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Ong MTY, LaCour MT, Yung PSH, Dessinger GM, Komistek RD. In Vivo Kinematics for Various Robotically Performed Total Knee Arthroplasty Implant Designs. J Orthop Res 2025. [PMID: 40325355 DOI: 10.1002/jor.26091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 03/28/2025] [Accepted: 04/13/2025] [Indexed: 05/07/2025]
Abstract
Although it is well-documented that robotic-assisted total knee arthroplasty (TKA) can improve surgical precision, evaluations of the postoperative kinematics of patients implanted using robotics remain less common. The objective of this study is to analyze the weight-bearing kinematics for multiple TKAs implanted using two different surgical robots. In vivo knee kinematics were assessed using fluoroscopy for 28 subjects implanted with a Bi-Cruciate Stabilized (BCS) TKA, 23 with a Bi-Cruciate Retaining (BCR) TKA, 13 with a posterior stabilized (PS) TKA, and 22 with a cruciate retaining (CR) TKA. All subjects were implanted by the same surgeon using the respective company's surgical robot. All subjects performed a weight-bearing deep knee bend. Parameters of interest include the femoral condylar anterior/posterior motion, femorotibial axial rotation, and weight-bearing range-of-motion. The BCS TKA experienced the most posterior rollback, 13.4 ± 4.4 mm for the lateral condyle and 5.8 ± 2.5 mm for the medial condyle. These subjects also experienced the most femorotibial axial rotation, +9.3 ± 5.3°. Conversely, CR subjects experienced the least overall rollback and most anterior sliding, 0.4 ± 3.8 mm of lateral rollback and 1.9 ± 4.1 mm of medial anterior sliding. Implant design appears to play a significant role in postoperative kinematics. Improved stability is evident in TKAs that account for the ACL. However, no system behaved significantly better nor worse than previously published literature evaluating standard instrumentation. Level of Evidence: Level 3, retrospective cohort study.
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Affiliation(s)
- Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Michael T LaCour
- Mechanical, Aerospace, and Biomedical Engineering, Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Garett M Dessinger
- Mechanical, Aerospace, and Biomedical Engineering, Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Richard D Komistek
- Mechanical, Aerospace, and Biomedical Engineering, Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
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Zheng N, Xia C, Dai H, Zou D, Long Y, Hou Z, Wang Q, Tsai TY. High posterior tibial slope increases anterior cruciate ligament elongation in unicompartmental knee arthroplasty during early-flexion of lunge. BMC Musculoskelet Disord 2025; 26:382. [PMID: 40259297 PMCID: PMC12010665 DOI: 10.1186/s12891-025-08335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 01/20/2025] [Indexed: 04/23/2025] Open
Abstract
BACKGROUND In-silico and in-vitro studies have revealed an appropriate posterior tibial slope (PTS) is critical for normal anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tension and knee biomechanical behavior of unicompartmental knee arthroplasty (UKA). However, the effects of PTS on in-vivo elongation of ACL and PCL in UKA remains unknown. The study aimed to quantify in-vivo ACL and PCL elongations during lunge and analyze their relations with PTS. METHODS Thirteen fixed-bearing (FB) and 11 mobile-bearing (MB) UKA patients were recruited. The postoperative medial PTS was defined as the angle between the tibial transverse plane (perpendicular to mechanical axis) and cut plane. Accurate knee spatial postures of UKA and contralateral native knees during single-leg lunge were measured by the dual fluoroscopic imaging system. The ACL (AM, PL bundles) and PCL (AL, PM bundles) footprints were determined based on anatomical features on femoral and tibial 3D surface model reconstructed from CT. A validated 3D wrapping method was used to measure ligament bundle length. The paired Wilcoxon signed-rank test was used to analyze the ligament elongation difference between bilateral knees. The Spearman correlation between PTS and average ligament elongation difference (ACL during 0-30° early-flexion, PCL during 60-100° deep-flexion) was calculated. RESULTS The elongation of FB UKA PCL double-bundle was larger than contralateral sides in most flexion range of lunge (Max-Difference: AL 7.6 ± 8.7%, PM 8.2 ± 5.1%, p < 0.05). In contrast, ACL double-bundle elongations of MB UKA in mid-flexion were larger than contralateral sides (Max-Difference: AM 8.0 ± 8.1%, PL 7.6 ± 9.8%, p < 0.05). The increased PTS was significantly relevant to the increased ACL double-bundle elongation difference of bilateral knees for both FB and MB UKA patients (R > 0.6, p < 0.05). CONCLUSION There was abnormal in-vivo elongation of PCL in FB UKA and ACL in MB UKA during lunge and cause over-constraints to the contralateral knee. There was a positive correlation between PTS and ACL elongation difference for both FB and MB UKA, indicating excessive PTS should be avoided to preserve native ACL function in further UKA implantation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
| | - Chunjie Xia
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
| | - Huiyong Dai
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
| | - Yubin Long
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qi Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China.
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Inui H, Yamagami R, Kono K, Kawaguchi K, Saita K, Taketomi S, Tanaka S. Temporal changes of tibial eminence after bi-cruciate retaining total knee arthroplasty. BMC Musculoskelet Disord 2025; 26:52. [PMID: 39815252 PMCID: PMC11734485 DOI: 10.1186/s12891-025-08305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/08/2025] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Bicruciate-retaining (BCR) prostheses have been introduced to recreate normal knee movements by preserving both the anterior and posterior cruciate ligaments. One of the surgical procedures essential to the success of BCR total knee arthroplasty (TKA) is preservation of the tibial eminence. However, in our clinical experience, we found that a well-preserved tibial eminence changed its shape chronologically after the operation. This study aimed to investigate the frequency of chronological changes in the tibial eminence after BCR TKA and its influence on the outcomes. METHODS This study included 59 patients with BCR TKA. Radiographs taken at 2 weeks postoperatively and at an average follow-up of 3.2 years were used to assess the tibial eminence. The patients' demographics, joint component gaps, and clinical scores were compared between the groups with chronological change (P group) and without change (N group). RESULTS The chronological change of the tibial eminence was found in 22 cases (37%). The joint component gaps at extension were larger in P group than in N group. The scores in the symptoms and ADL subscales of the KOOS were significantly higher at 1 year postoperatively in N group than in P group. There were no significant differences between the two groups at the final follow-up. CONCLUSIONS Chronological changes in the well-preserved tibial eminence were found in approximately one third of the BCR TKA patients. The mean scores at 1-year postoperatively were lower in the patients with chronological changes in the tibial eminence than in the patients without changes.
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MESH Headings
- Humans
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/instrumentation
- Arthroplasty, Replacement, Knee/trends
- Arthroplasty, Replacement, Knee/adverse effects
- Male
- Female
- Aged
- Middle Aged
- Tibia/diagnostic imaging
- Tibia/surgery
- Follow-Up Studies
- Knee Joint/surgery
- Knee Joint/diagnostic imaging
- Knee Prosthesis
- Time Factors
- Radiography
- Retrospective Studies
- Treatment Outcome
- Osteoarthritis, Knee/surgery
- Osteoarthritis, Knee/diagnostic imaging
- Posterior Cruciate Ligament/surgery
- Posterior Cruciate Ligament/diagnostic imaging
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Affiliation(s)
- Hiroshi Inui
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan.
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo City, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo City, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo City, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo City, Japan
| | - Kazuo Saita
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo City, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo City, Japan
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Xia C, Zheng N, Gu T, Dai H, Zou D, Wang Q, Tsai TY. The in-vivo medial and lateral collateral elongation correlated with knee functional score and joint space following unicompartmental knee arthroplasty. Orthop Traumatol Surg Res 2024:104052. [PMID: 39547306 DOI: 10.1016/j.otsr.2024.104052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 09/25/2024] [Accepted: 11/12/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are paramount for joint stability. Their elongation patterns may change during fixed-bearing and mobile-bearing unicompartmental knee arthroplasty (FB and MB UKA). This study aims to explore the relationship between the elongation of MCL, LCL, and changes in joint space, as well as their correlation with functional scale scores during FB and MB UKA. HYPOTHESIS We hypothesize that MCL and LCL have different elongation patterns in UKA patients, and there is a correlation between elongation and joint space and functional scores. MATERIALS AND METHODS The study recruited 24 patients undergoing UKA on a unilateral knee (13 FB and 11 MB). A dual fluoroscopic imaging system was employed to assess in-vivo knee kinematics during static standing and single-leg lunge. The superficial and deep MCL (sMCL, dMCL) and LCL were divided into anterior, medium, and posterior portions. The virtual ligament method quantified in-vivo ligament lengths. Analysis focused on the correlation of normalized ligament lengths with functional scores and joint space. RESULTS 1. LCL Elongation in FB UKA: There is a significant increase in LCL elongation during early and mid-flexion of the single-leg lunge (p < 0.05). 2. MCL Elongation in MB UKA: Both sMCL and dMCL exhibit significant elongation during early and mid-flexion of the single-leg lunge (p < 0.05). 3. Correlation with Functional Scores: Differences in collateral ligament elongation in FB UKA are significantly correlated with the OKS and KSS, highlighting the impact on functional outcomes. In MB UKA, differences in ligament elongation are significantly correlated with the FJS. 4. Joint Space Correlation: There is a significant correlation between the elongation of the anterior and medium portions of dMCL and joint space in the surgical compartment during mid- and deep flexion (30-100°, p < 0.05, r > 0.64). CONCLUSION The study reveals distinct ligament elongation patterns between UKA and native knees in LCL for FB UKA and MCL for MB UKA. These patterns are associated with knee functional scores. Moreover, dMCL elongation correlates significantly with the joint space for MB UKA during middle and deep flexion phases. LEVEL OF EVIDENCE III; prospective retrospective cohort study.
