Native Knee Laxities at 0°, 45°, and 90° of Flexion and Their Relationship to the Goal of the Gap-Balancing Alignment Method of Total Knee Arthroplasty.

Abstract

BACKGROUND:

Gap-balancing is an alignment method for total knee arthroplasty with the goal of creating uniform tension in the periarticular soft-tissue restraints and equal laxities throughout the arc of flexion. However, there is little evidence that achieving equal laxities prevents either overly tight or overly loose soft-tissue restraints after total knee arthroplasty. Accordingly, the purpose of the present study was to determine whether the laxities at 0°, 45°, and 90° of flexion are equal in the native knee.

METHODS:

Seven different laxities were measured at 0°, 45°, and 90° of flexion in ten fresh-frozen native cadaveric knees (with intact menisci, cartilage, and ligaments) by applying loads of ±5 Nm in varus-valgus rotation, ±3 Nm in internal-external rotation, 100 N in distraction, and ±45 N in anterior-posterior translation with use of a six-degrees-of-freedom load application system.

RESULTS:

The mean laxities (and standard deviations) at 45° of flexion were 1.7° ± 0.6° greater in varus, 0.9° ± 0.4° greater in valgus, 10.2° ± 2.7° greater in internal rotation, 10.1° ± 2.0° greater in external rotation, 1.7 ± 1.0 mm greater in distraction translation, and 3.3 ± 1.5 mm greater in anterior translation than those at 0° of flexion. The mean laxities at 90° of flexion were 2.5° ± 0.8° greater in varus, 1.0° ± 0.5° greater in valgus, 10.0° ± 4.6° greater in internal rotation, 10.1° ± 4.5° greater in external rotation, 1.8 ± 0.7 mm greater in distraction, and 1.6 ± 1.2 mm greater in anterior translation than those at 0° of flexion. The mean anterior translation at 90° of flexion was 1.7 ± 0.9 mm less than that at 45° of flexion.

CONCLUSIONS:

Because five of the seven laxities were at least 1.7° or 1.6 mm greater at both 45° and 90° of flexion than those at 0° of flexion, the laxities of the native knee measured in this study are unequal at these flexion angles and therefore do not support the goal of gap-balancing in total knee arthroplasty.

CLINICAL RELEVANCE:

One possible disadvantage of changing the native laxities at 45° and 90° of flexion to match those at 0° of flexion in a total knee arthroplasty is the overly tight soft-tissue restraints relative to those of the native knee, which patients may perceive as pain, stiffness, and/or limited flexion.

• Authors: Joshua D Roth, Stephen M Howell, Maury L Hull
• Journal: The Journal of bone and joint surgery. American volume (J Bone Joint Surg Am) Vol. 97 Issue 20 Pg. 1678-84 (Oct 21 2015) ISSN: 1535-1386 [Electronic] United States
• PMID: 26491132 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Topics

• Aged
• Aged, 80 and over
• Anterior Cruciate Ligament (surgery)
• Arthroplasty, Replacement, Knee (methods)
• Biomechanical Phenomena (physiology)
• Humans
• Knee (surgery)
• Knee Joint (surgery)
• Middle Aged
• Posterior Cruciate Ligament (surgery)
• Range of Motion, Articular (physiology)
• Rotation