In vivo kinematics and cruciate ligament forces in bicruciate-retaining total knee arthroplasty

Kenichi Kono,Darryl D D’Lima,Sakae Tanaka,Takaharu Yamazaki,Hiroshi Inui,Tetsuya Tomita,Shoji Konda,Shuji Taketomi

doi:10.1038/s41598-021-84942-y

Abstract

We analyzed the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on knee kinematics and cruciate ligament forces. Patients (N = 15) with osteoarthritis (OA) and an intact anterior cruciate ligament (ACL) underwent magnetic resonance imaging and single-plane fluoroscopy to measure tibiofemoral kinematics during two deep knee bend activities before and after BCR-TKA: (1) weight-bearing squat; (2) non-weight-bearing cross-legged sitting. Forces in ligament bundles were calculated using VivoSim. The dynamic range of varus-valgus angulation decreased from 3.9 ± 4.4° preoperatively to 2.2 ± 2.7° postoperatively. Preoperatively, the medial femoral condyle translated anteriorly from 10° to 50° of flexion, and posteriorly beyond 50° of flexion. Postoperatively, the medial and lateral femoral condyles translated posteriorly throughout flexion in a medial pivot pattern. ACL forces were high in extension and decreased with flexion pre- and postoperatively. PCL forces increased with flexion preoperatively and did not change significantly postoperatively. Preoperatively, ACL forces correlated with anteroposterior translation of the femoral condyles. Postoperatively, PCL forces correlated with anteroposterior translation of the lateral femoral condyle. BCR-TKA altered knee kinematics during high flexion activity which correlated significantly with changes in cruciate ligament forces.

Highlights

We analyzed the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on knee kinematics and cruciate ligament forces
Several studies demonstrated that knee kinematics during treadmill walking after BCR-TKA were not the same as normal knees and that anterior cruciate ligament forces were higher in cadavers implanted with BCR-TKA13,14
All components of Knee Injury and Osteoarthritis Outcome Scores (KOOS) increased significantly postoperatively; hip-knee-ankle angle (HKA) angle increased from 172° to 178° (Table 1)

Summary

Introduction

We analyzed the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on knee kinematics and cruciate ligament forces. BCR-TKA altered knee kinematics during high flexion activity which correlated significantly with changes in cruciate ligament forces. While total knee arthroplasty (TKA) is successful in relieving pain and partially restoring function, cruciate-retaining, cruciate-sacrificing, and cruciatesubstituting TKA designs do not restore normal knee kinematics[3]. These abnormal kinematics have been attributed to the sacrifice of the anterior cruciate ligament. Whether the cruciate ligament force in BCR-TKA knees differs depending on the high-flexion activities remains unknown

Methods

Results

Conclusion