Influence of the Medial Knee Structures on Valgus and Rotatory Stability in Total Knee Arthroplasty

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• 作者：Norishige Iizawa ; MD ; PhD^a ; ; Atsushi Mori ; MD ; PhD^a ; Tokifumi Majima ; MD ; PhD^b ; Hidemi Kawaji ; MD ; PhD^a ; Shuhei Matsui ; MD^a ; Shinro Takai ; MD ; PhD^a
• 关键词：deep medial collateral ligament ; posterior oblique ligament ; biomechanics ; instability ; soft tissue release ; navigation
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：31
• 期：3
• 页码：688-693
• 全文大小：540 K

文摘

Precise biomechanical knowledge of individual components of the MCL is critical for proper MCL release during TKA. This study was to define the influences of the deep MCL and the POL on valgus and rotatory stability in TKA using cadaveric knees.

Methods

This study used six fresh-frozen cadaveric knees. All TKA procedures were performed using a cruciate-retaining TKA with a CT-free navigation system. We did a sequential sectioning on each knee, S1; femoral arthroplasty only, S2; medial half tibial resection with spacer, S3; anterior cruciate ligament cut, S4; tibial arthroplasty, S5; release of the dMCL, S6; release of the POL. The navigation system monitored motion after application of 10 N-m valgus loads and 5 N-m internal and external rotation torques to the tibia at 0°, 20°, 30°, 60°, and 90° of knee flexion for each sequence.

Results

There were no significant differences in medial gaps. Internal rotation angles significantly increased after S2 at 0°, 20°, and 30°, and after S6 at 90°compared with those after S1. External rotation angles significantly increased after S3 at 0°, S4 at 60°, S5 at 0°, 30°and 90°, and after S6 at 30°, 60° compared with those after S1.

Conclusion

Significant increases of rotatory instability were seen on release of the dMCL, and then further increased after release of the POL. Surgical approach of retaining the dMCL and POL has a possibility to improve the outcome after primary TKA.