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Collateral ligament length change patterns after joint line elevation may not explain midflexion instability following TKA

Collateral ligament length change patterns after joint line elevation may not explain midflexion instability following TKA
Collateral ligament length change patterns after joint line elevation may not explain midflexion instability following TKA
Midflexion instability (MFI) after TKA is a phenomenon often described as varus-valgus instability between 30° and 45° knee flexion. The exact mechanisms causing MFI remain unclear, but elevation of the joint line (JLE) may be one possible cause. In an in-silico approach using 4 subject specific musculoskeletal models, the length change patterns of the collateral ligaments during knee flexion (relative to the extended knee) were calculated for the anatomically reconstructed joints as well as for JLEs of 5 and 10 mm. Analysis of the distance between the ligaments’ attachment sites (DA) in midflexion revealed a relative decrease in DA magnitude after JLE for both collateral ligaments in comparison to the anatomically reconstructed knee. This finding suggests that JLE could contribute to MFI. However, the anterior ligament regions also experienced a DA increase (MCL) or only a slight DA decrease (LCL) for each JLE simulated. From this perspective, the anterior ligament portions are unlikely to slacken in midflexion and JLE is unlikely to contribute greatly to MFI. In conclusion, our findings did not support the idea that JLE is a major contributor to midflexion instability for this particular ultra-congruent implant design.
knee, tka, joint line, stability, collateral ligaments, midflexion instability
1350-4533
1303-1308
König, C.
1d5d6617-571b-4b22-a1a2-083162035e7a
Matziolis, G.
7e8c1f72-6b02-403e-85e6-e0a4644f961a
Sharenkov, A.
b5af0392-9535-4d75-a478-1651a3df5a70
Taylor, W.R.
4f1cd2b0-4963-4b10-bbde-da586c069e77
Perka, C.
075d2c0e-b277-4a76-8b14-548bce0bb133
Duda, G.N.
32d09622-34ad-49dd-8314-3f61c99a764e
Heller, M.O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
König, C.
1d5d6617-571b-4b22-a1a2-083162035e7a
Matziolis, G.
7e8c1f72-6b02-403e-85e6-e0a4644f961a
Sharenkov, A.
b5af0392-9535-4d75-a478-1651a3df5a70
Taylor, W.R.
4f1cd2b0-4963-4b10-bbde-da586c069e77
Perka, C.
075d2c0e-b277-4a76-8b14-548bce0bb133
Duda, G.N.
32d09622-34ad-49dd-8314-3f61c99a764e
Heller, M.O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829

König, C., Matziolis, G., Sharenkov, A., Taylor, W.R., Perka, C., Duda, G.N. and Heller, M.O. (2011) Collateral ligament length change patterns after joint line elevation may not explain midflexion instability following TKA. Medical Engineering & Physics, 33 (10), 1303-1308. (doi:10.1016/j.medengphy.2011.06.008). (PMID:21764353)

Record type: Article

Abstract

Midflexion instability (MFI) after TKA is a phenomenon often described as varus-valgus instability between 30° and 45° knee flexion. The exact mechanisms causing MFI remain unclear, but elevation of the joint line (JLE) may be one possible cause. In an in-silico approach using 4 subject specific musculoskeletal models, the length change patterns of the collateral ligaments during knee flexion (relative to the extended knee) were calculated for the anatomically reconstructed joints as well as for JLEs of 5 and 10 mm. Analysis of the distance between the ligaments’ attachment sites (DA) in midflexion revealed a relative decrease in DA magnitude after JLE for both collateral ligaments in comparison to the anatomically reconstructed knee. This finding suggests that JLE could contribute to MFI. However, the anterior ligament regions also experienced a DA increase (MCL) or only a slight DA decrease (LCL) for each JLE simulated. From this perspective, the anterior ligament portions are unlikely to slacken in midflexion and JLE is unlikely to contribute greatly to MFI. In conclusion, our findings did not support the idea that JLE is a major contributor to midflexion instability for this particular ultra-congruent implant design.

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More information

Published date: December 2011
Keywords: knee, tka, joint line, stability, collateral ligaments, midflexion instability
Organisations: Bioengineering Group

Identifiers

Local EPrints ID: 348532
URI: http://eprints.soton.ac.uk/id/eprint/348532
ISSN: 1350-4533
PURE UUID: 005cb0da-abc6-4b7b-8b39-346fc3a9683c
ORCID for M.O. Heller: ORCID iD orcid.org/0000-0002-7879-1135

Catalogue record

Date deposited: 15 Feb 2013 16:42
Last modified: 17 Dec 2019 01:38

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