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Tibiofemoral forces for the native and post-arthroplasty knee: relationship to maximal laxity through a functional arc of motion

Lookup NU author(s): Dr Alasdair Blain, Lee Longstaff, Professor David Deehan

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Abstract

Purpose Accurate soft tissue balance must be achieved to improve functional outcome after total knee arthroplasty (TKA). Sensor-integrated tibial trials have been introduced that allow real-time measurement of tibiofemoral kinematics during TKA. This study examined the interplay between tibiofemoral force and laxity, under defined intraoperative conditions, so as to quantify the kinematic behaviour of the CR femoral single-radius knee. Methods TKA was undertaken in eight loaded cadaveric specimens. Computer navigation in combination with sensor data defined laxity and tibiofemoral contact force, respectively, during manual laxity testing. Fixed-effect linear modelling allowed quantification of the effect for flexion angle, direction of movement and TKA implantation upon the knee. Results An inverse relationship between laxity and contact force was demonstrated. With flexion, laxity increased as contact force decreased under manual stress. Change in laxity was significant beyond 30° for coronal plane laxity and beyond 60° for rotatory laxity (p < 0.01). Rotational stress in mid-flexion demonstrated the greatest mismatch in inter-compartmental forces. Contact point position over the tibial sensor demonstrated paradoxical roll-forward with knee flexion. Conclusion Traditional balancing techniques may not reliably equate to uniform laxity or contact forces across the tibiofemoral joint through a range of flexion and argue for the role of per-operative sensor use to aid final balancing of the knee.


Publication metadata

Author(s): Manning WA, Ghosh K, Blain A, Longstaff L, Deehan DJ

Publication type: Article

Publication status: Published

Journal: Knee Surgery, Sports Traumatology, Arthroscopy

Year: 2017

Volume: 25

Issue: 6

Pages: 1669-1677

Print publication date: 01/06/2017

Online publication date: 31/03/2016

Acceptance date: 14/03/2016

ISSN (print): 0942-2056

ISSN (electronic): 1433-7347

Publisher: Springer Verlag

URL: https://doi.org/10.1007/s00167-016-4093-2

DOI: 10.1007/s00167-016-4093-2

PubMed id: 27034084


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