Effect of rotational malposition of the femoral component on knee stability kinematics after total knee arthroplasty.

Excessive external rotation of the femoral component can cause an abnormally tight popliteus tendon complex, which induces loss of rotational laxity of the knee in the late phase of knee flexion after total knee arthroplasty. This study evaluated the effect of popliteus tendon release on rotational and varus-valgus laxity of implanted knees with an excessively externally rotated femoral component. Rotational and varus-valgus laxity was measured with a knee kinematics testing device before and after total knee arthroplasty. External rotational positions of the femoral component of 5 degrees and 8 degrees were compared, and the effects of popliteus tendon release on rotational and varus-valgus laxity were evaluated. To further investigate this question, the effect of a conforming articular design was compared with that of a flat tibial surface. External rotational position of 5 degrees did not change rotational or varus-valgus laxity of the knee. With an 8 degrees external rotational position, however, external rotational laxity significantly decreased in knees with a conforming surface at angles of 30 degrees, 45 degrees, 60 degrees, and 90 degrees. After popliteus tendon release, external rotational laxity significantly improved at 90 degrees flexion and was identical to that of the normal knee. Internal rotational range was similar before and after popliteus tendon release. Popliteus tendon release did not affect the varus-valgus laxity (stability) with either articular surface.