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Affiliation(s)
- Chunjie Xia
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, China; Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, China; Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China; Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyun Gu
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, China
| | - Huiyong Dai
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, China; Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China; Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, China; Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China; Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Kyriakidis T, Hernigou J, Pitsilos C, Verdonk R, Koulalis D. No clinical superiority of bi-cruciate retaining versus posterior stabilized total knee arthroplasty at two years follow-up. Acta Orthop Belg 2024; 90:409-414. [PMID: 39851011 DOI: 10.52628/90.3.11905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2025]
Abstract
The purpose of the present study was to evaluate and compare the clinical outcomes of two groups of patients subject to bi-cruciate retaining (BCR) or posterior-stabilized (PS) implants. It was hypothesized that patients treated with BCR prostheses would present higher flexion and better clinical and functional results than those treated with PS implants. This prospective study included thirty-two patients treated for primary knee osteoarthritis and assigned to two matched groups for their demographic characteristics and comorbidities. Those with functioning cruciate ligaments received bi- cruciate retaining prostheses. In the case of ligaments' insufficiency, the posterior-stabilised design was selected. The primary outcome was knee flexion, and secondary outcomes included the patient's reported outcomes as recorded by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, visual analogue scale (VAS) for pain, treatment- related complications, and surgical time. Complete data were recorded for all patients with a minimum of 2 years of follow-up. This study found a statistically significant improvement in all the analysed clinical and functional assessment tools from baseline to the latest follow-up (p<0.05) for both groups. However, no statistically significant difference was found between the two groups. Furthermore, bi-cruciate retaining design is surgical time. There was no evidence of clinical superiority of bi-cruciate retaining compared to posterior stabilized knee implants. Therefore, further randomized studies with more participants and a longer follow-up on comparing bi-cruciate retaining and posterior stabilized implants in primary knee osteoarthritis could be rewarding.
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Yu W, Zou D, Tan J, Zheng N, Ma X, Cheng R, Chen Y, Tsai TY. Medial-pivot total knee arthroplasty enhances tibiofemoral axial rotation stability in weight-bearing mid-range flexion compared to posterior-stabilised system. Knee Surg Sports Traumatol Arthrosc 2024; 32:2075-2086. [PMID: 38713882 DOI: 10.1002/ksa.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE Total knee arthroplasty (TKA) stands as a primary intervention for severe knee ailments, yet concerns remain regarding postoperative patient satisfaction and flexion instability. This study aims to evaluate the in-vivo kinematics of medial-pivot (MP) and posterior-stabilised (PS) designs during step-up activity, in comparison to the kinematics of the nonoperated contralateral knee. METHODS Sixteen patients with PS-TKA and 14 with MP-TKA were retrospectively examined. Clinical outcomes were assessed using patient-completed questionnaires. Motion during step-up was captured using a dual fluoroscopic system. Statistical analysis was applied to evaluate the in-vivo tibiofemoral six-degree-of-freedom kinematics and articular contact positions between the two groups. RESULTS Despite being older, patients in the MP group reported higher postoperative subjective scores for weight-bearing functional activities. The axial rotation centres of MP-TKA located on the medial tibial plateau exhibited less variance compared to PS-TKA and contralateral knees. Compared to the contralateral knee (contralateral to medial-pivot [C-MP] or contralateral to posterior-stabilised [C-PS]), the MP group exhibited limited range of motion in terms of anteroposterior translation (MP: 3.6 ± 1.3 mm vs. C-MP: 7.4 ± 2.5 mm, p < 0.01) and axial rotation (MP: 6.6 ± 1.9° vs. C-MP: 10.3 ± 4.9°, p = 0.02), as well as in the PS group for anteroposterior translation (PS: 3.9 ± 1.7 mm vs. C-PS: 7.2 ± 3.7 mm, p < 0.01). CONCLUSION The MP group with better postoperative ratings demonstrated a more stable MP axial rotation pattern during step-up activity compared to the PS group, underscoring the pivotal role of prosthetic design in optimising postoperative rehabilitation and functional recovery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Wanxin Yu
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Ma
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunsu Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Research and Development Division, TAOiMAGE Medical Technologies Corporation, Shanghai, China
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Valtanen RS, Seligson M, Huddleston HG, Angibaud L, Huddleston JI. Improved Clinical Outcomes With Dynamic, Force-Controlled, Gap-Balancing in Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2024; 39:S218-S223. [PMID: 38417556 DOI: 10.1016/j.arth.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Optimal soft-tissue management in total knee arthroplasty (TKA) may reduce symptomatic instability. We hypothesized that TKA outcomes using a computer-assisted dynamic ligament balancer that acquires medial and lateral gap sizes throughout the motion arc would show improved Knee Society Scores (KSS) compared to TKAs done with a traditional tensioner at 0 and 90°. We also sought to quantify the degree to which the planned femoral rotation chosen to optimize medio-lateral balance throughout the arc of motion deviated from the femoral rotation needed to achieve a rectangular flexion gap at 90° alone. METHODS Baseline demographics, clinical outcomes, KSSs, and femoral rotations were compared in 100 consecutive, computer-assisted TKAs done with the balancer (balancer group) to the immediately prior 100 consecutive computer-assisted TKAs done without the balancer (control group). Minimum follow-up was 13 months and all patients had osteoarthritis. Mean knee motion did not differ preoperatively (110.1 ± 13.6° balancer, 110.4 ± 12.5° control, P = .44) or postoperatively (119.1 ± 10.3° balancer, 118.8 ± 10.9° control, P = .42). Tourniquet times did not differ (93.1 ± 13.0 minutes balancer, 90.7 ± 13.0 minutes control, P = .13). Postoperative length of stay differed (40.2 ± 20.9 hours balancer, 49.0 ± 18.3 hours control, P = .0009). There were 14 readmissions (7 balancer, 7 control), 11 adverse events (4 balancer, 7 control), and 3 manipulations (1 balancer, 2 control). The cohorts were compared using Student's t-tests, Shapiro-Wilk normalities, Wilcoxon rank-sums, and multivariable logistic regression analyses. RESULTS Postoperative KSS improvements were higher in the balancer group (P < .0001). In multivariable regression analyses, the balancer group experienced 7 ± 2 point improvement in KSS Knee scores (P < .0001) and 4 ± 2 point improvement in KSS Function scores (P = .040) compared to the control group. CONCLUSIONS The statistically and clinically significant improvements in postoperative KSS demonstrated in the balancer cohort are likely driven by improved stability throughout the motion arc. Further study is warranted to evaluate replicability by non-design surgeons.
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Affiliation(s)
- Rosa S Valtanen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | | | - Heather G Huddleston
- Department of Obstetrics and Gynecology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
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Nakamura Y, Ogawa H, Ichikawa K, Sohmiya K, Sengoku M, Shimokawa T, Onishi K, Akiyama H. A new magnetic resonance imaging grading system for anterior cruciate ligament myxoid degeneration in osteoarthritis of the knee. Orthop Traumatol Surg Res 2024; 110:103740. [PMID: 37913867 DOI: 10.1016/j.otsr.2023.103740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/27/2023] [Accepted: 08/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND This study aimed to investigate association between magnetic resonance imaging (MRI) and histological findings of degenerated anterior cruciate ligament (ACL) in knee osteoarthritis (OA), and based on this result, to develop a new ACL degeneration grading system by MRI that corresponds to histological findings of degenerated ACL. HYPOTHESIS MRI signal intensity of the ACL could correspond to histological findings of collagen degeneration. PATIENTS AND METHODS A collection of 106 ACL specimens from 85 patients who underwent primary total knee arthroplasty was investigated for signal intensity of the ACL and muscle on axial Fat-saturated proton density-weighted MRI and MRI signal intensity ratio (ACL/muscle) was calculated. The correlation between ACL histological degeneration and MRI ACL/muscle signal intensity ratio was analyzed. The ACL was stratified into 3 grades based on signal intensity relative to muscle intensity (grade 1, low; grade 2, iso; and grade 3, high), and the extent to ACL degeneration in each MRI ACL degeneration grade was evaluated. RESULTS Collagen degeneration (53.5±24.0%) and myxoid change (25.2±18.8%) in degenerated ACL significantly correlated with MRI signal intensity ratio of the ACL/muscle (r=0.62, p<0.0001; r=0.67, p<0.0001). ACL were assigned to grade 1 (n=22 [20.8%]), grade 2 (n=56 [52.8%]), and grade 3 (n=28 [26.4%]). ACL collagen degeneration was 34.8±18.4% in grade 1, 49.3±21.7% in grade 2, and 76.6±12.0% in grade 3. ACL myxoid change was 10.0±11.3% in grade 1, 21.3±14.1% in grade 2, and 45.0±15.3% in grade 3. DISCUSSION The ACL/muscle signal intensity ratio on MRI correlated with the extent to ACL myxoid degeneration. The new MRI ACL degeneration grade is helpful to estimate the extent to ACL myxoid degeneration in knee OA. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Yutaka Nakamura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194 Japan
| | - Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194 Japan; Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, Gifu, 503-0015 Japan.
