Medial soft tissue release is also related to the anterior stability of cruciate‑retaining total knee arthroplasty: a cadaveric study
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Background: Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Methods: Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension, 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability was compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Results: Medial joint gap significantly increased from stage 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45°, and 90° flexion, respectively and from stage 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45°, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Conclusion: Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.
Abstract
Background: Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Methods: Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension, 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability was compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Results: Medial joint gap significantly increased from stage 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45°, and 90° flexion, respectively and from stage 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45°, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Conclusion: Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.
참고문헌 (42)
- Azukizawa M, "Intraoperative medial joint laxity in flexion decreases patient satisfaction after total knee arthroplasty", Arch Orthop Trauma Surg, 138, pp.1143~1150 (2018)[DOI]
- Noble PC, "The John Insall Award : patient expectations affect satisfaction with total knee arthroplasty", Clin Orthop Relat Res, 452, pp.35~43 (2006)[DOI]
- Thiele K, "Current failure mechanisms after knee arthroplasty have changed : polyethylene wear is less common in revision surgery", J Bone Joint Surg Am, 97, pp.715~720 (2015)[DOI]
- Kamenaga T, "The influence of postoperative knee stability on patient satisfaction in cruciate-retaining total knee arthroplasty", J Arthroplasty, 33, pp.2475~2479 (2018)[DOI]
- Mullaji A, "Quantification of effect of sequential posteromedial release on flexion and extension gaps : a computer-assisted study in cadaveric knees", J Arthroplasty, 24, pp.795~805 (2009)[DOI]
- Tsukiyama H, "Medial rather than lateral knee instability correlates with inferior patient satisfaction and knee function after total knee arthroplasty", Knee, 24, pp.1478~1484 (2017)[DOI]
- Iizawa N, "Influence of the medial knee structures on valgus and rotatory stability in total knee arthroplasty", J Arthroplasty, 31, pp.688~693 (2016)[DOI]
- Inui H, "The relationship between anteroposterior stability and medial-lateral stability of the bi-cruciate stabilized total knee arthroplasty", Knee, 25, pp.1247~1253 (2018)[DOI]
- Nakamura S, "Analysis of the flexion gap on in vivo knee kinematics using fluoroscopy", J Arthroplasty, 30, pp.1237~1242 (2015)[DOI]
- Nakamura S, "Correlation between intraoperative anterior stability and flexion gap in total knee arthroplasty", J Arthroplasty, 33, pp.2480~2484 (2018)[DOI]
- Tanaka Y, "Intraoperative physiological lateral laxity in extension and flexion for varus knees did not affect short-term clinical outcomes and patient satisfaction", Knee Surg Sports Traumatol Arthrosc, 28, pp.3888~3898 (2020)[DOI]
- Matsuda S, "Ligament balancing in total knee arthroplasty-medial stabilizing technique", Asia Pac J Sports Med Arthrosc Rehabil Technol, 2, pp.108~113 (2015)[DOI]
- Akagi M, "An anteroposterior axis of the tibia for total knee arthroplasty", Clin Orthop Relat Res (2004)[DOI]
- Saeki K, "Stability after medial collateral ligament release in total knee arthroplasty", Clin Orthop Relat Res (2001)[DOI]
- Okamoto S, "Lateral soft tissue laxity increases but medial laxity does not contract with varus deformity in total knee arthroplasty", Clin Orthop Relat Res, 471, pp.1334~1342 (2013)[DOI]
- Okamoto S, "Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty", Knee Surg Sports Traumatol Arthrosc, 22, pp.3174~3180 (2014)[DOI]
