PDF herunterladen
J Knee Surg 2024; 37(02): 128-134
DOI: 10.1055/s-0042-1760390
Original Article

Ligament Tension and Balance before and after Robotic-Assisted Total Knee Arthroplasty — Dynamic Changes with Increasing Applied Force

Abhinav K. Sharma 
1   Department of Orthopaedic Surgery, University of California, Irvine, School of Medicine, Orange, California
,
Christopher Plaskos
2   Corin, Raynham, Massachusetts
,
Sami Shalhoub
2   Corin, Raynham, Massachusetts
,
Dylan Lawrence
3   Department of Orthopaedic and Rehabilitation, University of Wisconsin, Madison, Wisconsin
,
Jonathan M. Vigdorchik
4   Department of Orthopaedic Surgery, Hospital For Special Surgery, New York, New York
,
Jeffrey M. Lawrence
5   Center of Orthopaedic Surgery, Gundersen Health System, Viroqua, Wisconsin
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

The optimal force applied during ligament balancing in total knee arthroplasty (TKA) is not well understood. We quantified the effect of increasing distraction force on medial and lateral gaps throughout the range of knee motion, both prior to and after femoral resections in tibial-first gap-balancing TKA. Twenty-five consecutive knees in 21 patients underwent robotic-assisted TKA. The posterior cruciate ligament was resected, and the tibia was cut neutral to the mechanical axis. A digital ligament tensioning tool recorded gaps and applied equal mediolateral loads of 70 N (baseline), 90 N, and 110 N from 90 degrees to full extension. A gap-balancing algorithm planned the femoral implant position to achieve a balanced knee throughout flexion. After femoral resections, gap measurements were repeated under the same conditions. Paired t-tests identified gap differences between load levels, medial/lateral compartments, and flexion angle. Gaps increased from 0 to 20 degrees in flexion, then remain consistent through 90 degrees of flexion. Baseline medial gap was significantly smaller than lateral gap throughout flexion (p <0.05). Increasing load had a larger effect on the lateral versus medial gaps (p <0.05) and on flexion versus extension gaps. Increasing distraction force resulted in non-linear and asymmetric gap changes mediolaterally and from flexion to extension. Digital ligament tensioning devices can give better understanding of the relationship between joint distraction, ligament tension, and knee stiffness throughout the range of flexion. This can aid in informed surgical decision making and optimal soft tissue tensioning during TKA.

