reconstruction using a semitendinosus tendon graft was performed, and the effect on kinematic behaviour under equivocal conditions was measured. Results In the CC-TKA knee, the sMCL was the major medial restraint in anterior drawer, internal–external, and valgus rotation. No significant differences were found between the rotational laxities of the reconstructed knee to the pre-deficient state for the arc of motion examined. The relative contribution of the reconstruction was higher in valgus rotation at 60° than the sMCL; otherwise, the contribution of the reconstruction was similar to that of the sMCL. Conclusion There is contention whether a CC-TKA can function with medial deficiency or more constraint is required. This work has shown that a CC-TKA may not provide enough stability with an absent sMCL. However, in such cases, combining the CC-TKA with a medial soft tissue reconstruction may be considered as an alternative to a hinged implant.
Publication Date: 29-Mar-2016
Date of Acceptance: 14-Mar-2016
URI: http://hdl.handle.net/10044/1/57024
DOI: https://dx.doi.org/10.1007/s00167-016-4087-0
ISSN: 0942-2056
Publisher: Springer Verlag
Start Page: 2646
End Page: 2655
Journal / Book Title: Knee Surgery, Sports Traumatology, Arthroscopy
Volume: 25
Issue: 8
Copyright Statement: © The Author(s) 2017. This article is an open access publication
Keywords: Science & Technology
Life Sciences & Biomedicine
Orthopedics
Sport Sciences
Surgery
Knee replacement
Constrained implant
Reconstruction
Total knee arthroplasty
Medial collateral ligament
Soft tissue deficiency
Stability
Laxity
ANTERIOR CRUCIATE LIGAMENT
COLLATERAL LIGAMENT
VALGUS DEFORMITY
INSTABILITY
LAXITY
BIOMECHANICS
PROSTHESIS
ENVELOPE
REPAIR
TKA
Constrained implant
Knee replacement
Laxity
Medial collateral ligament
Reconstruction
Soft tissue deficiency
Stability
Total knee arthroplasty
Aged
Arthroplasty, Replacement, Knee
Biomechanical Phenomena
Cadaver
Connective Tissue
Female
Humans
Joint Instability
Knee Joint
Male
Middle Aged
Range of Motion, Articular
Rotation
Tendons
Torque
Science & Technology
Life Sciences & Biomedicine
Orthopedics
Sport Sciences
Surgery
Knee replacement
Constrained implant
Reconstruction
Total knee arthroplasty
Medial collateral ligament
Soft tissue deficiency
Stability
Laxity
ANTERIOR CRUCIATE LIGAMENT
COLLATERAL LIGAMENT
VALGUS DEFORMITY
INSTABILITY
LAXITY
BIOMECHANICS
PROSTHESIS
ENVELOPE
REPAIR
TKA
1103 Clinical Sciences
1106 Human Movement And Sports Science
Orthopedics
Publication Status: Published
Appears in Collections:Faculty of Engineering
Mechanical Engineering



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