| | - Katsuhiro Ichikawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194 Japan
| | - Kazuki Sohmiya
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194 Japan
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, Gifu, 503-0015 Japan
| | - Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, Gifu, 503-0015 Japan
| | - Kazuichiro Onishi
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, Gifu, 503-0015 Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194 Japan
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Inui H, Yamagami R, Kono K, Kawaguchi K, Kage T, Murakami R, Nakamura H, Saita K, Taketomi S, Tanaka S. Short-term clinical results of bicruciate-retaining total knee arthroplasty using personalized alignment. BMC Musculoskelet Disord 2023; 24:965. [PMID: 38087214 PMCID: PMC10714564 DOI: 10.1186/s12891-023-07083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Bicruciate-retaining (BCR) prosthesis has been introduced to recreate normal knee movement by preserving both the anterior and posterior cruciate ligaments. However, the use of BCR total knee arthroplasty (TKA) is still debatable because of several disappointing reports. We have been performing BCR TKAs with personalized alignment (PA). This study aimed to reveal the limb alignment and soft tissue balance of FA-BCR TKAs and compare the clinical outcomes of FA-BCR TKAs with those of unicompartmental knee arthroplasty (UKA). METHODS Fifty BCR TKAs and 58 UKAs were included in this study. The joint component gaps of BCR TKA were evaluated intraoperatively and the postoperative hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were measured using full-length standing radiography. The short-term clinical outcomes of BCR TKAs were compared with those of UKA using the scoring system of 2011 Knee Society Scoring (KSS) and the knee injury and osteoarthritis outcome score (KOOS) at an average of 2 years postoperatively (1-4yeras). RESULTS The coronal alignment values of PA-BCR TKA were as follows: HKA angle, 177.9° ± 2.3°; MPTA, 85.4° ± 1.9°; and LDFA, 87.5° ± 1.9°. The joint component gaps at flexion angles of 10°, 30°, 60°, and 90° were 11.1 ± 1.2, 10.9 ± 1.4, 10.7 ± 1.3, and 11.2 ± 1.4 mm for the medial compartment and 12.9 ± 1.5, 12.6 ± 1.8, 12.5 ± 1.8 and 12.5 ± 1.7 mm for the lateral compartment, respectively. The patient expectation score and maximum extension angle of PA-BCR TKA were significantly better than those of UKAs. CONCLUSIONS The short-term clinical outcomes of PA-BCR TKA were comparable or a slightly superior to those of UKAs.
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Affiliation(s)
- Hiroshi Inui
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan.
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Haruhiko Nakamura
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan
| | - Kazuo Saita
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Kono K, Inui H, Tomita T, Yamazaki T, Konda S, Taketomi S, Tanaka S, D'Lima DD. Bicruciate-retaining total knee arthroplasty procedure reduced tensile force in the middle and posterior components of lateral collateral ligament during deep knee flexion activities with no effect on tensile force of the medial collateral ligament. Knee Surg Sports Traumatol Arthrosc 2023; 31:3889-3897. [PMID: 36928366 DOI: 10.1007/s00167-023-07342-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/05/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To analyse the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on the tensile force of the collateral ligaments during two deep knee flexion activities, cross-leg sitting and squatting. METHODS Thirteen patients (15 knees) treated using bicruciate-retaining total knee arthroplasty (BCR-TKA) for knee joint osteoarthritis were analysed. Knee joint kinematics during cross-leg sitting (open-chain flexion) and squatting (closed-chain flexion) were evaluated through fluoroscopy. The tensile force was calculated in vivo based on the change in the distance between the femoral and tibial attachment areas for the anterior, middle, and posterior components of the superficial (sMCL) and deep (dMCL) medial collateral ligament and the lateral collateral ligament (LCL). Differences in the calculated tensile forces of the collateral ligaments were evaluated using repeated measures of analysis of variance, with post hoc pairwise comparison (Bonferroni test). Statistical significance was set at P ≤ 0.05. RESULTS The correction of the coronal alignment was related to the surgical technique, not to the implant design. No significant change in the tensile force in all three components of the sMCL from pre- to post-TKA (n.s.) was observed. For dMCL, a pre- to post-TKA change in the tensile force was observed only for the anterior dMCL component (p = 0.03). No change was observed in the tensile force of the anterior LCL with increasing flexion, with no difference in pre- to post-TKA and between activities (n.s.). In contrast, tensile force in the middle LCL slightly decreased with increasing flexion during squatting, pre- and post-TKA. After surgery, lower forces were generated at 40° of flexion (p = 0.04). Tensile force in the posterior LCL was higher in extension than flexion, which remained high in the extension post-TKA. However, after surgery, lower tensile forces were generated at 10° (p = 0.04) and 40° (p = 0.04) of flexion. CONCLUSIONS The in vivo change in tensile forces of the collateral ligaments of the knee before and after BCR-TKA can inform the development of appropriate ligament balancing strategies to facilitate recovery of deep knee flexion activities after TKA, as well as for continued improvement of BCR-TKA designs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kenichi Kono
- Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, La Jolla, CA, USA
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Master Course of Health Sciences, Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of T1echnology, Fukaya, Saitama, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Darryl D D'Lima
- Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, La Jolla, CA, USA
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
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11
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Zou D, Ling Z, Tan J, Zheng N, Dimitriou D, Chen Y, Tsai TY. Medial stability and lateral flexibility of the collateral ligaments during mid-range flexion in medial-pivot total knee arthroplasty patients demonstrates favorable postoperative outcomes. Knee Surg Sports Traumatol Arthrosc 2023; 31:3734-3744. [PMID: 36670261 DOI: 10.1007/s00167-023-07307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/26/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE The objectives of the present study were to investigate the length change in different bundles of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) during lunge, and to evaluate their association with Knee Society Score (KSS) following medial-pivot total knee arthroplasty (MP-TKA). METHODS Patients with unilateral MP-TKA knees performed a bilateral single-leg lunge under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The contralateral non-operated knees were used as the control group. The attachment sites of the sMCL and LCL were marked to calculate the 3D wrapping length. The sMCL and LCL were divided into anterior, intermediate, and posterior portions (aMCL, iMCL, pMCL, aLCL, iLCL, pLCL). Correlations between lengths/elongation rate of ligament bundles from full extension to 100° flexion and the KSS were examined. RESULTS The sMCL and LCL demonstrated relative stability in length at low flexion, but sMCL length decreased whereas LCL increased with further flexion on operated knees. The sMCL length increased at low flexion and remained stable with further flexion, while the LCL length decreased with flexion on the contralateral non-operated knees. The lengths of aMCL, iMCL, and pMCL showed moderate (0.5 < r < 0.7, p < 0.05) negative correlations with the KSS, and the lengths of aLCL, iLCL, and pLCL were positively correlated with the KSS at mid flexion on operated knees (p < 0.05). The elongation rates of aLCL, iLCL, and pLCL were negatively correlated with the KSS at high flexion on operated knees (p < 0.05). However, no significant correlations between the length of different bundles of sMCL or LCL with KSS were found on contralateral non-operated knees. CONCLUSIONS The elongation pattern of sMCL/LCL on MP-TKA knees showed differences with contralateral non-operated knees. The sMCL is tense at low to middle flexion and relaxed at high flexion, while LCL is relaxed at low to middle flexion and tense at high flexion following MP-TKA. Medial stability and proper lateral flexibility during mid flexion were associated with favorable postoperative outcomes in MP-TKA patients. In contrast, lateral relaxation at deep flexion should be avoided when applying soft-tissue balancing in MP-TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi Ling
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tan
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland.
| | - Yunsu Chen
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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12
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Cools AS, Luyckx T, Victor J, Arnout N. Bicruciate retaining total knee arthroplasty: current state and future promise. Acta Orthop Belg 2023; 89:423-428. [PMID: 37935224 DOI: 10.52628/89.3.11663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Total knee arthroplasty (TKA) is a well-known surgical procedure performed to address end stage osteoarthritis. The main goal is to relieve pain, recover articular function and return to normal function as soon as possible. Over the years it is frequently performed in the elderly, but lately there is an increased demand in a younger and more active population. Up to 25% of patients feel dissatisfied about their TKA. The anterior cruciate ligament (ACL) is considered the main anteroposterior stabilizer of the knee; nevertheless the ACL is usually sacrificed during conventional TKA. Research shows this might be an unnecessary sacrifice in certain cases. The considerable dissatisfaction rate in mainly high-demanding patients, together with the literature reports on the importance of the ACL function, were the two main reasons for the development of bicruciate retaining (BCR) total knee arthroplasty. BCR TKA may offer superior knee kinematics and proprioception, through anterior cruciate ligament preservation, but requires a higher level of attention to obtain an accurate and precise component orientation to reach proper ligamentous balancing and restore the native knee biomechanics. Many surgeons abandoned its use due to its challenging technique and inconsistent results. Recent new BCR implant designs are promising. This systematic literature review aims to summarize the current state of BCR TKA and what to expect in the future.
