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Joint distraction force changes the three-dimensional articulation of the femur and tibia in total knee arthroplasty: a cadaveric study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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.

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Abbreviations

CR:

Cruciate retaining

ICC:

Intraclass correlation

LCL:

Lateral collateral ligament

MCL:

Medial collateral ligament

PCL:

Posterior cruciate ligament

TKA:

Total knee arthroplasty

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Acknowledgements

The authors wish to acknowledge Dr. Hiroshi Mikami, Vice-President of Yoshinogawa Medical Center, for his help in interpreting the significance of the results of this study. This research was not funded by any specific grants from public, commercial, or not-for-profit agencies.

Funding

No funding has been received for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan

    Keizo Wada, Daisuke Hamada, Tomoya Takasago, Tomohiro Goto, Ichiro Tonogai & Koichi Sairyo

  2. Department of Orthopaedic Surgery, Yoshinogawa Medical Center, 132-113 Kamojima Chiejima, Yoshinogawa, Tokushima, 776-0014, Japan

    Akihiro Nitta

  3. Department of Anatomy, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan

    Yoshihiro Tsuruo

Authors
  1. Keizo Wada
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  2. Daisuke Hamada
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  3. Tomoya Takasago
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  4. Akihiro Nitta
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  5. Tomohiro Goto
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  6. Ichiro Tonogai
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  7. Yoshihiro Tsuruo
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  8. Koichi Sairyo
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Contributions

KW carried out the measurements, performed the statistical analysis, and drafted the manuscript. DH participated in the design of the study and performed the TKA surgery as the surgeon. TT and AN performed the TKA surgery and kinematic measurements as assistants. IT and YT participated in coordination of this study. TG and KS helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daisuke Hamada.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All performed procedures were approved by the institutional review board of Tokushima University Hospital (the ID number of approval was 2068) and done in accordance with the 1964 Declaration of Helsinki and its later amendments for comparable ethical standards.

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Wada, K., Hamada, D., Takasago, T. et al. Joint distraction force changes the three-dimensional articulation of the femur and tibia in total knee arthroplasty: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 28, 1488–1496 (2020). https://doi.org/10.1007/s00167-019-05546-8

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  • DOI: https://doi.org/10.1007/s00167-019-05546-8

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