ACL Substitution May Improve Kinematics of PCL-retaining Total Knee Arthroplasty

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2016 Nov 13

PMID 27837219

Citations 6

Authors

Thomas Zumbrunn

Michael P Duffy

Harry E Rubash

Henrik Malchau

Orhun K Muratoglu

Kartik Mangudi Varadarajan

Affiliations

Soon will be listed here.

Abstract

Purpose: One of the key factors responsible for altered kinematics and joint stability following contemporary total knee arthroplasty (TKA) is resection of the anterior cruciate ligament (ACL). However, ACL retention can present several technical challenges, and in some cases may not be viable due to an absent or nonfunctional ACL. Therefore, the goal of this research was to investigate whether substitution of the ACL through an anterior post mechanism could improve kinematic deficits of contemporary posterior cruciate ligament (PCL) retaining implants.

Methods: Kinematic analysis of different implant types was done using KneeSIM, a previously established dynamic simulation tool. Walking, stair-ascent, chair-sit, and deep knee bend were simulated for an ACL-substituting (PCL-retaining) design, a bi-cruciate-retaining and ACL-sacrificing (PCL-retaining) implant, as well as the native knee. The motion of the femoral condyles relative to the tibia was recorded for kinematic comparisons.

Results: The ACL-substituting and ACL-retaining implants provided similar kinematic improvements over the ACL-sacrificing implant, by reducing posterior femoral shift in extension and preventing paradoxical anterior sliding. During all simulated activities, the ACL-sacrificing implant showed between 7 and 8 mm of posterior shift in extension in contrast to the ACL-retaining implant and the ACL-substituting design, which showed overall kinematic trends similar to the native knee.

Conclusion: The absence of ACL function has been linked to abnormal kinematics and joint stability in patients with contemporary TKA. ACL-substituting implants could be a valuable treatment option capable of overcoming the limitations of contemporary TKA, particularly when retaining the native ACL is not feasible or is challenging.

Citing Articles

Biomechanics and Outcomes of Modern Tibial Polyethylene Inserts.

Shah D, Bates T, Kampfer C, Hope D Curr Rev Musculoskelet Med. 2022; 15(3):194-204.

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Does contemporary bicruciate retaining total knee arthroplasty restore the native knee kinematics? A descriptive literature review.

Zhou C, Peng Y, An S, Bedair H, Li G Arch Orthop Trauma Surg. 2021; 142(9):2313-2322.

PMID: 34406507 DOI: 10.1007/s00402-021-04116-3.

Biomechanical and Clinical Effect of Patient-Specific or Customized Knee Implants: A Review.

Lee J, Koh Y, Kang K J Clin Med. 2020; 9(5).

PMID: 32455733 PMC: 7290390. DOI: 10.3390/jcm9051559.

The biomechanical effect of tibiofemoral conformity design for patient-specific cruciate retainging total knee arthroplasty using computational simulation.

Koh Y, Park K, Kang K J Exp Orthop. 2019; 6(1):23.

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Effect of geometric variations on tibiofemoral surface and post-cam design of normal knee kinematics restoration.

Koh Y, Nam J, Kang K J Exp Orthop. 2018; 5(1):53.

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