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13
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Larger Medial Contact Area and More Anterior Contact Position in Medial-Pivot than Posterior-Stabilized Total Knee Arthroplasty during In-Vivo Lunge Activity. Bioengineering (Basel) 2023; 10:bioengineering10030290. [PMID: 36978681 PMCID: PMC10045283 DOI: 10.3390/bioengineering10030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
This study aimed to compare the in-vivo kinematics and articular contact status between medial-pivot total knee arthroplasty (MP-TKA) and posterior stabilized (PS) TKA during weight-bearing single-leg lunge. 16 MP-TKA and 12 PS-TKA patients performed bilateral single-leg lunges under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The closest point between the surface models of the femoral condyle and the polyethylene insert was used to determine the contact position and area. The nonparametric statistics analysis was performed to test the symmetry of the kinematics between MP-TKA and PS-TKA. PS-TKA demonstrated a significantly greater range of AP translation than MP-TKA during high flexion (p = 0.0002). Both groups showed a significantly greater range of lateral compartment posterior translation with medial pivot rotation. The contact points of PS-TKA were located significantly more posterior than MP-TKA in both medial (10°–100°) and lateral (5°–40°, 55°–100°) compartments (p < 0.0500). MP-TKA had a significantly larger contact area in the medial compartment than in the lateral compartment. In contrast, no significant differences were observed in PS-TKA. The present study revealed no significant differences in clinical outcomes between the MP and PS groups. The PS-TKA demonstrated significantly more posterior translations than MP-TKA at high flexion. The contact points are located more posteriorly in PS-TKA compared with MP-TKA. A larger contact area and medial pivot pattern during high flexion in MP-TKA indicated that MP-TKA provides enhanced medial pivot rotation.
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14
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Nakamura Y, Ogawa H, Sohmiya K, Sengoku M, Shimokawa T, Ohnishi K, Matsumoto K, Akiyama H. Relationship between histological changes of the anterior cruciate ligament and knee function in osteoarthritis patients. Orthop Traumatol Surg Res 2022; 108:103341. [PMID: 35643361 DOI: 10.1016/j.otsr.2022.103341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The function of the anterior cruciate ligament (ACL) in osteoarthritis (OA) of the knee remains to be elucidated. The purpose of this study is to evaluate histological changes of the ACL in end-stage knee OA and to clarify the relationship between histological changes in the ACL and knee function. HYPOTHESIS The hypothesis in this study was that ACL degeneration in knee OA is associated with decreased knee function. PATIENTS AND METHODS Eighty-two ACL specimens from 65 patients who underwent primary total knee arthroplasty (TKA) were investigated. The correlation between histological changes of the ACL (myxoid changes, chondroid metaplasia, total collagen degeneration, microcyst formation, vascular proliferation, and inflammatory cell infiltration) and knee function (range of motion, anterior tibial translation test, knee extension muscle strength, one-leg standing time, and functional reach test) were investigated. Age, body mass index, joint space narrowing, osteophyte formation, lower extremity alignment, and knee medial/lateral instability were also evaluated. RESULTS Myxoid change in the ACLs was significantly negatively correlated with one-leg standing time. Chondroid metaplasia was not correlated with knee function. Collagen degeneration in the ACL was significantly negatively correlated with knee flexion angle and one-leg standing time. In addition, a negative correlation between microcyst formation and knee flexion angle was noted. Osteophyte formation, particularly lateral femoral intercondylar osteophytes, was correlated with myxoid changes. The other parameters did not correlate with ACL histological changes. DISCUSSION Myxoid changes in the ACL were shown to correlate with knee function. The osteophyte score, particularly as related to lateral femoral intercondylar osteophytes, correlated with the severity of myxoid changes in the ACL in knee OA. Precise ACL evaluation should be included in the indications for ACL-retaining surgeries because ACL degeneration may be related to decreased knee function after surgery. LEVEL OF EVIDENCE IV, Diagnostic case series.
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Affiliation(s)
- Yutaka Nakamura
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan; Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan
| | - Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan; Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan.
| | - Kazuki Sohmiya
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Kazuichiro Ohnishi
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan
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Klemt C, Padmanabha A, Tirumala V, Smith EJ, Kwon YM. The Effect of Joint Line Elevation on In Vivo Knee Kinematics in Bicruciate Retaining Total Knee Arthroplasty. J Knee Surg 2022; 35:1445-1452. [PMID: 33636741 DOI: 10.1055/s-0041-1724132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Prior studies have reported a negative effect on both clinical outcomes and patient-reported outcome measures (PROMS) following joint line elevation (JLE) in cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior stabilized (PS) TKA designs. This experimental study was aimed to quantify the effect of JLE on in vivo knee kinematics in patients with bicruciate retaining (BCR) TKA during strenuous activities. Thirty unilateral BCR TKA patients were evaluated during single-leg deep lunge and sit-to-stand using a validated combined computer tomography and dual fluoroscopic imaging system. Correlation analysis was performed to quantify any correlations between JLE and in vivo kinematics, as well as PROMS. There was a significant negative correlation between JLE and maximum flexion angle during single-leg deep lunge (ρ = -0.34, p = 0.02), maximum varus joint angles during single-leg deep lunge (ρ = -0.37, p = 0.04), and sit-to-stand (ρ = -0.29, p = 0.05). There was a significant negative correlation between JLE and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (ρ = -0.39, p = 0.01) and knee disability and osteoarthritis outcome score physical function (KOOS-PS; ρ = -0.33, p = 0.03). The JLE that yields a significant loss in PROMS and maximum flexion angles were 2.6 and 2.3 mm, respectively. There was a linear negative correlation of JLE with both in vivo knee kinematics and PROMS, with changes in JLE of greater than 2.6 and 2.3 mm, leading to a clinically significant loss in PROMS and maximum flexion angles, respectively, suggesting an increased need to improve surgical precision to optimize patient outcomes following BCR TKA.
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Affiliation(s)
- Christian Klemt
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand Padmanabha
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Venkatsaiakhil Tirumala
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evan J Smith
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Kage T, Inui H, Tomita T, Yamazaki T, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Murakami R, Arakawa T, Tanaka S. In vivo kinematic comparison of medial pivot total knee arthroplasty in weight-bearing and non-weight-bearing deep knee bending. Clin Biomech (Bristol, Avon) 2022; 99:105762. [PMID: 36148703 DOI: 10.1016/j.clinbiomech.2022.105762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to determine the kinematics of medial pivot total knee arthroplasty by comparing weight-bearing and non-weight-bearing deep knee bending and to evaluate the effect of the weight-bearing state on the kinematics. METHODS The kinematics of 19 knees were investigated under fluoroscopy during squatting (weight-bearing) and active-assisted knee bending (non-weight-bearing) using two- to three-dimensional registration technique. Accordingly, range of motion, anteroposterior translation for the medial and lateral low contact points, axial rotation of the femoral component relative to the tibial component and kinematic pathway were evaluated. FINDINGS There was no difference in range of motion between the two states. The medial anteroposterior translation showed no significant movement with no anterior translation in both the weight-bearing and non-weight-bearing from 0° to 90° of flexion. Regarding the lateral anteroposterior translation, a posterior translation was observed during weight-bearing, whereas a slight anterior translation from 0° to 30° of flexion and subsequent posterior translation were found in the non-weight-bearing. Femoral external rotation was observed in the weight-bearing, whereas femoral internal rotation was seen from 0° to 30° of flexion and subsequent femoral external rotation was observed in the non-weight-bearing. The kinematic pathway showed medial pivot motion and subsequent bicondylar rollback in the weight-bearing, whereas only medial pivot motion was observed in the non-weight-bearing. INTERPRETATION The medial anteroposterior translation of the femur during deep knee bending showed no anterior motion in the two states. The lateral anteroposterior translation and femoral rotation were different in the mid-flexion range between the two states.
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Affiliation(s)
- Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama 369-0293, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takahiro Arakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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17
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Does contemporary bicruciate retaining total knee arthroplasty restore the native knee kinematics? A descriptive literature review. Arch Orthop Trauma Surg 2022; 142:2313-2322. [PMID: 34406507 DOI: 10.1007/s00402-021-04116-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There has been no consensus on the benefit of retaining the anterior cruciate ligament (ACL) in TKAs. This study aims to review recent evidences around the kinematics of bicruciate retaining (BCR) total knee arthroplasty (TKA). MATERIALS AND METHODS A search of the literature was conducted on PubMed and Web of Science. Reports that assessed the BCR TKA kinematics, including both in vitro cadaveric studies and in vivo clinical studies, were reviewed. RESULTS A total number of 169 entries were obtained. By exclusion criteria, five in vitro studies using cadaveric knee specimens and six in vivo studies using patient cohorts were retained. In vitro studies showed a low internal rotation (< 10°) throughout the flexion path in all BCR TKAs. Compared to native knees, the difference in the internal rotation was maximal during early and late flexion; the femur in the BCR TKA was significantly more anteriorly positioned (1.7-3.6 mm from 0° to 110°) and more externally rotated (3.6°-4.2° at 110° and 120°). In vivo studies revealed that the native knee kinematics, in general, were not fully restored after BCR TKA during various knee activates (squatting, level-walking, and downhill-walking). There are asymmetric kinematics during the stance phase of gait cycle and a smaller range of axial rotation (23% patients exhibiting external tibial rotation) throughout the gait cycle in BCR TKAs. CONCLUSIONS Critical insights in the complex BCR TKA biomechanics have been reported from recent laboratory kinematics studies. However, whether contemporary BCR TKAs can fully restore native knee kinematics remains debatable, warranting further investigations.
