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Limited effect of anatomical insert geometry on in vitro laxity in balanced anatomic posterior cruciate ligament retaining total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The present study assessed the effect of insert articular surface geometry (anatomical versus conventional insert design) on anteroposterior (AP) translation and varus-valgus (VV) laxity in balanced posterior cruciate ligament (PCL) retaining total knee arthroplasty (TKA). Secondly, we evaluated if the AP translation and VV laxity in the reconstructed knee resembled the stability of the native knee.

Methods

Nine fresh-frozen full-leg cadaver specimens were used in this study. After testing the native knee, anatomical components of a PCL-retaining implant were implanted. The knee joints were subjected to anteriorly and posteriorly directed forces (at 20° and 90° flexion) and varus-valgus stresses (at 20°, 45° and 90° flexion) in both non-weightbearing and weightbearing situations in a knee kinematics simulator. Measurements were performed in the native knee, TKA with anatomical insert geometry (3° built-in varus, medial concave, lateral convex), and TKA with symmetrical insert geometry.

Results

In weightbearing conditions, anterior translations ranged between 2.6 and 3.9 mm at 20° flexion and were < 1 mm at 90° flexion. Posterior translation at 20° flexion was 2.7 mm for the native knee versus 4.0 mm (p = 0.047) and 7.0 mm (p = 0.02) for the symmetrical insert and the anatomical insert, respectively. Posterior translation at 90° flexion was < 1.1 mm and not significantly different between the native knee and insert types.

In non-weightbearing conditions, the anterior translation at 20° flexion was 5.9 mm for the symmetrical and 4.6 mm for the anatomical insert (n.s.), compared with 3.0 mm for the native knee (p = 0.02). The anterior translation at 90° flexion was significantly higher for the reconstructed knees (anatomical insert 7.0 mm; symmetrical insert 9.2 mm), compared with 1.6 mm for the native knee (both p = 0.02). Varus-valgus laxity at different flexion angles was independent of insert geometry. A valgus force in weightbearing conditions led to significantly more medial laxity (1°–3° opening) in the native knee at 45° and 90° flexion compared with the reconstructed knee for all flexion angles.

Conclusions

Insert geometry seems to have a limited effect with respect to AP translation and VV laxity, in the well-balanced PCL-retaining TKA with an anatomical femoral component. Secondly, AP translation and VV laxity in the reconstructed knee approximated the laxity of the native knee.

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Acknowledgements

We thank Ronny De Corte from the European Centre for Knee Research (EKCR) for his help in preparation, implantation and measurements of the specimens. Specimens and materials used in this study were kindly arranged by the European Centre for Knee Research, Smith and Nephew.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands

    Albert H. van Houten, Petra J. C. Heesterbeek, Gerjon Hannink & Ate B. Wymenga

  2. OCON Centre for Orthopaedic Surgery, Hengelo, The Netherlands

    Albert H. van Houten

  3. Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands

    Gerjon Hannink

  4. Department of Mechanical Engineering, KU Leuven, Geel, Belgium

    Luc Labey

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  1. Albert H. van Houten
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  2. Petra J. C. Heesterbeek
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  4. Luc Labey
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  5. Ate B. Wymenga
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Contributions

Study conception and design: A.H.v.H., P.J.C.H., L.L., A.B.W. Acquisition of data: P.J.C.H., L.L., A.B.W. Analysis and interpretation of data: A.H.v.H., P.J.C.H, G.H. Drafting of manuscript: A.H.v.H. Critical revision: P.J.C.H., G.H., L.L., A.B.W.

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Correspondence to Albert H. van Houten.

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The authors declare that they have no conflict of interest.

Funding

Specimen and materials used in this study were arranged by the former European Center of Knee Research (owned by Smith & Nephew). Smith & Nephew partially financed this study (payment to institution of author).

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van Houten, A.H., Heesterbeek, P.J.C., Hannink, G. et al. Limited effect of anatomical insert geometry on in vitro laxity in balanced anatomic posterior cruciate ligament retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 1273–1281 (2022). https://doi.org/10.1007/s00167-021-06564-1

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  • DOI: https://doi.org/10.1007/s00167-021-06564-1

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