Keywords

robotic-assisted - total knee arthroplasty - ligament balance - ligament tension


Publikationsverlauf

Eingereicht: 20. August 2022

Angenommen: 15. November 2022

Artikel online veröffentlicht:
02. Februar 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 2019 - AOANJRR n.d. Accessed September 21, 2021, at: https://aoanjrr.sahmri.com/annual-reports-2019 ()
    PubMed
  • 2 Khatib Y, Badge H, Xuan W, Naylor JM, Harris IA. Patient satisfaction and perception of success after total knee arthroplasty are more strongly associated with patient factors and complications than surgical or anaesthetic factors. Knee Surg Sports Traumatol Arthrosc 2020; 28 (10) 3156-3163
    CrossrefPubMedSuche in Google Scholar
  • 3 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
    CrossrefPubMedSuche in Google Scholar
  • 4 Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 2017; 32 (12) 3854-3860
    CrossrefPubMedSuche in Google Scholar
  • 5 Le DH, Goodman SB, Maloney WJ, Huddleston JI. Current modes of failure in TKA: infection, instability, and stiffness predominate. Clin Orthop Relat Res 2014; 472 (07) 2197-2200
    CrossrefPubMedSuche in Google Scholar
  • 6 Nagai K, Muratsu H, Takeoka Y, Tsubosaka M, Kuroda R, Matsumoto T. The influence of joint distraction force on the soft-tissue balance using modified gap-balancing technique in posterior-stabilized total knee arthroplasty. J Arthroplasty 2017; 32 (10) 2995-2999
    CrossrefPubMedSuche in Google Scholar
  • 7 Wada K, Hamada D, Takasago T. et al. Joint distraction force changes the three-dimensional articulation of the femur and tibia in total knee arthroplasty: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2020; 28 (05) 1488-1496
    CrossrefPubMedSuche in Google Scholar
  • 8 Heesterbeek PJC, Haffner N, Wymenga AB, Stifter J, Ritschl P. Patient-related factors influence stiffness of the soft tissue complex during intraoperative gap balancing in cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (09) 2760-2768
    CrossrefPubMedSuche in Google Scholar
  • 9 Mayman D, Plaskos C, Kendoff D, Wernecke G, Pearle AD, Laskin R. Ligament tension in the ACL-deficient knee: assessment of medial and lateral gaps. Clin Orthop Relat Res 2009; 467 (06) 1621-1628
    CrossrefPubMedSuche in Google Scholar
  • 10 Asano H, Muneta T, Sekiya I. Soft tissue tension in extension in total knee arthroplasty affects postoperative knee extension and stability. Knee Surg Sports Traumatol Arthrosc 2008; 16 (11) 999-1003
    CrossrefPubMedSuche in Google Scholar
  • 11 Shalhoub S, Lawrence JM, Keggi JM, Randall AL, DeClaire JH, Plaskos C. Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance. Arthroplast Today 2019; 5 (03) 334-340
    CrossrefPubMedSuche in Google Scholar
  • 12 Shalhoub S, Moschetti WE, Dabuzhsky L, Jevsevar DS, Keggi JM, Plaskos C. Laxity profiles in the native and replaced knee-application to robotic-assisted gap-balancing total knee arthroplasty. J Arthroplasty 2018; 33 (09) 3043-3048
    CrossrefPubMedSuche in Google Scholar
  • 13 Wakelin EA, Shalhoub S, Lawrence JM. et al. Improved total knee arthroplasty pain outcome when joint gap targets are achieved throughout flexion. Knee Surg Sports Traumatol Arthrosc 2022; Mar; 30 (03) 939-947
    CrossrefPubMedSuche in Google Scholar
  • 14 Lee G-C, Wakelin E, Randall A, Plaskos C. Can a robot help a surgeon to predict a good total knee arthroplasty?. Bone Joint J 2021; 103-B (6, suppl A): 67-73
    CrossrefPubMedSuche in Google Scholar
  • 15 Orsi AD, Wakelin EA, Plaskos C, Petterwood J, Coffey S. Restricted kinematic alignment achieves similar relative lateral laxity and greater joint line obliquity compared to gap balancing TKA. Knee Surg Sports Traumatol Arthrosc 2022; 30 (09) 2922-2930
    CrossrefPubMedSuche in Google Scholar
  • 16 Keggi JM, Wakelin EA, Koenig JA. et al. Impact of intra-operative predictive ligament balance on post-operative balance and patient outcome in TKA: a prospective multicenter study. Arch Orthop Trauma Surg 2021; 141 (12) 2165-2174
    CrossrefPubMedSuche in Google Scholar
  • 17 Lee G-C, Wakelin E, Plaskos C. What is the alignment and balance of a total knee arthroplasty performed using a calipered kinematic alignment technique?. J Arthroplasty 2022; 37 (6S): S176-S181
    CrossrefPubMedSuche in Google Scholar
  • 18 Shatrov J, Murphy GT, Duong J, Fritsch B. Robotic-assisted total knee arthroplasty with the OMNIBot platform: a review of the principles of use and outcomes. Arch Orthop Trauma Surg 2021; 141 (12) 2087-2096
    CrossrefPubMedSuche in Google Scholar
