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J Knee Surg 2019; 32(03): 284-289
DOI: 10.1055/s-0038-1641730
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of the Distal Femoral Joint Line on Ligament Tensions in Flexion with Cruciate-Retaining Total Knee Prostheses

Rajkishen Narayanan
1   Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
,
Nathaniel Lenz
2   Knee Product Development, Smith and Nephew Inc., Advanced Surgical Devices, Memphis, Tennessee
,
Jordan Alexander Werner
1   Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
,
Michael B. Cross
3   Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
,
Dean Hughes
2   Knee Product Development, Smith and Nephew Inc., Advanced Surgical Devices, Memphis, Tennessee
,
Scott Laster
2   Knee Product Development, Smith and Nephew Inc., Advanced Surgical Devices, Memphis, Tennessee
,
Ran Schwarzkopf
1   Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
› Author Affiliations
Further Information

Publication History

26 April 2017

25 February 2018

Publication Date:
13 April 2018 (online)

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Abstract

Proper ligament tension in knee flexion within cruciate-retaining (CR) total knee arthroplasty has long been associated with clinical success; however, traditional balancing principles have assumed that the distal femoral joint line (DFJL) affects only extension. The purpose of this study was to determine the effect DFJL may have on ligament strains and tibiofemoral kinematics of CR knee designs in flexion. A computational analysis was performed using a musculoskeletal modeling system for two different knee implants, the high-flex CR (HFCR) and guided-motion CR (GMCR). Tibiofemoral kinematics and ligament strain were measured at 90-degree knee flexion while the implants' DFJL was incrementally shifted proximally. Femoral implant position and kinematics were used to determine the femur's anteroposterior position relative to the tibia. The change in the femoral medial condyle position relative to the tibia was 0.33 mm and 0.53 mm more anterior per each 1-mm elevation of the DFJL for HFCR and GMCR, respectively. The change in the lateral condyle position was 0.20 mm more anterior and 0.06 mm more posterior for HFCR and GMCR, respectively. The strain in the lateral and medial collateral ligaments changed minimally with elevation of the DFJL. In both implants, strain increased in the anterior lateral and posterior medial bundles of the posterior collateral ligament with elevation of the DFJL, whereas strain decreased in the iliotibial band and iliotibial patellar band. Our findings suggest that DFJL affects ligament tension at 90-degree knee flexion and therefore flexion balance for CR implants. Elevating the DFJL to address tight extension space in a CR knee while flexion space is well balanced could result in increased flexion tension especially when the flexion–extension mismatch is large. To achieve balanced flexion and extension, the amount of DFJL elevation may need to be reduced.

Keywords

total knee arthroplasty - cruciate retaining - distal femoral joint line - kinematics
 

