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

Wada, Keizo; Hamada, Daisuke; Takasago, Tomoya; Nitta, Akihiro; Goto, Tomohiro; Tonogai, Ichiro; Tsuruo, Yoshihiro; Sairyo, Koichi

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.

TOTAL knee replacement; POSTERIOR cruciate ligament; MOLECULAR rotation; SURGEONS; SURGICAL excision; FEMUR surgery; KNEE surgery; KNEE physiology; FEMUR physiology; TIBIA physiology; TIBIA surgery; COMPUTER-assisted surgery; RANGE of motion of joints; STEREOTAXIC techniques; ARTIFICIAL joints; ROTATIONAL motion; DEAD; KNEE

Knee Surgery, Sports Traumatology, Arthroscopy, 2020, Vol 28, Issue 5, p1488

0942-2056

Academic Journal

10.1007/s00167-019-05546-8