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Klemt C, Drago J, Oganesyan R, Smith EJ, Yeo I, Kwon YM. Gait and Knee Flexion In Vivo Kinematics of Asymmetric Tibial Polyethylene Geometry Cruciate Retaining Total Knee Arthroplasty. J Knee Surg 2022; 35:828-837. [PMID: 33111271 DOI: 10.1055/s-0040-1718681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The preservation of the posterior cruciate ligament in cruciate retaining (CR) total knee arthroplasty (TKA) designs has the potential to restore healthy knee biomechanics; however, concerns related to kinematic asymmetries during functional activities still exist in unilateral TKA patients. As there is a limited data available regarding the ability of the contemporary CR TKA design with concave medial and convex lateral tibial polyethylene bearing components to restore healthy knee biomechanics, this study aimed to investigate in vivo three-dimensional knee kinematics in CR TKA patients during strenuous knee flexion activities and gait. Using a combined computer tomography and dual fluoroscopic imaging system approach, in vivo kinematics of 15 unilateral CR TKA patients (comparison of replaced and contralateral nonreplaced knee) were evaluated during sit-to-stand, step-ups, single-leg deep lunge, and level walking. The patient cohort was followed-up at an average of 24.5 months ( ± 12.6, range 13-42) from surgical procedure. Significantly smaller internal knee rotation angles were observed for the contemporary CR TKA design during step-ups (2.6 ± 5.8 vs. 6.3 ± 6.6 degrees, p < 0.05) and gait (0.6 ± 4.6 vs. 6.3 ± 6.8 degrees, p < 0.05). Significantly larger proximal and anterior femoral translations were measured during sit-to-stand (34.7 ± 4.5 vs. 29.9 ± 3.1 mm, p < 0.05; -2.5 ± 2.9 vs. -8.1 ± 4.4 mm, p < 0.05) and step-ups (34.1 ± 4.5 vs. 30.8 ± 2.9 mm, p < 0.05; 2.2 ± 3.2 vs. -3.5 ± 4.5 mm, p < 0.05). Significantly smaller ranges of varus/valgus and internal/external rotation range of motion were observed for CR TKA, when compared with the nonoperated nee, during strenuous activities and gait. The preservation of the posterior cruciate ligament in the contemporary asymmetric bearing geometry CR TKA design with concave medial and convex lateral tibial polyethylene bearing components has the potential to restore healthy knee biomechanics; however, the study findings demonstrate that native knee kinematics were not fully restored in patients with unilateral asymmetric tibial polyethylene bearing geometry CR TKA during functional activities.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Drago
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Oganesyan
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evan J Smith
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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19
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Shah D, Bates T, Kampfer C, Hope D. Biomechanics and Outcomes of Modern Tibial Polyethylene Inserts. Curr Rev Musculoskelet Med 2022; 15:194-204. [PMID: 35381973 PMCID: PMC9107564 DOI: 10.1007/s12178-022-09755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW There have been many attempts to use variations in tibial polyethylene design to better recreate normal knee kinematics in the total knee arthroplasty. The goal of this review is to provide an overview of the various types of tibial inserts that exist and review the theoretical mechanics versus what was demonstrated in vivo. RECENT FINDINGS Many polyethylene inserts have been attempted to re-create normal knee kinematics, but none have been able to successfully do so. Previously the only two types of inserts were posterior stabilized (PS) and cruciate retaining (CR) polyethylene inserts. Both of these have shown excellent long-term survival but neither has demonstrated native kinematics. Initially, it was thought that retention of the posterior cruciate ligament (PCL) would allow for more native kinematics, but fluoroscopic evidence has shown that the PCL alone cannot accomplish this. Newer inserts try to restore femoral roll back and the screw home mechanism. The bicruciate retaining total knee inserts are having the most "normal" kinematics, suggesting the importance of both the ACL and PCL in knee biomechanics. Modern polyethylene inserts show favorable short-term data with bicruciate retaining inserts having the best kinematics; however, long-term studies are still needed to determine if survivorship and patient outcomes remain favorable.
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Affiliation(s)
- Darshan Shah
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA.
| | - Taylor Bates
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
| | - Craig Kampfer
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
| | - Donald Hope
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
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20
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Klemt C, Bounajem G, Tirumala V, Xiong L, Oganesyan R, Kwon YM. Posterior Tibial Slope Increases Anterior Cruciate Ligament Stress in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematic Analysis. J Knee Surg 2022; 35:788-797. [PMID: 33111270 DOI: 10.1055/s-0040-1718602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The study design involved here is experimental in nature. The resection of the anterior cruciate ligament (ACL) during conventional total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal in vivo knee kinematics. Bi-cruciate retaining (BCR) TKA designs allow the preservation of the ACL with the potential to restore native knee kinematics. This study aimed to investigate the effect of posterior tibial slope (PTS) on stress experienced by the ACL during weight bearing sit-to-stand (STS) and single-leg deep lunge. The ACL elongation patterns were measured in 30 unilateral BCR TKA patients during weight-bearing STS and single-leg deep lunge using a validated dual fluoroscopic tracking technique. The minimum normalized stress within the anteromedial (AM) and posterolateral (PL) bundle of the ACL during weight-bearing STS and single-leg deep lunge was found at a PTS of 3.7 degrees. The maximum AM and PL bundle stresses were observed at a PTS of 8.5 and 9.3 degrees, respectively during STS and at 8.4, and 9.1 degrees, respectively during single-leg deep lunge. There was a significant positive correlation between PTS and stress observed within the AM and PL bundle of the ACL during weight-bearing STS (R 2 = 0.37; p < 0.01; R2 = 0.36; p = 0.01) and single-leg deep lunge (R 2 = 0.42; p < 0.01; R 2 = 0.40; p < 0.01). The study demonstrates that PTS of operated BCR TKA knees has a significant impact on the stress experienced by the preserved ACL during weight-bearing STS and single-leg deep lunge. This suggests that avoiding excessive PTS may be one of the surgical implant alignment factors to consider during surgery to minimize increased loading of the preserved ACL.
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Affiliation(s)
- Christian Klemt
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Georges Bounajem
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Venkatsaiakhil Tirumala
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Liang Xiong
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Oganesyan
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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21
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Wan T, Huang Y, Gao X, Wu W, Guo W. Microglia Polarization: A Novel Target of Exosome for Stroke Treatment. Front Cell Dev Biol 2022; 10:842320. [PMID: 35356292 PMCID: PMC8959940 DOI: 10.3389/fcell.2022.842320] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
The vast majority of cells in the human body are capable of secreting exosomes. Exosomes have become an important vehicle for signaling between cells. Exosomes secreted by different cells have some of the structural and functional properties of that cell and thus have different regulatory functions. A large number of recent experimental studies have shown that exosomes from different sources have different regulatory effects on stroke, and the mechanisms still need to be elucidated. Microglia are core members of central intrinsic immune regulatory cells, which play an important regulatory role in the pathogenesis and progression of stroke. M1 microglia cause neuroinflammation and induce neurotoxic effects, while M2 microglia inhibit neuroinflammation and promote neurogenesis, thus exerting a series of neuroprotective effects. It was found that there is a close link between exosomes and microglia polarization, and that exosome inclusions such as microRNAs play a regulatory role in the M1/M2 polarization of microglia. This research reviews the role of exosomes in the regulation of microglia polarization and reveals their potential value in stroke treatment.
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Affiliation(s)
- Teng Wan
- Hengyang Medical College, University of South China, Hengyang, China.,Sports Medicine Department, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yunling Huang
- Hengyang Medical College, University of South China, Hengyang, China
| | - Xiaoyu Gao
- Hengyang Medical College, University of South China, Hengyang, China
| | - Wanpeng Wu
- Shenzhen Futian District Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Weiming Guo
- Sports Medicine Department, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
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22
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Hananouchi T, Suzuki T, Dorthe EW, Du J, D’Lima DD. The Resistance Force of the Anterior Cruciate Ligament during Pull Probing Is Related to the Mechanical Property. Bioengineering (Basel) 2021; 9:bioengineering9010004. [PMID: 35049713 PMCID: PMC8773175 DOI: 10.3390/bioengineering9010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/21/2022] Open
Abstract
There are various methods for reconstructing the anterior cruciate ligament (ACL) from other muscles or tendons. Initial tension of the reconstructed ACL is one of the key elements affecting postoperative outcomes. However, tension cannot be measured after graft fixation. The only intraoperative assessment is pull probing, which is performed by pulling joint soft tissues with the arthroscopic probe and can be measured quantitatively. Therefore, its value might be used as an alternative value for the mechanical property of the ACL. Using a probing device one author developed to measure the resistance force of soft tissues quantitatively while probing, we measured the resistance force of dissected ACLs and used tensile testing to investigate the correlation between the resistance force and the mechanical property of the ligaments. According to the results, when a certain amount of tension (strain; 16.6%) was applied, its mechanical properties were moderately correlated (r = 0.56 [p = 0.045]) with the probing force. Therefore, the tension of the reconstructed ACL after fixation under real ACL reconstruction surgery can be derived from the value of the probing device.
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Affiliation(s)
- Takehito Hananouchi
- Medical Engineering Laboratory, Department of Mechanical Engineering, Faculty of Engineering, Osaka Sangyo University, Daito 574-8530, Osaka, Japan
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA; (E.W.D.); (D.D.D.)
- Correspondence: ; Tel.: +81-72-875-3001
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopedics Hospital, Sapporo 060-0007, Hokkaido, Japan;
| | - Erik W. Dorthe
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA; (E.W.D.); (D.D.D.)
