Influence of bi- and tri-compartmental knee arthroplasty on the kinematics of the knee joint

Markus Wünschel,Nikolaus Wülker,Jiahsuan Lo,Torsten Dilger,Otto Müller

doi:10.1186/1471-2474-12-29

Markus Wünschel, Nikolaus Wülker + Show 3 more

Open Access

https://doi.org/10.1186/1471-2474-12-29

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Abstract

BackgroundThe cruciate ligaments are important stabilizers of the knee joint and determine joint kinematics in the natural knee and after cruciate retaining arthroplasty.No in vitro data is available to biomechanically evaluate the ability of the anterior cruciate ligament (ACL) to maintain knee joint kinematics after bicruciate-retaining bi-compartmental knee arthroplasty (BKA).Therefore, the objective of the current study was to investigate the kinematics of the natural knee joint, before and after installing bicruciate-retaining BKA and posterior cruciate retaining total knee arthroplasty. Specifically, we incorporated a dynamic knee simulator to simulate weight-bearing flexions on cadaveric knee specimen before and after surgical manipulations.MethodsIn this cadaveric study we investigated rotational and translational tibiofemoral kinematics during simulated weight-bearing flexions of the intact knee, after bi-compartmental knee arthroplasty (BKA+), after resecting the ACL in BKA (BKA-), and after posterior cruciate retaining total knee arthroplasty (TKA).ResultsRotation of BKA+ is closest to the intact knee joint, whereas TKA shows significant differences from 30 to 90 degree of flexion. Within the tested flexion range (15 to 90 degree of flexion), there was no significant difference in the anterior-posterior translation among intact, BKA+, and TKA knees. Resecting the ACL in BKA leads to a significant anterior tibial translation.ConclusionsBKA with intact cruciate ligaments resembles rotation and translation of the natural knee during a simulated weight-bearing flexion. It is a suitable treatment option for medial and patellofemoral osteoarthritis with advantages in rotational characteristics compared to TKA.

Highlights

The cruciate ligaments are important stabilizers of the knee joint and determine joint kinematics in the natural knee and after cruciate retaining arthroplasty
It provides the possibility to switch to a total knee arthroplasty (TKA) later, even though Unicondylar knee Arthroplasty (UKA) conversion to TKA has been shown to be associated with poorer clinical outcome compared to primary TKA [1]
After installing bi-compartmental knee arthroplasty (BKA)+, the internal tibial rotation reduced throughout the whole range of motion by up to 4 degree and was significantly different from the intact knee trials from 30 to 60 degree of flexion

Summary

Introduction

The cruciate ligaments are important stabilizers of the knee joint and determine joint kinematics in the natural knee and after cruciate retaining arthroplasty. No in vitro data is available to biomechanically evaluate the ability of the anterior cruciate ligament (ACL) to maintain knee joint kinematics after bicruciate-retaining bi-compartmental knee arthroplasty (BKA). The objective of the current study was to investigate the kinematics of the natural knee joint, before and after installing bicruciate-retaining BKA and posterior cruciate retaining total knee arthroplasty. Advantages include the minimal surgical exposure and the intact cruciate ligaments. Shortcomings include: that it is unable to correct severe deviations of the mechanical axis; may result in restricted joint range of motion; requires intact ligamentous structures.

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