  • References

  • 1 Dennis DA, Komistek RD, Scuderi GR, Zingde S. Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res 2007; 464 (464) 53-60
    CrossrefPubMedSearch in Google Scholar
  • 2 Victor J, Bellemans J. Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res 2006; 452 (452) 53-58
    CrossrefPubMedSearch in Google Scholar
  • 3 Moro-oka TA, Muenchinger M, Canciani JP, Banks SA. Comparing in vivo kinematics of anterior cruciate-retaining and posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2007; 15 (01) 93-99
    CrossrefPubMedSearch in Google Scholar
  • 4 Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M. In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplasty 2005; 20 (06) 777-783
    CrossrefPubMedSearch in Google Scholar
  • 5 Martin JW, Whiteside LA. The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 1990; (259) 146-156
    PubMedSearch in Google Scholar
  • 6 Kowalczewski JB, Labey L, Chevalier Y, Okon T, Innocenti B, Bellemans J. 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 2015; 11 (02) 311-318
    Search in Google Scholar
  • 7 Nägerl H, Dathe H, Fiedler C. , et al. The morphology of the articular surfaces of biological knee joints provides essential guidance for the construction of functional knee endoprostheses. Acta Bioeng Biomech 2015; 17 (02) 45-53
    PubMedSearch in Google Scholar
  • 8 Ji SJ, Zhou YX, Jiang X. , et al. Effect of joint line elevation after posterior-stabilized and cruciate-retaining total knee arthroplasty on clinical function and kinematics. Chin Med J (Engl) 2015; 128 (21) 2866-2872
    CrossrefPubMedSearch in Google Scholar
  • 9 Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J. Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 1999; (367) 165-171
    PubMedSearch in Google Scholar
  • 10 Bellemans J. Restoring the joint line in revision TKA: does it matter?. Knee 2004; 11 (01) 3-5
    CrossrefPubMedSearch in Google Scholar
  • 11 Laskin RS. Joint line position restoration during revision total knee replacement. Clin Orthop Relat Res 2002; (404) 169-171
    PubMedSearch in Google Scholar
  • 12 Robinson JR, Bull AM, Amis AA. Structural properties of the medial collateral ligament complex of the human knee. J Biomech 2005; 38 (05) 1067-1074
    CrossrefPubMedSearch in Google Scholar
  • 13 Sugita T, Amis AA. Anatomic and biomechanical study of the lateral collateral and popliteofibular ligaments. Am J Sports Med 2001; 29 (04) 466-472
    CrossrefPubMedSearch in Google Scholar
  • 14 Merican AM, Sanghavi S, Iranpour F, Amis AA. The structural properties of the lateral retinaculum and capsular complex of the knee. J Biomech 2009; 42 (14) 2323-2329
    CrossrefPubMedSearch in Google Scholar
  • 15 Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 1994; 27 (01) 13-24
    CrossrefPubMedSearch in Google Scholar
  • 16 Robinson JR, Sanchez-Ballester J, Bull AM, Thomas RdeW, Amis AA. The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg Br 2004; 86 (05) 674-681
    PubMedSearch in Google Scholar
  • 17 Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy 2007; 23 (03) 269-274
    CrossrefPubMedSearch in Google Scholar
  • 18 Lopes Jr OV, Ferretti M, Shen W, Ekdahl M, Smolinski P, Fu FH. Topography of the femoral attachment of the posterior cruciate ligament. J Bone Joint Surg Am 2008; 90 (02) 249-255
    CrossrefPubMedSearch in Google Scholar
  • 19 Papannagari R, DeFrate LE, Nha KW. , et al. Function of posterior cruciate ligament bundles during in vivo knee flexion. Am J Sports Med 2007; 35 (09) 1507-1512
    CrossrefPubMedSearch in Google Scholar
  • 20 Lenz N. Comparing Ligament Strain in Total Knee Arthroplasty Designs using a Computational Model. Presented at the 62nd Annual Meeting of the Orthopaedic Research Society, Orlando, FL; 2016
    PubMed
  • 21 Mahfouz MR, Komistek RD, Dennis DA, Hoff WA. In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am 2004; 86-A (Suppl. 02) 56-61
    Search in Google Scholar
  • 22 Lin KJ, Wei HW, Huang CH. , et al. Change in collateral ligament length and tibiofemoral movement following joint line variation in TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24 (08) 2498-2505
    CrossrefPubMedSearch in Google Scholar
  • 23 Mahoney OM, Noble PC, Rhoads DD, Alexander JW, Tullos HS. Posterior cruciate function following total knee arthroplasty. A biomechanical study. J Arthroplasty 1994; 9 (06) 569-578
    CrossrefPubMedSearch in Google Scholar
  • 24 Yue B, Varadarajan KM, Rubash HE, Li G. In vivo function of posterior cruciate ligament before and after posterior cruciate ligament-retaining total knee arthroplasty. Int Orthop 2012; 36 (07) 1387-1392
    CrossrefPubMedSearch in Google Scholar
  • 25 Most E, Li G, Sultan PG, Park SE, Rubash HE. Kinematic analysis of conventional and high-flexion cruciate-retaining total knee arthroplasties: an in vitro investigation. J Arthroplasty 2005; 20 (04) 529-535
    CrossrefPubMedSearch in Google Scholar
  • 26 Yue B, Varadarajan KM, Moynihan AL, Liu F, Rubash HE, Li G. Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty. J Orthop Res 2011; 29 (01) 40-46
    CrossrefPubMedSearch in Google Scholar
  • 27 Pagnano MW, Cushner FD, Scott WN. Role of the posterior cruciate ligament in total knee arthroplasty. J Am Acad Orthop Surg 1998; 6 (03) 176-187
    CrossrefPubMedSearch in Google Scholar