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, CA 92093, USA;
| | - Darryl D. D’Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA; (E.W.D.); (D.D.D.)
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23
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Sugi A, Matsuki K, Fukushi R, Shimoto T, Hirose T, Shibayama Y, Nishinaka N, Iba K, Yamashita T, Banks SA. Comparing in vivo three-dimensional shoulder elevation kinematics between standing and supine postures. JSES Int 2021; 5:1001-1007. [PMID: 34766076 PMCID: PMC8568990 DOI: 10.1016/j.jseint.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background It is often assumed that body posture, standing vs. supine, changes shoulder muscle activation and range of motion, but these altered shoulder mechanics have not been objectively assessed. We expected the supine posture might facilitate scapular rotation and change subacromial pressure. The purpose of this study is to evaluate the influence of body posture on shoulder kinematics during arm elevation. Methods Ten males and eight females with a mean age of 33 years participated in this study. Shoulder kinematics were assessed during scapular plane elevation in the standing and supine postures by using single-plane fluoroscopic images. Kinematics were measured using 3-dimensional to 2-dimensional model-image registration techniques: matching the 3-dimensional bone model derived from computed tomography onto each fluoroscopic image. Glenohumeral superior/inferior translation, acromiohumeral distance, and scapular rotations were compared between the postures. The effect of sex also was evaluated. Results With the arm at the side position, the humeral head in the supine posture was located 0.5 mm superior compared to the standing posture (P < .001). During humeral elevation, the humeral head significantly shifted more inferiorly in the supine posture than in standing; the biggest mean difference was 0.6 mm, P = .003. But acromiohumeral distance during elevation was not significantly affected by the body posture (P = .05). Scapular upward rotation and posterior tilt were significantly different between the postures (P < .001). Sex had statistically significant, but quantitatively small, effects on shoulder kinematics. Conclusions Body postures affect shoulder kinematics during humeral elevation. This knowledge will be useful to optimize rehabilitation exercises and for diagnostic insight.
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Affiliation(s)
- Akira Sugi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
- Corresponding author: Akira Sugi, MD, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Keisuke Matsuki
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Ryunosuke Fukushi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Shimoto
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
- Department of Information and System Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | | | - Yuji Shibayama
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Nishinaka
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Scott A. Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
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24
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Sabatini L, Barberis L, Camazzola D, Centola M, Capella M, Bistolfi A, Schiraldi M, Massè A. Bicruciate-retaining total knee arthroplasty: What’s new? World J Orthop 2021; 12:732-742. [PMID: 34754829 PMCID: PMC8554348 DOI: 10.5312/wjo.v12.i10.732] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/23/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Primary total knee arthroplasty (TKA) is a widespread procedure to address end stage osteoarthritis with good results, clinical outcomes, and long-term survivorship. Although it is frequently performed in elderly, an increased demand in young and active people is expected in the next years. However, a considerable dissatisfaction rate has been reported by highly demanding patients due to the intrinsic limitations provided by the TKA. Bicruciate-retaining (BCR) TKA was developed to mimic knee biomechanics, through anterior cruciate ligament preservation. First-generation BCR TKA has not gained popularity due to its being a challenging technique and having poor survival outcomes. Thanks to implant design improvement and surgeon-friendly instrumentation, second-generation BCR TKA has seen renewed interest. This review will focus on surgical indications, kinematical basis, clinical results and latest developments of second-generation BCR TKA.
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Affiliation(s)
- Luigi Sabatini
- Orthopaedics and Traumatology Department, Presidio CTO, Torino 10126, Italy
| | - Luca Barberis
- Orthopaedics and Traumatology Department, Presidio CTO, Torino 10126, Italy
| | - Daniele Camazzola
- Orthopaedics and Traumatology Department, CTO Hospital, Torino 10126, Italy
| | - Michele Centola
- Orthopaedics and Traumatology Department, Presidio CTO, Torino 10126, Italy
| | - Marcello Capella
- Orthopaedics and Traumatology Department, CTO Hospital, Torino 10126, Italy
| | | | - Marco Schiraldi
- Orthopedics and Traumaology Department, Michele e Pietro Ferrero Hospital, Verduno 12060, Italy
| | - Alessandro Massè
- Orthopaedics and Traumatology Department, CTO Hospital, Torino 10126, Italy
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25
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Kono K, Inui H, Tomita T, D'Lima DD, Yamazaki T, Konda S, Taketomi S, Yamagami R, Kawaguchi K, Sameshima S, Kage T, Tanaka S. Cruciate ligament force of knees following mobile-bearing unicompartmental knee arthroplasty is larger than the preoperative value. Sci Rep 2021; 11:18233. [PMID: 34521921 PMCID: PMC8440682 DOI: 10.1038/s41598-021-97655-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
We analyzed the implantation effects on cruciate ligament force in unicompartmental knee arthroplasty (UKA) and determined whether kinematics is associated with the cruciate ligament force. We examined 16 patients (17 knees) undergoing medial UKA. Under fluoroscopy, each participant performed a deep knee bend before and after UKA. A two-dimensional/three-dimensional registration technique was employed to measure tibiofemoral kinematics. Forces in the anteromedial and posterolateral bundles of both the anterior cruciate ligament (aACL and pACL) and the anterolateral and posteromedial bundles of the posterior cruciate ligament (aPCL and pPCL) during knee flexion were analyzed pre- and post-UKA. Correlations between changes in kinematics and ligament forces post-UKA were also analyzed. Preoperatively, the aACL forces were highly correlated with anteroposterior (AP) translation of the lateral condyles (Correlation coefficient [r] = 0.59). The pPCL forces were highly correlated with the varus–valgus angulation (r = − 0.57). However, postoperatively, the PCL forces in both bundles were highly correlated with the AP translation of the medial femoral condyle (aPCL: r = 0.62, pPCL: r = 0.60). The ACL and PCL forces of the knees post-UKA were larger than those of the knees pre-UKA. Kinematic changes were significantly correlated with the cruciate ligament force changes.
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Affiliation(s)
- Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Darryl D D'Lima
- Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, La Jolla, CA, 92037, USA.,Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, 92121, USA
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama, 369-0293, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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26
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Arauz P, Peng Y, Castillo T, Klemt C, Kwon YM. In Vitro Kinematic Analysis of Single Axis Radius Posterior-Substituting Total Knee Arthroplasty. J Knee Surg 2021; 34:1253-1259. [PMID: 32268403 DOI: 10.1055/s-0040-1708039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This is an experimental study. As current posterior-substituting (PS) total knee arthroplasties have been reported to incompletely restore intrinsic joint biomechanics of the healthy knee, the recently designed single axis radius PS knee system was introduced to increase posterior femoral translation and promote ligament isometry. As there is a paucity of data available regarding its ability to replicate healthy knee biomechanics, this study aimed to assess joint and articular contact kinematics as well as ligament isometry of the contemporary single axis radius PS knee system. Implant kinematics were measured from 11 cadaveric knees using an in vitro robotic testing system. In addition, medial collateral ligament (MCL) and lateral collateral ligament (LCL) forces were quantified under simulated functional loads during knee flexion for the contemporary PS knee system. Posterior femoral translation between the intact knee and the single axis radius PS knee system differed significantly (p < 0.05) at 60, 90, and 120 degrees of flexion. The LCL force at 60 degrees (9.06 ± 2.81 N) was significantly lower (p < 0.05) than those at 30, 90, and 120 degrees of flexion, while MCL forces did not differ significantly throughout the range of tested flexion angles. The results from this study suggest that although the contemporary single axis radius PS knee system has the potential to mimic the intact knee kinematics under muscle loading during flexion extension due to its design features, single axis radius PS knee system did not fully replicate posterior femoral translation and ligament isometry of the healthy knee during knee flexion.
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Affiliation(s)
- Paul Arauz
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yun Peng
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tiffany Castillo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Dai H, Zheng N, Zou D, Zhu Z, Liow MHL, Tsai TY, Wang Q. More Anterior in vivo Contact Position in Patients With Fixed-Bearing Unicompartmental Knee Arthroplasty During Daily Activities Than in vitro Wear Simulator. Front Bioeng Biotechnol 2021; 9:666435. [PMID: 34095100 PMCID: PMC8173134 DOI: 10.3389/fbioe.2021.666435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While in vitro wear simulation of unicompartmental knee arthroplasty (UKA) showed outstanding long-term wear performance, studies reported that polyethylene (PE) wear was responsible for 12% fixed-bearing (FB) UKA failure. This paper aimed to quantify the in vivo 6-degrees-of-freedom (6-DOF) knee kinematics and contact positions of FB UKA during daily activities and compare with the previous results of in vitro wear simulator. METHODS Fourteen patients following unilateral medial FB UKA received a CT scan and dual fluoroscopic imaging during level walking, single-leg deep lunge, and sit-to-stand motion for evaluating in vivo 6-DOF FB UKA kinematics. The closest point between surface models of the femoral condyle and PE insert was determined to locate the medial compartmental articular contact positions, which were normalized relative to the PE insert length. The in vivo contact area was compared with the in vitro wear region in previous simulator studies. RESULTS The in vivo contact positions during daily activities were more anterior than those in the previous in vitro wear simulator studies (p < 0.001). Significant differences in the femoral anteroposterior translation and tibial internal rotation during the stance phase were observed and compared with those in lunge and sit-to-stand motions (p < 0.05). The in vivo contact position located anteriorly and medially by 5.2 ± 2.7 and 1.8 ± 1.6 mm on average for the stance phase, 1.0 ± 2.4 and 0.9 ± 1.5 mm for the lunge, and 2.1 ± 3.3 and 1.4 ± 1.4 mm for sit-to-stand motion. The in vivo contact position was in the more anterior part during the stance phase (p < 0.05). CONCLUSION The current study revealed that the contact position of FB UKA was located anteriorly and medially on the PE insert during in vivo weight-bearing activities and different from previous findings of the in vitro wear simulator. We should take in vivo 6-DOF knee kinematics and contact patterns of FB UKA into account to reproduce realistic wear performance for in vitro wear simulator and to improve implant design.
