scholarly journals Obliteration of Intercondylar Notch Mimicking Flexion-Extension Gap Imbalance in a Cruciate Retaining Total Knee Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Harun Resit Gungor ◽  
Esat Kiter ◽  
Semih Akkaya ◽  
Nusret Ok ◽  
Cagdas Yorukoglu
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Period ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Early Postoperative Period ◽  
Intercondylar Notch ◽  
Cruciate Retaining ◽  
Flexion Extension ◽  
Total Knee

Following total knee arthroplasty (TKA), the most frequent cause of extension deficit and limitation of range of motion in early postoperative period is related to improper tensioning of soft tissues and failure to balance extension and flexion gaps. If a cruciate retaining (CR) prosthesis is the planned implant, then attention should be given to balancing the posterior cruciate ligament (PCL), and any factor that alters this balance may also cause deterioration of knee balance in postoperative period. Here, we report on an unusual case referred from another hospital because of continuous pain and restriction of knee motion in early postoperative period following CR-designed TKA that was initially thought to be due to flexion-extension imbalance. However, during the revision procedure, extruded cement to the intercondylar notch was found to be both mechanically blocking terminal extension and limiting flexion by possible mechanism of irritation of the synovial nerve endings around the stretched anterior fibers of PCL during flexion. This case was successfully treated by removal of extruded cement from intercondylar notch to decompress PCL, polyethylene exchange, and secondary patellar resurfacing.

scholarly journals Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

2019 ◽  
Vol 8 (10) ◽  
pp. 495-501 ◽  
Author(s):  
Emily L. Hampp ◽  
Nipun Sodhi ◽  
Laura Scholl ◽  
Matthew E. Deren ◽  
Zachary Yenna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Soft Tissue Damage ◽  
Anatomical Structures ◽  
Cruciate Retaining ◽  
Robotic Assisted ◽  
Total Knee

Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

Posterior cruciate ligament resection in total knee arthroplasty

2019 ◽  
Vol 101-B (10) ◽  
pp. 1230-1237 ◽  
Author(s):  
Babar Kayani ◽  
Sujith Konan ◽  
Saman Horriat ◽  
Mazin S. Ibrahim ◽  
Fares S. Haddad
Keyword(s):  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Limb Alignment ◽  
Flexion Gap ◽  
Flexion Extension ◽  
Total Knee ◽  
The Mean ◽  
Extension Gap

Aims The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). Patients and Methods This prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4). Results PCL resection increased the mean flexion gap significantly more than the extension gap in the medial (2.4 mm (sd 1.5) vs 1.3 mm (sd 1.0); p < 0.001) and lateral (3.3 mm (sd 1.6) vs 1.2 mm (sd 0.9); p < 0.01) compartments. The mean gap differences after PCL resection created significant mediolateral laxity in flexion (gap difference: 1.1 mm (sd 2.5); p < 0.001) but not in extension (gap difference: 0.1 mm (sd 2.1); p = 0.51). PCL resection significantly improved the mean FFD (6.3° (sd 4.4) preoperatively vs 3.1° (sd 1.5) postoperatively; p < 0.001). There was a strong positive correlation between the preoperative FFD and change in FFD following PCL resection (Pearson’s correlation coefficient = 0.81; p < 0.001). PCL resection did not significantly affect limb alignment (mean change in alignment: 0.2° valgus (sd 1.2); p = 0.60). Conclusion PCL resection creates flexion-extension mismatch by increasing the flexion gap more than the extension gap. The increase in the lateral flexion gap is greater than the increase in the medial flexion gap, which creates mediolateral laxity in flexion. Improvements in FFD following PCL resection are dependent on the degree of deformity before PCL resection. Cite this article: Bone Joint J 2019;101-B:1230–1237

scholarly journals A Surgical Reduction Technique for Posterior Cruciate Ligament Avulsion Fracture in Total Knee Arthroplasty: A Comparison Study

2020 ◽  
Author(s):  
Wei Lin ◽  
Jinghui Niu ◽  
Yike Dai ◽  
Huaxing Zhang ◽  
Jing Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Cruciate Retaining ◽  
Total Knee ◽  
The Mean ◽  
Pcl Avulsion

Abstract Background: Posterior cruciate ligament (PCL) avulsion fracture of tibia is an uncommon but serious complication during primary cruciate retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.Methods: From January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of tibia in primary cruciate-retaining TKA were included in study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA but no PCL avulsion fracture occurred. Range of motion of the knee and Knee Society Scores were assessed. The forgotten joint score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.Results: In our series, the incidence of PCL avulsion fracture was 4.6%. There was no significant differences with regard to preoperative or postoperative range of motion of the knee (p > 0.05). At the final follow-up of 4 years, the mean clinical scores of study and control groups were 92.4±2.7 and 93.6±1.9, respectively (p > 0.05). The mean functional scores were 85.1±1.8 and 87.1±1.2, respectively (p > 0.05). There was no significant statistical difference with regard to forgotten joint score (p > 0.05). Conclusions: The incidence of PCL avulsion fracture of tibia is relatively high. Older age and female gender were two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with high-strength line can achieve good stability and function of the knee.

scholarly journals A Surgical Reduction Technique for Posterior Cruciate Ligament Avulsion Fracture in Total Knee Arthroplasty: A Comparison Study

2020 ◽  
Author(s):  
Wei Lin ◽  
Jinghui Niu ◽  
Yike Dai ◽  
Huaxing Zhang ◽  
Jing Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Cruciate Retaining ◽  
Total Knee ◽  
Pcl Avulsion

Abstract Background: Posterior cruciate ligament (PCL) avulsion fracture of tibia is an uncommon but serious complication during primary cruciate retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.Methods: From January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of tibia in primary cruciate-retaining TKA were included in study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA but no PCL avulsion fracture occurred. Range of motion of the knee and Knee Society Scores were assessed. The forgotten joint score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.Results: In our series, the incidence of PCL avulsion fracture was 4.6%. There was no significant differences (p > 0.05) with regard to preoperative or postoperative range of motion of the knee, final 4 year mean clinical score in study and control groups 92.4 ± 2.7 and 93.6 ± 1.9, respectively, and mean functional scores of 85.1 ± 1.8 and 87.1 ± 1.2, respectively.Conclusions: The incidence of PCL avulsion fracture of tibia is relatively high. Older age and female gender were two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with high-strength line can achieve good stability and function of the knee.

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