Ignace Ghijselings1, Orcun Taylan2, Hendrik Pieter Delport3,4, Josh Slane2, Hans Van den Wyngaert1, Alex Demurie1, Lennart Scheys2,5. 1. Department of Orthopedics and Traumatology, AZ Alma, Ringlaan 15, Eeklo, Belgium. 2. Institute for Orthopedic Research and Training (IORT), KU Leuven, UZ Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium. 3. Institute for Orthopedic Research and Training (IORT), KU Leuven, UZ Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium. hendrik.delport@hotmail.be. 4. Division of Orthopedics, University Hospitals Leuven, Leuven, Belgium. hendrik.delport@hotmail.be. 5. Division of Orthopedics, University Hospitals Leuven, Leuven, Belgium.
Abstract
INTRODUCTION: Poor soft tissue balance in total knee arthroplasty (TKA) often results in patient dissatisfaction and reduced joint longevity. Patella-in-place balancing (PIPB) is a novel technique which aims to restore native collateral ligament behavior without collateral ligament release, while restoring post-operative patellar position. This study aimed to assess the effectiveness of this novel technique through a detailed ex vivo biomechanical analysis by comparing post-TKA tibiofemoral kinematics and collateral ligament behavior to the native condition. MATERIALS AND METHODS: Eight fresh-frozen cadaveric legs (89.2 ± 6 years) were tested on a validated dynamic knee simulator, following computed tomography imaging. Specimens were subjected to passive flexion (10-120°), squatting (35-100°), and varus/valgus laxity testing (10 Nm at 0°, 30°, 60°, 90° flexion). An optical motion capture system recorded markers affixed rigidly to the femur, tibia, and patella, while digital extensometers longitudinally affixed to the superficial medial collateral ligament (MCL) and lateral collateral ligament (LCL) collected synchronized strain data. Following native testing, a Stryker Triathlon CR TKA (Stryker, MI, USA) was performed on each specimen and the identical testing protocol was repeated. Statistical analyses were performed using a linear mixed model for functional motor tasks, while Wilcoxon signed-rank test was used for laxity tests (p < 0.05). RESULTS: Postoperative laxity was lower than the native condition at all flexion angles while post-operative ligament strain was lowered only for MCL at 30° (p = 0.017) and 60° (p = 0.011). Postoperative femoral rollback patterns were comparable to the native condition in passive flexion but demonstrated a more pronounced medial pivot during squatting. CONCLUSIONS: Balancing a TKA with the PIPB technique resulted in reduced joint laxity, while restoring collateral ligament strains. The technique also seemed to restore kinematics and strains, especially in passive flexion.
INTRODUCTION: Poor soft tissue balance in total knee arthroplasty (TKA) often results in patient dissatisfaction and reduced joint longevity. Patella-in-place balancing (PIPB) is a novel technique which aims to restore native collateral ligament behavior without collateral ligament release, while restoring post-operative patellar position. This study aimed to assess the effectiveness of this novel technique through a detailed ex vivo biomechanical analysis by comparing post-TKA tibiofemoral kinematics and collateral ligament behavior to the native condition. MATERIALS AND METHODS: Eight fresh-frozen cadaveric legs (89.2 ± 6 years) were tested on a validated dynamic knee simulator, following computed tomography imaging. Specimens were subjected to passive flexion (10-120°), squatting (35-100°), and varus/valgus laxity testing (10 Nm at 0°, 30°, 60°, 90° flexion). An optical motion capture system recorded markers affixed rigidly to the femur, tibia, and patella, while digital extensometers longitudinally affixed to the superficial medial collateral ligament (MCL) and lateral collateral ligament (LCL) collected synchronized strain data. Following native testing, a Stryker Triathlon CR TKA (Stryker, MI, USA) was performed on each specimen and the identical testing protocol was repeated. Statistical analyses were performed using a linear mixed model for functional motor tasks, while Wilcoxon signed-rank test was used for laxity tests (p < 0.05). RESULTS: Postoperative laxity was lower than the native condition at all flexion angles while post-operative ligament strain was lowered only for MCL at 30° (p = 0.017) and 60° (p = 0.011). Postoperative femoral rollback patterns were comparable to the native condition in passive flexion but demonstrated a more pronounced medial pivot during squatting. CONCLUSIONS: Balancing a TKA with the PIPB technique resulted in reduced joint laxity, while restoring collateral ligament strains. The technique also seemed to restore kinematics and strains, especially in passive flexion.
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