Limited effect of anatomical insert geometry on in vitro laxity in balanced anatomic posterior cruciate ligament retaining total knee arthroplasty

Abstract

Purpose: The present study assessed the effect of insert articular surface geometry (anatomical versus conventional insert design) on anteroposterior (AP) translation and varus-valgus (VV) laxity in balanced posterior cruciate ligament (PCL) retaining total knee arthroplasty (TKA). Secondly, we evaluated if the AP translation and VV laxity in the reconstructed knee resembled the stability of the native knee.

Methods: Nine fresh-frozen full-leg cadaver specimens were used in this study. After testing the native knee, anatomical components of a PCL-retaining implant were implanted. The knee joints were subjected to anteriorly and posteriorly directed forces (at 20° and 90° flexion) and varus-valgus stresses (at 20°, 45° and 90° flexion) in both non-weightbearing and weightbearing situations in a knee kinematics simulator. Measurements were performed in the native knee, TKA with anatomical insert geometry (3° built-in varus, medial concave, lateral convex), and TKA with symmetrical insert geometry.

Results: In weightbearing conditions, anterior translations ranged between 2.6 and 3.9 mm at 20° flexion and were < 1 mm at 90° flexion. Posterior translation at 20° flexion was 2.7 mm for the native knee versus 4.0 mm (p = 0.047) and 7.0 mm (p = 0.02) for the symmetrical insert and the anatomical insert, respectively. Posterior translation at 90° flexion was < 1.1 mm and not significantly different between the native knee and insert types. In non-weightbearing conditions, the anterior translation at 20° flexion was 5.9 mm for the symmetrical and 4.6 mm for the anatomical insert (n.s.), compared with 3.0 mm for the native knee (p = 0.02). The anterior translation at 90° flexion was significantly higher for the reconstructed knees (anatomical insert 7.0 mm; symmetrical insert 9.2 mm), compared with 1.6 mm for the native knee (both p = 0.02). Varus-valgus laxity at different flexion angles was independent of insert geometry. A valgus force in weightbearing conditions led to significantly more medial laxity (1°-3° opening) in the native knee at 45° and 90° flexion compared with the reconstructed knee for all flexion angles.

Conclusions: Insert geometry seems to have a limited effect with respect to AP translation and VV laxity, in the well-balanced PCL-retaining TKA with an anatomical femoral component. Secondly, AP translation and VV laxity in the reconstructed knee approximated the laxity of the native knee.

Keywords: Anteroposterior translation; Cruciate-retaining total knee arthroplasty; PCL-retaining total knee arthroplasty; Spacer technique; Total knee arthroplasty; Varus-valgus laxity.