Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Archives of Orthopaedic and Trauma Surgery
Erschienen in: Archives of Orthopaedic and Trauma Surgery 6/2022

27.05.2021 | Knee Arthroplasty

Functional stability: an experimental knee joint cadaveric study on collateral ligaments tension

verfasst von: Bernardo Innocenti, Edoardo Bori, Thomas Paszicsnyek

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 6/2022

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Applying proper tension to collateral ligaments during total knee arthroplasty surgery is fundamental to achieve optimal implant performance: low tension could lead to joint instability, over-tensioning leads to pain and stiffness. A “functional stability” must be defined and achieved during surgery to guarantee optimal results. In this study, an experimental cadaveric activity was performed to measure the minimum tension required to achieve knee functional stability.

Materials and methods

Ten knee specimens were investigated; femur and tibia were fixed in specifically designed fixtures and clamped to a loading frame; constant displacement rate was applied and resulting tension force was measured. Joint stability was determined as the slope change in the force/displacement curve, representing the activation of both collateral ligaments elastic region; the tension required to reach joint functional stability is then the span between ligaments toe region and this point. Intact, ACL (anterior cruciate ligament)-resected and ACL & PCL (posterior cruciate ligament)-resected knees were tested. The test was performed at different flexion angles; each configuration was analyzed three times.

Results

Results demonstrated an overall tension of 40–50 N to be enough to reach stability in intact knees. Similar values are sufficient in ACL-resected knees, while significantly higher tension is required (up to 60 N) after cruciate ligaments resection. The tension required was slightly higher at 60° of flexion.

