In Vivo Kinematics and Cruciate Ligament Tension Are Not Restored to Normal After Bicruciate-Preserving Arthroplasty

Kenichi Kono; Tetsuya Tomita; Takaharu Yamazaki; Hiroshi Inui; Sakae Tanaka; Darryl D D'Lima

doi:10.1016/j.arth.2024.03.060

In Vivo Kinematics and Cruciate Ligament Tension Are Not Restored to Normal After Bicruciate-Preserving Arthroplasty

J Arthroplasty. 2024 Mar 28:S0883-5403(24)00300-0. doi: 10.1016/j.arth.2024.03.060. Online ahead of print.

Authors

Kenichi Kono¹, Tetsuya Tomita², Takaharu Yamazaki³, Hiroshi Inui⁴, Sakae Tanaka⁵, Darryl D D'Lima⁶

Affiliations

¹ Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan.
² Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Health Science, Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka, Japan.
³ Faculty of Engineering, Department of Information Systems, Saitama Institute of Technology, Fukaya, Saitama, Japan.
⁴ Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan; Department of Orthopedic Surgery, Saitama Medical University, Saitama Medical Center, Kawagoe, Saitama, Japan.
⁵ Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan.
⁶ Shiley Center for Orthopaedic Research & Education, Scripps Health, La Jolla, California.

PMID: 38552864
DOI: 10.1016/j.arth.2024.03.060

Abstract

Background: Whether cruciate ligament forces in cruciate-preserving designs, such as unicompartmental knee arthroplasty (UKA) or bi-cruciate-retaining total knee arthroplasty (BCR-TKA), differ from those in normal knees remains unknown. The purpose of this study was to compare the in vivo kinematics and cruciate ligament force in knees before and after UKA or BCR-TKA to those in normal knees during high-flexion activity.

Methods: Overall, twenty normal knees, 17 knees with medial UKA, and 15 knees with BCR-TKA were fluoroscopically examined while performing a squatting activity. A 2-dimensional or 3-dimensional registration technique was employed to measure tibio-femoral kinematics. Ligament strains and tensions in the anteromedial bundle of the anterior cruciate ligament and posterolateral bundle of the anterior cruciate ligament and the anterolateral bundle of the posterior cruciate ligament (aPCL) and posteromedial bundle of the posterior cruciate ligament (pPCL) during knee flexion were analyzed.

Results: Tension in both bundles of the anterior cruciate ligament decreased with flexion. At 60° of flexion, anteromedial bundle of the anterior cruciate ligament tension in postoperative UKA knees was greater than that in normal knees. At 30° of flexion, posterolateral bundle of the anterior cruciate ligament tension in postoperative UKA knees was greater than that in normal knees. On the other hand, aPCL and pPCL tensions increased with flexion. From 40 to 110° of flexion, the postoperative aPCL tension in UKA knees was greater than that in normal knees. At 110° of flexion, the preoperative pPCL tension in UKA knees was greater than that in normal knees. In addition, the postoperative pPCL tension in UKA knees was larger than that in normal knees beyond 20° of flexion. Furthermore, the pPCL tension of postoperative BCR-TKA knees was larger than that in normal knees from 20 to 50° and beyond 90° of flexion.

Conclusions: The cruciate ligament tensions, especially posterior cruciate ligament tension in knees after UKA, were greater than those in the normal knees. Surgeons performing bi-cruciat-preserving knee arthroplasties should therefore balance cruciate ligament tension more carefully in flexion and extension.

Keywords: bi-cruciate-retaining arthroplasty; cruciate ligament tension; high-flexion activities; kinematics; preoperative knee; unicompartmental knee arthroplasty.