- Matsumoto T, "Soft-tissue balancing in total knee arthroplasty : cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique", Int Orthop, 38, pp.531~537 (2014)[DOI]
- Matsumoto T, "Soft tissue balance measurement in minimal incision surgery compared to conventional total knee arthroplasty", Knee Surg Sports Traumatol Arthrosc, 19, pp.880~886 (2011)[DOI]
- Sasaki S, "Effect of medial collateral ligament release and osteophyte resection on medial laxity in total knee arthroplasty", Knee Surg Sports Traumatol Arthrosc, 29, pp.3418~3425 (2021)[DOI]
- Yagishita K, "Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees", J Arthroplasty, 18, pp.313~320 (2003)[DOI]
- Chen W, "Effect of medial soft-tissue releases during posterior-stabilised total knee arthroplasty", J Orthop Surg, 19, pp.230~233 (2011)[DOI]
- Matsueda M, "Soft tissue release in total knee arthroplasty. Cadaver study using knees without deformities", Clin Orthop Relat Res (1999)[DOI]
- Robinson JR, "The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity", Am J Sports Med, 34, pp.1815~1823 (2006)[DOI]
- Mochizuki T, "Association between anteroposterior laxity in mid-range flexion and subjective healing of instability after total knee arthroplasty", Knee Surg Sports Traumatol Arthrosc, 25, pp.3543~3548 (2017)[DOI]
- Wierer G, "The superficial medial collateral ligament is the major restraint to anteromedial instability of the knee", Knee Surg Sports Traumatol Arthrosc, 29, pp.405~416 (2021)[DOI]
- Parratte S, "Instability after total knee arthroplasty", J Bone Joint Surg Am, 90, pp.184~194 (2008)
- Okazaki K, "Asymmetry of mediolateral laxity of the normal knee", J Orthop Sci, 11, pp.264~266 (2006)[DOI]
- Ishibashi K, "Medial stabilizing technique preserves anatomical joint line and increases range of motion compared with the gap-balancing technique in navigated total knee arthroplasty", Knee, 27, pp.558~564 (2020)[DOI]
- Lee SS, "Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique", Knee Surg Sports Traumatol Arthrosc, 31, pp.3745~3754 (2023)[DOI]
- Meneghini RM, "Optimizing asymmetric native knee flexion gap balance promotes superior outcomes in primary total knee arthroplasty", J Am Acad Orthop Surg, 31, pp.e834~e844 (2023)[DOI]
- Sakai S, "Anterior position of the femoral condyle during mid-flexion worsens knee activity after cruciate-retaining total knee arthroplasty", J Arthroplasty (2024)[DOI]
- Alesi D, "In vivo femorotibial kinematics of medial-stabilized total knee arthroplasty correlates to post-operative clinical outcomes", Knee Surg Sports Traumatol Arthrosc, 29, pp.491~497 (2021)[DOI]
- Angerame MR, "Total knee arthroplasty kinematics", J Arthroplasty, 34, pp.2502~2510 (2019)[DOI]
- Dennis DA, "In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics", J Biomech, 38, pp.241~253 (2005)[DOI]
- Van Onsem S, "Are TKA kinematics during closed kinetic chain exercises associated with patient-reported outcomes? a preliminary analysis", Clin Orthop Relat Res, 478, pp.255~263 (2020)[DOI]
- Seah RB, "Evaluation of medial-lateral stability and functional outcome following total knee arthroplasty : results of a single hospital joint registry", J Arthroplasty, 29, pp.2276~2279 (2014)[DOI]
- Thiel W, "The preservation of the whole corpse with natural color", Ann Anat, 174, pp.185~195 (1992)
- Vollner F, "Stability of knee ligament complex of Thiel-embalmed cadaver compared to in vivo knee", J Mech Behav Biomed Mater, 71, pp.392~396 (2017)[DOI]
- Wada K, "Influence of medial collateral ligament release for internal rotation of tibia in posterior-stabilized total knee arthroplasty : a cadaveric study", J Arthroplasty, 32, pp.270~273 (2017)[DOI]
- D’Ambrosi R, "Biomechanics of the posterior oblique ligament of the knee", Clin Biomech, 80, pp.105205~ (2020)[DOI]
- Griffith CJ, "Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads", Am J Sports Med, 37, pp.140~148 (2009)[DOI]
- LaPrade MD, "Anatomy and biomechanics of the medial side of the knee and their surgical implications", Sports Med Arthrosc Rev, 23, pp.63~70 (2015)[DOI]