PURPOSE The purpose of this study was to test the hypotheses that the joint distraction force changes the three-dimensional articulation between the femur and the tibia and that the presence of posterior cruciate ligament (PCL) affects the three-dimensional articulation during joint gap evaluation in total knee arthroplasty (TKA). METHODS Cruciate-retaining TKA procedures were performed on 6 cadaveric knees using a navigation system. The joint center gap and varus ligament balance were measured using Offset Repo-Tensor® with the knee at 90° of flexion before and after PCL resection for joint distraction forces of 89, 178, and 266 N. The three-dimensional location of the tibia relative to the femur and the axial rotational angle of the tibia were also assessed. RESULTS Regardless of PCL resection, the joint center gap became larger (p = 0.002, p = 0.020) and varus ligament balance became more varus (p = 0.002, p = 0.002) with increasing joint distraction force, whereas the tibia was more internally rotated (p = 0.015, p = 0.009) and more anteriorly located (p = 0.004, p = 0.009). The tibia was more internally rotated (p = 0.015) and more posteriorly located (p = 0.026) after PCL resection than before resection. CONCLUSIONS Joint distraction force changed three-dimensional articulation regardless of PCL preservation. PCL function was revealed as a factor restraining both tibial posterior translation and internal rotation. Surgeons should recognize that joint gap evaluation using a tensor device is subject to three-dimensional changes depending on the magnitude of the joint distraction force.

中文翻译：

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联合牵引力改变了全膝关节置换术中股骨和胫骨的三维关节：尸体研究。

目的本研究的目的是检验以下假设：关节牵张力改变了股骨和胫骨之间的三维关节，并且后​​交叉韧带（PCL）的存在在评估关节间隙时影响了三维关节。全膝关节置换术（TKA）。方法采用导航系统在6个尸体膝盖上进行保留交叉TKA的手术。在进行PCL切除之前和之后，在89、178和266 N的联合牵引力下，使用OffsetRepo-Tensor®膝关节屈曲90°，测量关节中央间隙和内翻韧带平衡。胫骨的三维位置还评估了相对于股骨的相对位置以及胫骨的轴向旋转角度。结果无论PCL切除如何，关节中心间隙均变大（p = 0.002，p = 0.020），并且随着关节牵张力的增加，内翻韧带平衡变得更内翻（p = 0.002，p = 0.002），而胫骨更向内旋转（p = 0.015，p = 0.009）并且位于更前方（p = 0.004） ，p = 0.009）。与切除前相比，PCL切除后胫骨更向内旋转（p = 0.015），位于更向后（p = 0.026）。结论关节撑开力改变了三维关节，而与PCL的保存无关。PCL功能被揭示为限制胫骨后翻译和内旋的因素。外科医生应认识到，根据张紧力的大小，使用张量器进行关节间隙评估会发生三维变化。002）时，关节牵引力增加，而胫骨更向内旋转（p = 0.015，p = 0.009），更靠前（p = 0.004，p = 0.009）。与切除前相比，PCL切除后胫骨更向内旋转（p = 0.015），位于更向后（p = 0.026）。结论关节撑开力改变了三维关节，而与PCL的保存无关。PCL功能被揭示为限制胫骨后翻译和内旋的因素。外科医生应认识到，根据张紧力的大小，使用张量器进行关节间隙评估会发生三维变化。002）时，关节牵引力增加，而胫骨更向内旋转（p = 0.015，p = 0.009），更靠前（p = 0.004，p = 0.009）。与切除前相比，PCL切除后胫骨更向内旋转（p = 0.015），位于更向后（p = 0.026）。结论关节撑开力改变了三维关节，而与PCL的保存无关。PCL功能被揭示为限制胫骨后翻译和内旋的因素。外科医生应认识到，根据张紧力的大小，使用张量器进行关节间隙评估会发生三维变化。与切除前相比，PCL切除后胫骨更向内旋转（p = 0.015），位于更向后（p = 0.026）。结论关节撑开力改变了三维关节，而与PCL的保存无关。PCL功能被揭示为限制胫骨后翻译和内旋的因素。外科医生应认识到，根据张紧力的大小，使用张量器进行关节间隙评估会发生三维变化。与切除前相比，PCL切除后胫骨更向内旋转（p = 0.015），位于更向后（p = 0.026）。结论关节撑开力改变了三维关节，而与PCL的保存无关。PCL功能被揭示为限制胫骨后翻译和内旋的因素。外科医生应认识到，根据张紧力的大小，使用张量器进行关节间隙评估会发生三维变化。