Does Selective Posterior Tibial Slope Technique in Cruciate-Retaining Total Knee Arthroplasty Result in the Elimination of Posterior Cruciate Ligament Management?

Overview

Journal Arthroplast Today

Publisher Elsevier

Date 2024 Feb 2

PMID 38304244

Authors

Takashi Nakamura

Ryo Takamatsu

Hideyuki Aoki

Hiroshi Takahashi

Affiliations

Soon will be listed here.

Abstract

In cruciate-retaining total knee arthroplasty (CR-TKA), intraoperative posterior cruciate ligament (PCL) management is necessary because retention of optimum PCL tension with high reproducibility is difficult. If PCL management is not performed appropriately, problems such as postoperative pain, poor range of motion, and a feeling of instability may occur. The posterior tibial slope (PTS) has a major influence on the tension of the PCL in CR-TKA. Changes in femoral posterior condylar offset also influences PCL tension in CR-TKA. We designed a surgical procedure in which the PTS is adjusted in association with the posterior condylar offset during surgery. The postoperative clinical results of the primary total knee arthroplasty 159 knee performed by this procedure were favorable. In addition, none of the knees required management of PCL. In our procedure, PCL management, which is the main problem in CR-TKA, is not necessary, and this may be the main advantage of the new procedure.

Citing Articles

Association of Posterior Tibial Slope and Functional Outcome After Total Knee Arthroplasty: An Observational Study.

Singh A, Verma P, Kushwaha N, Mohan R, Rastogi D Cureus. 2024; 16(11):e74201.

PMID: 39712763 PMC: 11663243. DOI: 10.7759/cureus.74201.

References

Ritter M, Faris P, Keating E . Posterior cruciate ligament balancing during total knee arthroplasty. J Arthroplasty. 1988; 3(4):323-6. DOI: 10.1016/s0883-5403(88)80032-9. View

Scott R, Thornhill T . Posterior cruciate supplementing total knee replacement using conforming inserts and cruciate recession. Effect on range of motion and radiolucent lines. Clin Orthop Relat Res. 1994; (309):146-9. View

Howell S, Papadopoulos S, Kuznik K, Hull M . Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc. 2013; 21(10):2271-80. DOI: 10.1007/s00167-013-2621-x. View

Kang K, Koh Y, Son J, Kwon O, Lee J, Kwon S . Influence of Increased Posterior Tibial Slope in Total Knee Arthroplasty on Knee Joint Biomechanics: A Computational Simulation Study. J Arthroplasty. 2017; 33(2):572-579. DOI: 10.1016/j.arth.2017.09.025. View

Ostermeier S, Schlomach C, Hurschler C, Windhagen H, Stukenborg-Colsman C . Dynamic in vitro measurement of posterior cruciate ligament load and tibiofemoral stress after TKA in dependence on tibiofemoral slope. Clin Biomech (Bristol). 2006; 21(5):525-32. DOI: 10.1016/j.clinbiomech.2005.12.019. View

Freeman M, Pinskerova V . The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res. 2003; (410):35-43. DOI: 10.1097/01.blo.0000063598.67412.0d. View

Faschingbauer M, Sgroi M, Juchems M, Reichel H, Kappe T . Can the tibial slope be measured on lateral knee radiographs?. Knee Surg Sports Traumatol Arthrosc. 2014; 22(12):3163-7. DOI: 10.1007/s00167-014-2864-1. View

Kuriyama S, Ishikawa M, Nakamura S, Furu M, Ito H, Matsuda S . Posterior tibial slope and femoral sizing affect posterior cruciate ligament tension in posterior cruciate-retaining total knee arthroplasty. Clin Biomech (Bristol). 2015; 30(7):676-81. DOI: 10.1016/j.clinbiomech.2015.05.006. View

Christen B, Heesterbeek P, Heesterbeek P, Wymenga A, Wehrli U . Posterior cruciate ligament balancing in total knee replacement: the quantitative relationship between tightness of the flexion gap and tibial translation. J Bone Joint Surg Br. 2007; 89(8):1046-50. DOI: 10.1302/0301-620X.89B8.18976. View

10.

Kuriyama S, Hyakuna K, Inoue S, Tanaka Y, Tamaki Y, Ito H . Is a "sulcus cut" technique effective for determining the level of distal femoral resection in total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc. 2014; 22(12):3060-6. DOI: 10.1007/s00167-014-3217-9. View

11.

Hofmann A, Bachus K, Wyatt R . Effect of the tibial cut on subsidence following total knee arthroplasty. Clin Orthop Relat Res. 1991; (269):63-9. View

12.

Banks S, Bellemans J, Nozaki H, Whiteside L, Harman M, Hodge W . Knee motions during maximum flexion in fixed and mobile-bearing arthroplasties. Clin Orthop Relat Res. 2003; (410):131-8. DOI: 10.1097/01.blo.0000063121.39522.19. View

13.

de Jong R, Heesterbeek P, Wymenga A . A new measurement technique for the tibiofemoral contact point in normal knees and knees with TKR. Knee Surg Sports Traumatol Arthrosc. 2009; 18(3):388-93. DOI: 10.1007/s00167-009-0986-7. View

14.

Walker P, Garg A . Range of motion in total knee arthroplasty. A computer analysis. Clin Orthop Relat Res. 1991; (262):227-35. View

15.

de Boer J, Blankevoort L, Kingma I, Vorster W . In vitro study of inter-individual variation in posterior slope in the knee joint. Clin Biomech (Bristol). 2009; 24(6):488-92. DOI: 10.1016/j.clinbiomech.2009.03.008. View

16.

Matsuda S, Miura H, Nagamine R, Urabe K, Ikenoue T, Okazaki K . Posterior tibial slope in the normal and varus knee. Am J Knee Surg. 1999; 12(3):165-8. View

17.

Nowakowski A, Majewski M, Muller-Gerbl M, Valderrabano V . Measurement of knee joint gaps without bone resection: "physiologic" extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes. J Orthop Res. 2012; 30(4):522-7. DOI: 10.1002/jor.21564. View

18.

Nakagawa S, Johal P, Pinskerova V, Komatsu T, Sosna A, Williams A . The posterior cruciate ligament during flexion of the normal knee. J Bone Joint Surg Br. 2004; 86(3):450-6. DOI: 10.1302/0301-620x.86b3.14330. View

19.

Singerman R, Dean J, Pagan H, Goldberg V . Decreased posterior tibial slope increases strain in the posterior cruciate ligament following total knee arthroplasty. J Arthroplasty. 1996; 11(1):99-103. DOI: 10.1016/s0883-5403(96)80167-7. View

20.

Kang K, Koh Y, Son J, Kwon O, Lee J, Kwon S . A computational simulation study to determine the biomechanical influence of posterior condylar offset and tibial slope in cruciate retaining total knee arthroplasty. Bone Joint Res. 2018; 7(1):69-78. PMC: 5805829. DOI: 10.1302/2046-3758.71.BJR-2017-0143.R1. View