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. 2022 Dec 24;13(1):36.
doi: 10.3390/jpm13010036.

Total Knee Arthroplasty Violates the Law of Burmester-A Biomechanical Investigation

Günther Maderbacher  1 , Armin Keshmiri  1 , Hans Robert Springorum  1 , Andreas Mösenbacher  2 , Joachim Grifka  1 , Clemens Baier  1
Affiliations

Total Knee Arthroplasty Violates the Law of Burmester-A Biomechanical Investigation

Günther Maderbacher et al. J Pers Med. .

Abstract

Background: Kinematic patterns of knees after total knee arthroplasty (TKA) are different from those of healthy knees. We hypothesised that these changes cause a relevant shift in the medial and lateral epicondyles and, consequently, the insertion sites of the collateral ligaments. Any alterations, however, violate the law of Burmester, which states a close relation between the course of the collateral and cruciate ligaments, and the articular surfaces.

Methods: Ten healthy knees of whole body cadavers were investigated. The positions of the medial and lateral epicondyles in relation to the tibia were compared before and after cruciate retaining fixed bearing TKA between 0 and 90° of flexion using a navigational device.

Results: After TKA, the medial and lateral epicondyles significantly shifted laterally (~3-5mm) between 0° and 40° of flexion. Additionally, the lateral epicondyle was located significantly more dorsal (~3-5mm) during 0° and 20° of flexion and significantly shifted proximally (~2.5-3mm) between 0° and 30° of flexion.

Conclusions: By changing the epicondylar positions relative to the articular surfaces, the law of Burmester is violated in the present study setting. This might explain the impairment in motion, instability, or mid-flexion instability and the persistent pain in the knees after TKA.

Keywords: Burmester; TKA; kinematics; knee; mid-flexion instability; total knee arthroplasty.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
According to Burmester, fibres and insertion points of the collateral ligaments correspond to two-third-order curves, which are related to the articular surface and intersect at the crossing point of the four-bar linkage. This guarantees tensioned ligamentous fibres throughout flexion.
Figure 2
Figure 2
Positions of the medial epicondyles before (black dots) and after total knee arthroplasty (TKA) (white dots), and lateral epicondyles before (black squares) and after TKA (white squares) in millimetres between 0 and 90° of flexion are shown.
See this image and copyright information in PMC

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