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Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

11.11.2016 | Knee

ACL substitution may improve kinematics of PCL-retaining total knee arthroplasty

verfasst von: Thomas Zumbrunn, Michael P. Duffy, Harry E. Rubash, Henrik Malchau, Orhun K. Muratoglu, Kartik Mangudi Varadarajan

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 5/2018

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Abstract

Purpose

One of the key factors responsible for altered kinematics and joint stability following contemporary total knee arthroplasty (TKA) is resection of the anterior cruciate ligament (ACL). However, ACL retention can present several technical challenges, and in some cases may not be viable due to an absent or nonfunctional ACL. Therefore, the goal of this research was to investigate whether substitution of the ACL through an anterior post mechanism could improve kinematic deficits of contemporary posterior cruciate ligament (PCL) retaining implants.

Methods

Kinematic analysis of different implant types was done using KneeSIM, a previously established dynamic simulation tool. Walking, stair-ascent, chair-sit, and deep knee bend were simulated for an ACL-substituting (PCL-retaining) design, a bi-cruciate-retaining and ACL-sacrificing (PCL-retaining) implant, as well as the native knee. The motion of the femoral condyles relative to the tibia was recorded for kinematic comparisons.

Results

The ACL-substituting and ACL-retaining implants provided similar kinematic improvements over the ACL-sacrificing implant, by reducing posterior femoral shift in extension and preventing paradoxical anterior sliding. During all simulated activities, the ACL-sacrificing implant showed between 7 and 8 mm of posterior shift in extension in contrast to the ACL-retaining implant and the ACL-substituting design, which showed overall kinematic trends similar to the native knee.

Conclusion

The absence of ACL function has been linked to abnormal kinematics and joint stability in patients with contemporary TKA. ACL-substituting implants could be a valuable treatment option capable of overcoming the limitations of contemporary TKA, particularly when retaining the native ACL is not feasible or is challenging.

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Titel: ACL substitution may improve kinematics of PCL-retaining total knee arthroplasty
verfasst von: Thomas Zumbrunn
Michael P. Duffy
Harry E. Rubash
Henrik Malchau
Orhun K. Muratoglu
Kartik Mangudi Varadarajan
Publikationsdatum: 11.11.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 5/2018
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4372-y

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ACL substitution may improve kinematics of PCL-retaining total knee arthroplasty

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Conclusion

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