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Affiliation(s)
- Huiyong Dai
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhemin Zhu
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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Zhang Q, Chen Z, Jin Z, Muratoglu OK, Varadarajan KM. Patient-specific musculoskeletal models as a framework for comparing ACL function in unicompartmental versus bicruciate retaining arthroplasty. Proc Inst Mech Eng H 2021; 235:861-872. [PMID: 33913346 DOI: 10.1177/09544119211011827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unicompartmental knee arthroplasty has been shown to provide superior functional outcomes compared to total knee arthroplasty and have motivated development of advanced implant designs including bicruciate retaining knee arthroplasty. However, few validated frameworks are available to directly compare the effect of implant design and surgical techniques on ligament function and joint kinematics. In the present study, the subject-specific lower extremity models were developed based on musculoskeletal modeling framework using force-dependent kinematics method, and validated against in vivo telemetric data. The experiment data of two subjects who underwent TKA were obtained from the SimTK "Grand Challenge Competition" repository, and integrated into the subject-specific lower extremity model. Five walking gait trials and three different knee implant models for each subject were used as partial inputs for the model to predict knee biomechanics for unicompartmental, bicruciate retaining, and total knee arthroplasty. The results showed no significant differences in the tibiofemoral contact forces or angular kinematic parameters between three groups. However, unicompartmental knee arthroplasty demonstrated significantly more posterior tibial location between 0% and 40% of the gait cycle (p < 0.017). Significant differences in range of tibiofemoral anterior/posterior translation and medial/lateral translation were also observed between unicompartmental and bicruciate retaining arthroplasty (p < 0.017). Peak values of anterior cruciate ligament forces differed between unicompartmental and bicruciate retaining arthroplasty from 10% to 30% of the gait cycle. Findings of this study indicate that unicompartmental and bicruciate retaining arthroplasty do not have identical biomechanics and point to the complementary role of anterior cruciate ligament and articular geometry in guiding knee function. Further, the patient-specific musculoskeletal model developed provides a reliable framework for assessing new implant designs, and effect of surgical techniques on knee biomechanics following arthroplasty.
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Affiliation(s)
- Qida Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang'an University, Xi'an, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China.,Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Orhun K Muratoglu
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kartik M Varadarajan
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Sezer HB, Bohu Y, Hardy A, Lefevre N. Knee Prosthesis in the Computer Era. Orthop Surg 2021; 13:395-401. [PMID: 33506615 PMCID: PMC7957434 DOI: 10.1111/os.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
Over the past two decades, computer assistance has revolutionalized surgery and has enabled enormous advancements in knee prosthesis surgery. Total knee arthroplasty (TKA) is a hot topic of orthopaedic research. Reflecting population dynamics, its use continues to increase, especially in high demand populations. Therefore, efforts to achieve the best fit and precise alignment in TKA continue. Computer assistance is valuable for knee prosthesis surgeons in this regard. This manuscript investigated the use of computer assistance in knee prosthesis surgery. The effects of computer use on important facets of knee prosthesis surgery, such as precision, clinical aspects, and costs, were examined. Moreover, an overall review of the recent literature on the navigation and personalized cutting guides was conducted.
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Affiliation(s)
| | - Yoann Bohu
- Clinique du Sport Paris VParisFrance
- Institut de L'Appareil Locomoteur NolletParisFrance
| | - Alexandre Hardy
- Clinique du Sport Paris VParisFrance
- Institut de L'Appareil Locomoteur NolletParisFrance
| | - Nicolas Lefevre
- Clinique du Sport Paris VParisFrance
- Institut de L'Appareil Locomoteur NolletParisFrance
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In vivo kinematics and cruciate ligament forces in bicruciate-retaining total knee arthroplasty. Sci Rep 2021; 11:5645. [PMID: 33707473 PMCID: PMC7952554 DOI: 10.1038/s41598-021-84942-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/19/2021] [Indexed: 12/18/2022] Open
Abstract
We analyzed the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on knee kinematics and cruciate ligament forces. Patients (N = 15) with osteoarthritis (OA) and an intact anterior cruciate ligament (ACL) underwent magnetic resonance imaging and single-plane fluoroscopy to measure tibiofemoral kinematics during two deep knee bend activities before and after BCR-TKA: (1) weight-bearing squat; (2) non-weight-bearing cross-legged sitting. Forces in ligament bundles were calculated using VivoSim. The dynamic range of varus-valgus angulation decreased from 3.9 ± 4.4° preoperatively to 2.2 ± 2.7° postoperatively. Preoperatively, the medial femoral condyle translated anteriorly from 10° to 50° of flexion, and posteriorly beyond 50° of flexion. Postoperatively, the medial and lateral femoral condyles translated posteriorly throughout flexion in a medial pivot pattern. ACL forces were high in extension and decreased with flexion pre- and postoperatively. PCL forces increased with flexion preoperatively and did not change significantly postoperatively. Preoperatively, ACL forces correlated with anteroposterior translation of the femoral condyles. Postoperatively, PCL forces correlated with anteroposterior translation of the lateral femoral condyle. BCR-TKA altered knee kinematics during high flexion activity which correlated significantly with changes in cruciate ligament forces.
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Bi-cruciate retaining total knee arthroplasty: a systematic literature review of clinical outcomes. Arch Orthop Trauma Surg 2021; 141:293-304. [PMID: 33047230 DOI: 10.1007/s00402-020-03622-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022]
Abstract
Total knee arthroplasty (TKA) has been shown to have good long-term outcomes and survivorship. Nonetheless, dissatisfied patients are frequently reported in the literature. Bi-cruciate retaining total knee prostheses (BCR TKA) were designed to address the demand for more kinematically functional implants that better reconstruct natural knee kinematics. In BCR TKA, the anterior cruciate ligament (ACL) is preserved. Improved patient-reported outcomes and satisfaction levels are expected. This review aimed to summarize indications for and clinical outcomes of BCR TKA. A systematic literature review on BCR TKA was performed. 24 articles were included for data analysis. Indications covered osteoarthritis, inflammatory arthritis and others. The degree of deformity was often but not always limited to minor axial deformity and contractures: maximum acceptable varus/valgus deformity reached 10°-30° and flexion contractures of 15°-65°. ACL intactness was macroscopically examined intraoperatively in nine studies and clinically tested in ten studies (e.g., Lachmann Test, drawer-test). Objective and patient-reported outcome scores were reported for follow-up periods of up to 22 years. Survival rates varied significantly. For first generation implants, 22-year survival reached 82% while a second generation design was associated with 13.5% revision rate at 18 months. Reasons for varying outcomes were not clear and may be attributed to the implant itself, surgical techniques and patient specific variables including changed expectations and functional demand. The literature has not shown clear indications and guidelines for the use of BCR implants. The promising results of first generation BCR TKA designs may be optimized through improved implant designs in the future. Further studies are advocated to provide the necessary evidence of second generation BCR TKA designs.
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Klemt C, Tirumala V, Oganesyan R, Xiong L, van den Kieboom J, Kwon YM. Single-Stage Revision of the Infected Total Knee Arthroplasty Is Associated With Improved Functional Outcomes: A Propensity Score-Matched Cohort Study. J Arthroplasty 2021; 36:298-304. [PMID: 32778418 DOI: 10.1016/j.arth.2020.07.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Single-stage revision is an alternative to the standard 2-stage revision, potentially minimizing morbidities and improving functional outcomes. This study aimed at comparing single-stage and 2-stage revision total knee arthroplasty (TKA) for chronic periprosthetic joint infection (PJI) with regard to patient-reported outcome measures (PROMs) and complication rates. METHODS A total of 185 consecutive revision TKA patients for chronic PJI with complete preoperative and postoperative PROMs were investigated. A total of 44 patients with single-stage revision TKA were matched to 88 patients following 2-stage revision TKA using propensity score matching, yielding a total of 132 propensity score-matched patients for analysis. Patient demographics and clinical information including reinfection and readmission rates were evaluated. RESULTS There was no significant difference in preoperative PROMs between propensity score-matched single-stage and 2-stage revision TKA cohorts. Postoperatively, significantly higher PROMs for single-stage revision TKA were observed for Knee disability and Osteoarthritis Outcome Score physical function (62.2 vs 51.9, P < .01), physical function short form 10A (42.8 vs 38.1, P < .01), PROMIS SF Physical (44.8 vs 41.0, P = .01), and PROMIS SF Mental (50.5 vs 47.1, P = .02). There was no difference between propensity score-matched single-stage and 2-stage revision TKA cohorts for clinical outcomes including reinfection rates (25.0% vs 27.2%, P = .78) and 90-day readmission rates (22.7% vs 25.0%, P = .77). CONCLUSION This study illustrated that single-stage revision TKA for chronic PJI may be associated with superior patient-reported outcomes compared to 2-stage revision for the infected TKA using a variety of PROMs. Improved PROMs were not accompanied by differences in complication rates between both cohorts, suggesting that single-stage revision TKA may provide an effective alternative to 2-stage revision in patients with chronic TKA PJI.
