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Tibiofemoral forces for the native and post-arthroplasty knee: relationship to maximal laxity through a functional arc of motion

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Accurate soft tissue balance must be achieved to improve functional outcome after total knee arthroplasty (TKA). Sensor-integrated tibial trials have been introduced that allow real-time measurement of tibiofemoral kinematics during TKA. This study examined the interplay between tibiofemoral force and laxity, under defined intraoperative conditions, so as to quantify the kinematic behaviour of the CR femoral single-radius knee.

Methods

TKA was undertaken in eight loaded cadaveric specimens. Computer navigation in combination with sensor data defined laxity and tibiofemoral contact force, respectively, during manual laxity testing. Fixed-effect linear modelling allowed quantification of the effect for flexion angle, direction of movement and TKA implantation upon the knee.

Results

An inverse relationship between laxity and contact force was demonstrated. With flexion, laxity increased as contact force decreased under manual stress. Change in laxity was significant beyond 30° for coronal plane laxity and beyond 60° for rotatory laxity (p < 0.01). Rotational stress in mid-flexion demonstrated the greatest mismatch in inter-compartmental forces. Contact point position over the tibial sensor demonstrated paradoxical roll-forward with knee flexion.

Conclusion

Traditional balancing techniques may not reliably equate to uniform laxity or contact forces across the tibiofemoral joint through a range of flexion and argue for the role of per-operative sensor use to aid final balancing of the knee.

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Acknowledgments

Technical support was provided by Phil Jackson and Kate Moyle (Newcastle Surgical Training Centre) and Andrew Bowman (Stryker, UK). Funding for this work was obtained through Newcastle Charitable Trustees and a generous grant from Stryker Europe Research Division. We would like to thank Chris Anderson of Orthosensor for his advice and support.

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Authors and Affiliations

  1. Newcastle upon Tyne, Tyne and Wear, UK

    William A. Manning, Kanishka Ghosh, Alasdair Blain, Lee Longstaff & David John Deehan

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  1. William A. Manning
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  2. Kanishka Ghosh
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  4. Lee Longstaff
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  5. David John Deehan
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Correspondence to David John Deehan.

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Manning, W.A., Ghosh, K., Blain, A. et al. Tibiofemoral forces for the native and post-arthroplasty knee: relationship to maximal laxity through a functional arc of motion. Knee Surg Sports Traumatol Arthrosc 25, 1669–1677 (2017). https://doi.org/10.1007/s00167-016-4093-2

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