  • 19 Nagai K, Muratsu H, Matsumoto T, Miya H, Kuroda R, Kurosaka M. Soft tissue balance changes depending on joint distraction force in total knee arthroplasty. J Arthroplasty 2014; 29 (03) 520-524
    CrossrefPubMedSuche in Google Scholar
  • 20 Koulalis D, O'Loughlin PF, Plaskos C, Kendoff D, Cross MB, Pearle AD. Sequential versus automated cutting guides in computer-assisted total knee arthroplasty. Knee 2011; 18 (06) 436-442
    CrossrefPubMedSuche in Google Scholar
  • 21 Fishkin Z, Miller D, Ritter C, Ziv I. Changes in human knee ligament stiffness secondary to osteoarthritis. J Orthop Res 2002; 20 (02) 204-207
    CrossrefPubMedSuche in Google Scholar
  • 22 Holst DC, Doan GW, Angerame MR, Roche MW, Clary CW, Dennis DA. What is the effect of posterior osteophytes on flexion and extension gaps in total knee arthroplasty? A cadaveric study. Arthroplast Today 2021; 11: 127-133
    CrossrefPubMedSuche in Google Scholar
  • 23 Kinoshita T, Hino K, Kutsuna T, Watamori K, Tsuda T, Miura H. Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty. J Exp Orthop 2021; 8 (01) 102
    CrossrefPubMedSuche in Google Scholar
  • 24 Bellemans J, D'Hooghe P, Vandenneucker H, Van Damme G, Victor J. Soft tissue balance in total knee arthroplasty: does stress relaxation occur perioperatively?. Clin Orthop Relat Res 2006; 452 (452) 49-52
    CrossrefPubMedSuche in Google Scholar
  • 25 Luyckx T, Vandenneucker H, Ing LS, Vereecke E, Ing AV, Victor J. Raising the joint line in TKA is associated with mid-flexion laxity: a study in cadaver knees. Clin Orthop Relat Res 2018; 476 (03) 601-611
    CrossrefPubMedSuche in Google Scholar
  • 26 Cross MB, Nam D, Plaskos C. et al. Recutting the distal femur to increase maximal knee extension during TKA causes coronal plane laxity in mid-flexion. Knee 2012; 19 (06) 875-879
    CrossrefPubMedSuche in Google Scholar
  • 27 Wakelin EA, Shalhoub S, Lawrence JM. et al. Improved total knee arthroplasty pain outcome when joint gap targets are achieved throughout flexion. Knee Surg Sports Traumatol Arthrosc 2022; 30 (03) 939-947
    CrossrefPubMedSuche in Google Scholar
  • 28 Van Damme G, Defoort K, Ducoulombier Y, Van Glabbeek F, Bellemans J, Victor J. What should the surgeon aim for when performing computer-assisted total knee arthroplasty?. J Bone Joint Surg Am 2005; 87 (Suppl. 02) 52-58
    PubMedSuche in Google Scholar
  • 29 Roth JD, Howell SM, Hull ML. 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. J Bone Joint Surg Am 2015; 97 (20) 1678-1684
    CrossrefPubMedSuche in Google Scholar
  • 30 Verstraete MA, Meere PA, Salvadore G, Victor J, Walker PS. Contact forces in the tibiofemoral joint from soft tissue tensions: implications to soft tissue balancing in total knee arthroplasty. J Biomech 2017; 58: 195-202
    CrossrefPubMedSuche in Google Scholar
  • 31 Wilson WT, Deakin AH, Payne AP, Picard F, Wearing SC. Comparative analysis of the structural properties of the collateral ligaments of the human knee. J Orthop Sports Phys Ther 2012; 42 (04) 345-351
    CrossrefPubMedSuche in Google Scholar
  • 32 Asano H, Muneta T, Hoshino A. Stiffness of soft tissue complex in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008; 16 (01) 51-55
    CrossrefPubMedSuche in Google Scholar
  • 33 Anderson C, Golladay G, Roche M, Gustke K, Elson L. Using intraoperative sensors to define intra-articular loading patterns during total knee arthroplasty. Orthop Proc 2018; 100-B: 60-60
    PubMedSuche in Google Scholar
  • 34 Gustke KA. Soft-tissue and alignment correction: the use of smart trials in total knee replacement. Bone Joint J 2014; 96-B (suppl A11): 78-83
    CrossrefPubMedSuche in Google Scholar
  • 35 Roche M, Elson L, Anderson C. Dynamic soft tissue balancing in total knee arthroplasty. Orthop Clin North Am 2014; 45 (02) 157-165
    CrossrefPubMedSuche in Google Scholar
  • 36 Meneghini RM, Ziemba-Davis MM, Lovro LR, Ireland PH, Damer BM. Can intraoperative sensors determine the “target” ligament balance? Early outcomes in total knee arthroplasty. J Arthroplasty 2016; 31 (10) 2181-2187
    CrossrefPubMedSuche in Google Scholar
  • 37 Golladay GJ, Bradbury TL, Gordon AC. et al. Are patients more satisfied with a balanced total knee arthroplasty?. J Arthroplasty 2019; 34 (7S): S195-S200
    CrossrefPubMedSuche in Google Scholar
  • 38 Chow JC, Breslauer L. The use of intraoperative sensors significantly increases the patient-reported rate of improvement in primary total knee arthroplasty. Orthopedics 2017; 40 (04) e648-e651
    PubMedSuche in Google Scholar