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Affiliation(s)
- Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
| | | | - Ruben Oganesyan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Liang Xiong
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Janna van den Kieboom
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
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Takasago T, Hamada D, Wada K, Nitta A, Tamaki Y, Goto T, Tsuruo Y, Sairyo K. Insufficient lateral joint laxity after bicruciate-retaining total knee arthroplasty potentially influences kinematics during flexion: A biomechanical cadaveric study. Knee 2021; 28:311-318. [PMID: 33477002 DOI: 10.1016/j.knee.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Soft tissue balancing in bicruciate-retaining (BCR) total knee arthroplasty (TKA) is a challenge that must be overcome to achieve excellent clinical outcomes. However, the optimal degree of joint laxity has yet to be clarified. This cadaveric study sought to examine joint laxity after BCR TKA using a navigation system. METHODS Knee joint laxity was quantified using an image-free navigation system in 8 intact fresh frozen cadavers under three conditions: the native knee, BCR TKA knee, and BCR TKA knee after anterior cruciate ligament resection. Rotational kinematics in the BCR TKA knee during flexion were compared according to whether joint laxity was increased or decreased. RESULTS Knee joint laxity after BCR TKA under varus-valgus movement, anterior translation, and internal-external rotation loadings was similar to that of the native knee. However, lateral joint laxity was decreased during flexion in some cases. BCR TKA-treated knees with decreased lateral joint laxity at 90° of flexion demonstrated more limited tibial internal rotation in deep flexion than the native knee (p < 0.05). The loss of internal rotation in deep flexion was partly recovered by using a lateral insert with a posterior slope of +3°. CONCLUSIONS Restoring optimal joint laxity was not always straightforward in BCR TKA if the 4 ligaments were preserved. Lateral joint laxity was potentially decreased in BCR TKA and may result in kinematic conflict during flexion. Surgeons should be aware of the need to achieve sufficient lateral joint laxity in this type of BCR TKA.
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Affiliation(s)
- Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Akihiro Nitta
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Yoshihiro Tsuruo
- Department of Anatomy, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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Ogawa H, Matsumoto K, Akiyama H. Functional assessment of the anterior cruciate ligament in knee osteoarthritis. J Orthop 2020; 23:175-179. [PMID: 33551609 DOI: 10.1016/j.jor.2020.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/23/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study was to evaluate anterior cruciate ligament (ACL) function in knee osteoarthritis (OA) and clarify the relationship of MRI and arthroscopic findings with ACL function. Eighty patients with knee OA were evaluated for anterior knee joint laxity, Kellgren-Lawrence grade, MRI ACL grade, arthroscopic ACL grade, osteophytes, and meniscus tears. ACL function was significantly correlated with osteophyte scores and medial and lateral meniscus tears. The MRI ACL grade was strongly correlated with the arthroscopic ACL grade, and anterior knee joint laxity decreased as the grades increased, suggesting a decrease in the elasticity of degenerated ACLs.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan.,Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
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Early results with a bicruciate-retaining total knee arthroplasty: a match-paired study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:785-790. [PMID: 33215307 DOI: 10.1007/s00590-020-02834-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study is to compare 2 groups of total knee arthroplasties (TKAs): the bicruciate-retaining (BCR-group) and cruciate-retaining total knee arthroplasty (CR-group), evaluating the functional results in the short-term follow-up. METHODS 24 BCR were included in the study and were compared with a group of 24 TKAs performed with the same implant, but with sacrifice of the ACL and retention of the posterior cruciate ligament. For preoperative and postoperative clinical evaluation, the visual analogue score (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used. Radiological evaluation included weight-bearing long-leg view, a Rosemberg view, lateral view of the knee and tangential view of the patella. Hip-knee-ankle angle (HKA) was recorded pre and postoperatively. Radiolucent lines (RLLs) were evaluated according the Knee Society Roentgenographic Evaluation System (KSRES). RESULTS At last follow-up the mean VAS score was 1.81 for BCR group and 1.43 for CR group (p = 0.61). The mean WOMAC score was 8.68 for BCR group and 12.81 for CR group (p = 0.33). As for the radiological evaluation, preoperative HKA angle was 0.53° varus for BCR group and 3.14° varus for CR group (p = 0.24); postoperative HKA was 0.72° valgus for BCR group and 0.38° valgus for CR group (p = 0.75). The percentage of RLLs was similar between the two groups (12% versus 15%). CONCLUSIONS BCR-TKA has showed to give similar functional and radiographic outcomes compared to conventional CR-TKA in a similar cohort of patients. An higher operative times and higher number of complications respect were found in BCR group. These results can be explained by the early learning curve experiences. Future randomized controlled trials should be performed to support new implant designs such as BCR. LEVEL OF EVIDENCE Level of evidence Case-control study, level III.
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Zhang Q, Chen Z, Zhang Z, Jin Z, Muratoglu OK, Varadarajan KM. Leveraging subject-specific musculoskeletal modeling to assess effect of anterior cruciate ligament retaining total knee arthroplasty during walking gait. Proc Inst Mech Eng H 2020; 234:1445-1456. [DOI: 10.1177/0954411920947204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Bi-cruciate retaining total knee arthroplasty has several potential advantages including improved anteroposterior knee stability compared to contemporary posterior cruciate-retaining total knee arthroplasty. However, few studies have explored whether there is significant differences of knee biomechanics following bi-cruciate retaining total knee arthroplasty compared to posterior cruciate-retaining total knee arthroplasty. In the present study, subject-specific lower extremity musculoskeletal multi-body dynamics models for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty were developed based on the musculoskeletal modeling framework using force-dependent kinematics method and validated against in vivo telemetric data. The experiment data of two subjects who underwent total knee arthroplasty were obtained for the SimTK “Grand Challenge Competition” repository, and integrated into the musculoskeletal model. Five walking gait trials for each subject were used as partial inputs for the model to predict the knee biomechanics for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty. The results revealed significantly greater range of anterior/posterior tibiofemoral translation, and significantly more posterior tibial location during the early phase of gait and more anterior tibial location during the late phase of gait were found in bi-cruciate retaining total knee arthroplasty without anterior cruciate ligament when compared to the bi-cruciate retaining total knee arthroplasty. No significant differences in tibiofemoral contact forces, rotations, translations, and ligament forces between bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty during normal walking gait, albeit slight differences in range of tibiofemoral internal/external rotation and anterior/posterior translation were observed. The present study revealed that anterior cruciate ligament retention has a positive effect on restoring normal knee kinematics in bi-cruciate retaining total knee arthroplasty. Preservation of anterior cruciate ligament in total knee arthroplasty and knee implant designs interplay each other and both contribute to restoring normal knee kinematics in different types of total knee arthroplasty. Further evaluation of more demanding activities and subject data from patients with bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty via musculoskeletal modeling may better highlight the role of the anterior cruciate ligament and its stabilizing influence.
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Affiliation(s)
- Qida Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang’an University, Xi’an, China
| | - Zhifeng Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Orhun K Muratoglu
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kartik M Varadarajan
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Kwon YM, Arauz P, Peng Y, Klemt C. In vivo kinematics of deep lunges and sit-to-stand activities in patients with bicruciate-retaining total knee arthroplasty. Bone Joint J 2020; 102-B:59-65. [PMID: 32475273 DOI: 10.1302/0301-620x.102b6.bjj-2019-1552.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS The removal of the cruciate ligaments in total knee arthroplasty (TKA) has been suggested as a potential contributing factor to patient dissatisfaction, due to alteration of the in vivo biomechanics of the knee. Bicruciate retaining (BCR) TKA allows the preservation of the cruciate ligaments, thus offering the potential to reproduce healthy kinematics. The aim of this study was to compare in vivo kinematics between the operated and contralateral knee in patients who have undergone TKA with a contemporary BCR design. METHODS A total of 29 patients who underwent unilateral BCR TKA were evaluated during single-leg deep lunges and sit-to-stand tests using a validated computer tomography and fluoroscopic imaging system. In vivo six-degrees of freedom (6DOF) kinematics were compared between the BCR TKA and the contralateral knee. RESULTS During single-leg deep lunge, BCR TKAs showed significantly less mean posterior femoral translation (13 mm; standard deviation (SD) 4) during terminal flexion, compared with the contralateral knee (16.6 mm, SD 3.7; p = 0.001). Similarly, BCR TKAs showed significantly less mean femoral rollback (11.6 mm (SD 4.5) vs 14.4 mm (SD 4.6); p < 0.043) during sit-to-stand. BCR TKAs showed significantly reduced internal rotation during many parts of the strenuous flexion activities particularly during high-flexion lunge (4° (SD 5.6°) vs 6.5° (SD 6.1°); p = 0.051) and during sit-to-stand (4.5° (SD 6°) vs 6.9° (SD 6.3°); p = 0.048). CONCLUSION The contemporary design of BCR TKA showed asymmetrical flexion-extension and internal-external rotation, suggesting that the kinematics are not entirely reproduced during strenuous activities. Future studies are required to establish the importance of patient factors, component orientation and design, in optimizing kinematics in patients who undergo BCR TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):59-65.
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Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Arauz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yun Peng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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