Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 27;22(1):830.
doi: 10.1186/s12891-021-04709-4.

Both intraoperative medial and lateral soft tissue balances influence intraoperative rotational knee kinematics in bi-cruciate stabilized total knee arthroplasty: A retrospective investigation

Kentaro Takagi  1 , Hiroshi Inui  2 , Shuji Taketomi  1 , Ryota Yamagami  1 , Kenichi Kono  1 , Kohei Kawaguchi  1 , Shin Sameshima  1 , Tomofumi Kage  1 , Sakae Tanaka  1
Affiliations

Both intraoperative medial and lateral soft tissue balances influence intraoperative rotational knee kinematics in bi-cruciate stabilized total knee arthroplasty: A retrospective investigation

Kentaro Takagi et al. BMC Musculoskelet Disord. .

Abstract

Background: Tibial internal rotation following total knee arthroplasty (TKA) is important in achieving favorable postoperative clinical outcomes. Studies have reported the effect of intraoperative soft tissue balance on tibial internal rotation in conventional TKA, no studies have evaluated the effects of soft tissue balance at medial or lateral compartments separately on tibial internal rotation in bi-cruciate stabilized (BCS) TKA. The purpose of this study was to clarify the relationship between medial or lateral component gaps and rotational knee kinematics in BCS TKA.

Methods: One hundred fifty-eight knees that underwent BCS TKA were included in this study. The intraoperative medial and lateral joint laxities which was defined as the value of component gap minus the thickness of the tibial component were firstly divided into two groups, respectively: Group M-stable (medial joint laxity, ≤ 2 mm) or Group M-loose (medial joint laxity, ≥ 3 mm) and Group L-stable (lateral joint laxity, ≤ 3 mm) or Group L-loose (lateral joint laxity, ≥ 4 mm). And finally, the knees enrolled in this study were divided into four groups based on the combination of Group M and Group L: Group A (M-stable and L-stable), Group B (M-stable and L-loose), Group C (M-loose and L-stable), and Group D (M-loose and L-loose). The intraoperative rotational knee kinematics were compared between the four Groups at 0°, 30°, 60°, and 90° flexion, respectively.

Results: The rotational angular difference between 0° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group A at 30° flexion (*p < 0.05). The rotational angular difference between 30° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group D at 30° flexion (*p < 0.05). The rotational angular differences between 30° or 90° flexion and maximum flexion in Group B at 60° flexion were significantly larger than those in Group A at 60° flexion (*p < 0.05).

Conclusion: Surgeons should pay attention to the importance of medial joint stability at midflexion and lateral joint laxities at midflexion and 90° flexion on a good tibial internal rotation in BCS TKA.

Keywords: Bi-cruciate stabilized; Lateral soft tissue balance; Medial soft tissue balance; Tibial internal rotation; Total knee arthroplasty.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The analysis between RAD 0 and Group A, B, C, and D. RAD 0 in Group B at 30° flexion was significantly larger than that in Group A at 30° flexion (*p < 0.05). RAD 0, the rotational angular difference between 0° flexion and maximum flexion
Fig. 2
Fig. 2
The analysis between RAD 30 and Group A, B, C, and D. RAD 30 in Group B at 30° flexion was significantly larger than that in Group D at 30° flexion (*p < 0.05). RAD 30 in Group B at 60° flexion was significantly larger than that in Group A at 60° flexion (*p < 0.05). RAD 30, the rotational angular difference between 30° flexion and maximum flexion
Fig. 3
Fig. 3
The analysis between RAD 60 and Group A, B, C, and D. No statistical correlation was observed between RAD 60 and the joint laxities at each angle. RAD 60, the rotational angular difference between 60° flexion and maximum flexion
Fig. 4
Fig. 4
The analysis between RAD 90 and Group A, B, C, and D. RAD 90 in Group B at 60° flexion was significantly larger than that in Group A at 60° flexion (*p < 0.05). RAD 90 in Group D at 90° flexion was significantly larger than that in Group A at 90° flexion (*p < 0.05). RAD 90, the rotational angular difference between 90° flexion and maximum flexion
See this image and copyright information in PMC

References

    1. Liebs TR, Kloos SA, Herzberg W, Rüther W, Hassenpflug J. The significance of an asymmetric extension gap on routine radiographs after total knee replacement: A new sign and its clinical significance. Bone Joint J. 2013;95-B:472–7. - PubMed
    1. Seil R, Pape D. Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19:1418–32. - PubMed
    1. Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB. Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res. 2003;416:37–57. - PubMed
    1. Freeman MAR, Pinskerova V. The movement of the normal tibio-femoral joint. J Biomech. 2005;38:197–208. - PubMed
    1. Hamai S, Moro-oka T, Miura H, et al. Knee kinematics in medial osteoarthritis during in vivo weight-bearing activities. J Orthop Res. 2009;27:1555–61. - PubMed

MeSH terms