Jörg Lützner1, F-P Firmbach, C Lützner, J Dexel, S Kirschner. 1. Department of Orthopaedic Surgery, Medical Faculty, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany, Joerg.Luetzner@uniklinikum-dresden.de.
Abstract
PURPOSE: The use of an ultracongruent (UC) insert with a standard femoral component for substitution of the posterior cruciate ligament (PCL) is a bone-preserving and therefore interesting alternative to the established box and cam mechanism of posterior-stabilized total knee arthroplasty (TKA). Despite the regular use of these UC inserts, there is little evidence about stability and range of motion (ROM). METHODS: The aim of this study was to evaluate the stability and ROM in standard cruciate-retaining (CR) and cruciate-substituting UC inserts of the same TKA. In 39 patients, intraoperative measurements of stability and ROM were taken (1) before soft tissue release and bone cuts, (2) after implantation of a CR TKA and (3) after resection of the PCL and substitution with an UC insert. All measurements were taken using a navigation system. RESULTS: Stability measurements demonstrated no differences between CR (PCL intact) and UC TKA (PCL resected), but significantly increased anteroposterior translation at 60° and 90° of knee flexion compared with the preoperative condition. ROM measurements demonstrated improvement of knee flexion from preoperatively mean 105° (SD 14.1°) to intraoperative 120.2° (SD 6.7°) with the CR and 121.0° (SD 7.5°) with the UC insert and 113.5° (SD 14.0°) at the 1-year follow-up. CONCLUSION: This study demonstrates similar stability of an UC insert compared with a standard CR insert. UC inserts are therefore a bone-preserving solution if the PCL needs to be substituted. ROM was not improved after resection of the PCL and substitution with the UC insert. LEVEL OF EVIDENCE: II.
PURPOSE: The use of an ultracongruent (UC) insert with a standard femoral component for substitution of the posterior cruciate ligament (PCL) is a bone-preserving and therefore interesting alternative to the established box and cam mechanism of posterior-stabilized total knee arthroplasty (TKA). Despite the regular use of these UC inserts, there is little evidence about stability and range of motion (ROM). METHODS: The aim of this study was to evaluate the stability and ROM in standard cruciate-retaining (CR) and cruciate-substituting UC inserts of the same TKA. In 39 patients, intraoperative measurements of stability and ROM were taken (1) before soft tissue release and bone cuts, (2) after implantation of a CR TKA and (3) after resection of the PCL and substitution with an UC insert. All measurements were taken using a navigation system. RESULTS: Stability measurements demonstrated no differences between CR (PCL intact) and UC TKA (PCL resected), but significantly increased anteroposterior translation at 60° and 90° of knee flexion compared with the preoperative condition. ROM measurements demonstrated improvement of knee flexion from preoperatively mean 105° (SD 14.1°) to intraoperative 120.2° (SD 6.7°) with the CR and 121.0° (SD 7.5°) with the UC insert and 113.5° (SD 14.0°) at the 1-year follow-up. CONCLUSION: This study demonstrates similar stability of an UC insert compared with a standard CR insert. UC inserts are therefore a bone-preserving solution if the PCL needs to be substituted. ROM was not improved after resection of the PCL and substitution with the UC insert. LEVEL OF EVIDENCE: II.
Authors: Christopher L Peters; Patrick Mulkey; Jill Erickson; Michael B Anderson; Christopher E Pelt Journal: Clin Orthop Relat Res Date: 2014-01 Impact factor: 4.176
Authors: J-N Argenson; S Boisgard; S Parratte; S Descamps; M Bercovy; P Bonnevialle; J-L Briard; J Brilhault; J Chouteau; R Nizard; D Saragaglia; E Servien Journal: Orthop Traumatol Surg Res Date: 2013-05-02 Impact factor: 2.256
Authors: F D Naal; F M Impellizzeri; M Sieverding; M Loibl; F von Knoch; A F Mannion; M Leunig; U Munzinger Journal: Osteoarthritis Cartilage Date: 2008-07-07 Impact factor: 6.576
Authors: Pieter-Jan T K Vandekerckhove; Roel Parys; Thomas Tampere; Patrick Linden; Luc Van den Daelen; Peter C Verdonk Journal: Knee Surg Sports Traumatol Arthrosc Date: 2014-10-25 Impact factor: 4.342
Authors: Dae Kyung Bae; Sang Jun Song; Kang Il Kim; Dong Hur; Hyun Ho Lee Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-01-05 Impact factor: 4.342