Conclusion

Results agree with other experimental studies, showing that the tensions required to stabilize a knee joint are lower than the ones applied nowadays via surgical tensioners.
To reach functional stability, surgeons should consider such results intraoperatively and avoid ligament laxity or over-tension.
Literatur
1.
Gustke K, Golladay G, Roche M et al (2014) Increased satisfaction after total knee replacement using sensor-guided technology. Bone Joint J 96-B(10):1333PubMedCrossRef
2.
Sharkey P, Hozack W, Rothman R et al (2002) Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13 (Insall award paper)CrossRef
3.
Sharkey P, Lichstein P, Shen C et al (2014) Why are total knee arthroplasties failing today—has anything changed after 10 years? J Arthroplasty 29(9):1774–1778PubMedCrossRef
4.
Delport H, Labey L, Corte RD et al (2013) Collateral ligament strains during knee joint laxity evaluation before and after TKA. Clin Biomech 28(7):777–782CrossRef
5.
Dhurve K, Scholes C, El-Tawil S et al (2017) Multifactorial analysis of dissatisfaction after primary total knee replacement. Knee 24(4):856–862PubMedCrossRef
6.
Freisinger G, Hutter E, Lewis J et al (2017) Relationships between varus–valgus laxity of the severely osteoarthritic knee and gait, instability, clinical performance, and function. J Orthop Res 35(8):1644–1652PubMedCrossRef
7.
Wright T (2017) Joint stability in total knee arthroplasty: what is the target for a stable knee? J Am Acad Orthop Surg 25:S25–S28PubMedCrossRef
8.
Del Gaizo D, Della VC (2011) Instability in primary total knee arthroplasty. Orthopedics 34:e519–e521PubMed
9.
Parratte S, Pagnano M (2008) Instability after total knee arthroplasty. J Bone Joint Surg Am 90:184–194PubMed
10.
Burstein T, Wright A. (1994). Fundamentals of orthopaedic biomechanics. Baltimore MD, Wolters Kluwer/Lippincott Williams & Wilkins. p. 63
11.
Belvedere C, Leardini A, Catani F et al (2017) In vivo kinematics of knee replacement during daily living activities: condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses. J Orthop Res 35(7):1396–1403PubMedCrossRef
12.
Incavo S, Mullins E, Coughlin K et al (2004) Tibio-femoral kinematic analysis of kneeling after total knee arthroplasty. J Arthroplasty 19:906–910PubMedCrossRef
13.
Catani F, Innocenti B, Belvedere C et al (2010) The Mark Coventry Award: articular contact estimation in TKA using in vivo kinematics and finite element analysis. Clin Orthop Relat Res 468:19–28PubMedCrossRef
14.
Butler D (1989) Anterior cruciate ligament: its normal response and replacement. J Orthop Res 7(6):910–921PubMedCrossRef
15.
16.
Li X, Liu B, Deng B, Zhang S (1996) Normal six-degree-of-freedom motions of knee joint during level walking. J Biomech Eng 118(2):258–261PubMedCrossRef
17.
Vince K, Abdeen A, Sugimori T (2006) The unstable total knee arthroplasty: causes and cures. J Arthroplasty 21(4 Suppl 1):44–49PubMedCrossRef
18.
Manrique J, Gomez M, Parvizi J (2015) Stiffness after total knee arthroplasty. J Knee Surg 28(2):119–126PubMedCrossRef
19.
20.
Sambatakakis A, Attfield S, Newton G (1993) Quantification of soft-tissue imbalance in condylar knee arthroplasty. J Biomed Eng 15(4):339–343PubMedCrossRef
21.
Insall J, Easley M (2001) Surgical techniques and instrumentation in total knee arthroplasty. In: Insall JN, Scott WN (eds) Surgery of the Knee. Vol 3. New York, p. 1553–1620.
22.
Whiteside L (2003) Tensioners: dangerous toys in the operating room. Whiteside Orthop 26(9):963–965CrossRef
23.
Booth R (2003) Tensioners: essential for accurate performance of TKA. Orthopedics 26(9):962–964PubMedCrossRef
24.
Basselot F, Gicquel T, Common H et al (2016) Are ligament-tensioning devices interchangeable? A study of femoral rotation. Orthop Traumatol Surg Res 102(4 Suppl):S213–S219PubMedCrossRef
25.
Elmallah R, Mistry J, Cherian J et al (2016) Can we really “feel” a balanced total knee arthroplasty? J Arthroplasty 31(9):102–105PubMedCrossRef
26.
Wilson W, Deakin A, Payne A et al (2012) Comparative analysis of the structural properties of the collateral ligaments of the human knee. J Orthop Sports Phys 42(4):345–351CrossRef
27.
Van Dommelen JA, Ivarsson BJ, Jolandan MM et al (2005) Characterization of the rate-dependent mechanical properties and failure of human knee ligaments. SAE Trans. 80–90
28.
Völlner F, Fischer J, Weber M et al (2019) Weakening of the knee ligament complex due to sequential medial release in total knee arthroplasty. Arch Orthop Trauma Surg 139(7):999–1006PubMedCrossRef
29.
30.
Manning W, Blain A, Longstaff L, Deehan DJ (2018) A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state. Knee Surg Sports Traumatol Arthrosc 27(7):2238–2250PubMedPubMedCentralCrossRef
31.
Nowakowski A, Majewski M, Müller-Gerbl M, Valderrabano V (2012) Measurement of knee joint gaps without bone resection: “physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes. J Ortoph Res 30:522–527CrossRef
32.
33.
Kawamura H, Bourne R (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 6(3):248–252PubMedCrossRef
34.
Shelburne K, Torry M, Pandy M (2005) Muscle, ligament, and joint-contact forces at the knee during walking. Med Sci Sports Exerc 37:1948–1956PubMedCrossRef
35.
Noyes F (2009) The function of the human anterior cruciate ligament and analysis of single- and double-bundle graft reconstructions. Sports Health 1(1):66–75PubMedPubMedCentralCrossRef
36.
Yagi M, Wong E, Kanamori A et al (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30(5):660–666PubMedCrossRef
37.
Amis A, Bull A, Gupte C et al (2003) Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sport Tr A 11(5):271–281CrossRef
38.
Veltri D, Deng X, Torzilli P et al (1995) The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study. Am J Sports Med 23:436–443PubMedCrossRef
39.
Toutoungi D, Lu T, Leardini A et al (2000) Cruciate ligament forces in the human knee during rehabilitation exercises. Clin Biomech 15:176–187CrossRef
40.
Nasab Hosseini S, Smith C, Schütz P et al (2019) Elongation patterns of the collateral ligaments after total knee arthroplasty are dominated by the knee flexion angle. Front Bioeng Biotechnol 7:323CrossRef
41.
Robinson J, Bull A, Amis A (2005) Structural properties of the medial collateral ligament complex of the human knee. J Biomech 38:1067–1074PubMedCrossRef
42.
Sugita T, Amis A (2001) Anatomic and biomechanical study of the lateral collateral and popliteofibular ligaments. Am J Sports Med 29:466–472PubMedCrossRef
43.
Wijdicks C, Ewart D, Nuckley D et al (2010) Structural properties of the primary medial knee ligaments. Am J Sport Med 38(8):1638–1646CrossRef
44.
Victor J, Labey L, Wong P, Innocenti B, Bellemans J (2010) The influence of muscle load on tibiofemoral knee kinematics. J Orthop Res 28(4):419–428PubMed
45.
Innocenti B, Larrieu J, Lambert P, Pianigiani S (2017) Automatic characterization of soft tissues material properties during mechanical tests. Muscles Ligaments Tendons J 7:529–537PubMedCrossRef
46.
Delport H, Labey L, Innocenti B et al (2015) Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments. Knee Surg Sport Tr A 23(8):2159–2169CrossRef
47.
Kowalczewski J, Labey L, Chevalier Y et al (2015) Does joint line elevation after revision knee arthroplasty affect tibio-femoral kinematics, contact pressure or collateral ligament lengths? An in vitro analysis. Arch Med Sci 2:311–318CrossRef
Metadaten
Titel
Functional stability: an experimental knee joint cadaveric study on collateral ligaments tension
verfasst von
Bernardo Innocenti
Edoardo Bori
Thomas Paszicsnyek
Publikationsdatum
27.05.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 6/2022
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-021-03966-1

Weitere Artikel der Ausgabe 6/2022

Archives of Orthopaedic and Trauma Surgery 6/2022 Zur Ausgabe

Trauma Surgery

Standard radiographic assessments of distal radius fractures miss involvement of the distal radioulnar joint: a diagnostic study

Trauma Surgery

Comparable outcomes of in-cement revision and uncemented modular stem revision for Vancouver B2 periprosthetic femoral fracture at 5 years

Trauma Surgery

Perioperative antibiotic prophylaxis in long bone open fractures: the need for randomized controlled trials

Handsurgery

Comparison of extension block pinning technique versus pin orthosis-extension block pinning technique for acute mallet fractures: a prospective randomized clinical trial

Trauma Surgery

History of diagnostics and treatment of scapular fractures in children and adolescents and its clinical importance

Hip Arthroplasty

Component placement accuracy of two digital intraoperative fluoroscopy supplementation systems in direct anterior total hip arthroplasty

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise