Abstract
BackgroundTibial internal rotation following total knee arthroplasty (TKA) is important in achieving favorable postoperative clinical outcomes. Studies have reported the effect of intraoperative soft tissue balance on tibial internal rotation in conventional TKA, no studies have evaluated the effects of soft tissue balance at medial or lateral compartments separately on tibial internal rotation in bi-cruciate stabilized (BCS) TKA. The purpose of this study was to clarify the relationship between medial or lateral component gaps and rotational knee kinematics in BCS TKA.MethodsOne hundred fifty-eight knees that underwent BCS TKA were included in this study. The intraoperative medial and lateral joint laxities which was defined as the value of component gap minus the thickness of the tibial component were firstly divided into two groups, respectively: Group M-stable (medial joint laxity, ≤ 2 mm) or Group M-loose (medial joint laxity, ≥ 3 mm) and Group L-stable (lateral joint laxity, ≤ 3 mm) or Group L-loose (lateral joint laxity, ≥ 4 mm). And finally, the knees enrolled in this study were divided into four groups based on the combination of Group M and Group L: Group A (M-stable and L-stable), Group B (M-stable and L-loose), Group C (M-loose and L-stable), and Group D (M-loose and L-loose). The intraoperative rotational knee kinematics were compared between the four Groups at 0°, 30°, 60°, and 90° flexion, respectively.ResultsThe rotational angular difference between 0° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group A at 30° flexion (*p < 0.05). The rotational angular difference between 30° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group D at 30° flexion (*p < 0.05). The rotational angular differences between 30° or 90° flexion and maximum flexion in Group B at 60° flexion were significantly larger than those in Group A at 60° flexion (*p < 0.05).ConclusionSurgeons should pay attention to the importance of medial joint stability at midflexion and lateral joint laxities at midflexion and 90° flexion on a good tibial internal rotation in BCS TKA.
Highlights
Total knee arthroplasty (TKA) is a reliable procedure for relieving pain or restoring function for progressed knee joint destruction
Inui et al [10]. have reported that the amount of intraoperative tibial internal rotation between 30°, 60°, and 90° flexion and maximum flexion were correlated with improvement of postoperative Patient-reported outcome measure (PROM) following bi-cruciate stabilized (BCS) total knee arthroplasty (TKA)
Studies have reported the relationship between the tibial rotational angle and intraoperative soft tissue balance in CR or PS TKA [7, 8], only one study has evaluated the effect of soft tissue balance on tibial internal rotation in BCS TKA [11]
Summary
Total knee arthroplasty (TKA) is a reliable procedure for relieving pain or restoring function for progressed knee joint destruction. Studies have reported the relationship between the tibial rotational angle and intraoperative soft tissue balance in CR or PS TKA [7, 8], only one study has evaluated the effect of soft tissue balance on tibial internal rotation in BCS TKA [11]. Studies have shown that both medial and lateral soft tissue balances are important for good tibial internal rotation [7, 8], no study has evaluated the effects of soft tissue balance at medial or lateral compartments separately on tibial internal rotation in BCS TKA. Studies have reported the effect of intraoperative soft tissue balance on tibial internal rotation in conventional TKA, no studies have evaluated the effects of soft tissue balance at medial or lateral compartments separately on tibial internal rotation in bi-cruciate stabilized (BCS) TKA.
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