Download PDF
J Knee Surg 2022; 35(07): 788-797
DOI: 10.1055/s-0040-1718602
Original Article

Posterior Tibial Slope Increases Anterior Cruciate Ligament Stress in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematic Analysis

Christian Klemt
1   Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Georges Bounajem
1   Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Venkatsaiakhil Tirumala
1   Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Liang Xiong
1   Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Ruben Oganesyan
1   Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Young-Min Kwon
1   Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The study design involved here is experimental in nature. The resection of the anterior cruciate ligament (ACL) during conventional total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal in vivo knee kinematics. Bi-cruciate retaining (BCR) TKA designs allow the preservation of the ACL with the potential to restore native knee kinematics. This study aimed to investigate the effect of posterior tibial slope (PTS) on stress experienced by the ACL during weight bearing sit-to-stand (STS) and single-leg deep lunge. The ACL elongation patterns were measured in 30 unilateral BCR TKA patients during weight-bearing STS and single-leg deep lunge using a validated dual fluoroscopic tracking technique. The minimum normalized stress within the anteromedial (AM) and posterolateral (PL) bundle of the ACL during weight-bearing STS and single-leg deep lunge was found at a PTS of 3.7 degrees. The maximum AM and PL bundle stresses were observed at a PTS of 8.5 and 9.3 degrees, respectively during STS and at 8.4, and 9.1 degrees, respectively during single-leg deep lunge. There was a significant positive correlation between PTS and stress observed within the AM and PL bundle of the ACL during weight-bearing STS (R 2 = 0.37; p < 0.01; R2  = 0.36; p = 0.01) and single-leg deep lunge (R 2 = 0.42; p < 0.01; R 2 = 0.40; p < 0.01). The study demonstrates that PTS of operated BCR TKA knees has a significant impact on the stress experienced by the preserved ACL during weight-bearing STS and single-leg deep lunge. This suggests that avoiding excessive PTS may be one of the surgical implant alignment factors to consider during surgery to minimize increased loading of the preserved ACL.

Keywords

total knee arthroplasty - anterior cruciate ligament - normalized stress - posterior tibial slope


Publication History

Received: 21 May 2020

Accepted: 25 August 2020

Article published online:
27 October 2020

© 2020. Thieme. All rights reserved.

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

 

  • References

  • 1 Pritchett JW. Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis. J Arthroplasty 2011; 26 (02) 224-228
    CrossrefPubMedGoogle Scholar
  • 2 Bertin KC, Komistek RD, Dennis DA, Hoff WA, Anderson DT, Langer T. In vivo determination of posterior femoral rollback for subjects having a NexGen posterior cruciate-retaining total knee arthroplasty. J Arthroplasty 2002; 17 (08) 1040-104
    CrossrefPubMedGoogle Scholar
  • 3 Klemt C, Tirumala V, Oganesyan R, Xiong L, van den Kieboom J, Kwon Y-M. Single-stage revision of the infected total knee arthroplasty is associated with improved functional outcomes: a Propensity Score Matched Cohort Study. J Arthroplasty 2021; 36 (01) 298-304
    CrossrefPubMedGoogle Scholar
  • 4 Hennessy D, Arauz P, Klemt C, An S, Kwon Y-M. Gender influences gait asymmetry following bicruciate-retaining total knee arthroplasty. J Knee Surg 2020; 33 (06) 582-588
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Arauz P, Klemt C, Limmahakhun S, An S, Kwon Y-M. Stair climbing and high knee flexion activities in bi-cruciate retaining total knee arthroplasty: in vivo kinematics and articular contact analysis. J Arthroplasty 2019; 34 (03) 570-576
    CrossrefPubMedGoogle Scholar
  • 6 Tsai T-Y, Liow MHL, Li G. et al. Bi-cruciate retaining total knee arthroplasty does not restore native tibiofemoral articular contact kinematics during gait. J Orthop Res 2019; 37 (09) 1929-1937
    CrossrefPubMedGoogle Scholar
  • 7 Pritchett JW. Bicruciate-retaining total knee replacement provides satisfactory function and implant survivorship at 23 years. Clin Orthop Relat Res 2015; 473 (07) 2327-2333
    CrossrefPubMedGoogle Scholar
  • 8 Sabouret P, Lavoie F, Cloutier J-M. Total knee replacement with retention of both cruciate ligaments: a 22-year follow-up study. Bone Joint J 2013; 95-B (07) 917-922
    CrossrefPubMedGoogle Scholar
  • 9 Halewood C, Traynor A, Bellemans J, Victor J, Amis AA. Anteroposterior laxity after bicruciate-retaining total knee arthroplasty is closer to the native knee than ACL-resecting TKA: a biomechanical cadaver study. J Arthroplasty 2015; 30 (12) 2315-2319
    CrossrefPubMedGoogle Scholar
  • 10 Moro-oka TA, Muenchinger M, Canciani J-P, Banks SA. Comparing in vivo kinematics of anterior cruciate-retaining and posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2007; 15 (01) 93-99
    CrossrefPubMedGoogle Scholar
  • 11 Christensen JC, Brothers J, Stoddard GJ. et al. Higher frequency of reoperation with a new bicruciate-retaining total knee arthroplasty. Clin Orthop Relat Res 2017; 475 (01) 62-69
    CrossrefPubMedGoogle Scholar
  • 12 Pelt CE, Sandifer PA, Gililland JM, Anderson MB, Peters CL. Mean three-year survivorship of a new bicruciate-retaining total knee arthroplasty: are revisions still higher than expected?. J Arthroplasty 2019; 34 (09) 1957-1962
    CrossrefPubMedGoogle Scholar
  • 13 Arauz P, Peng Y, Kwon Y-M. Knee motion symmetry was not restored in patients with unilateral bi-cruciate retaining total knee arthroplasty-in vivo three-dimensional kinematic analysis. Int Orthop 2018; 42 (12) 2817-2823
    CrossrefPubMedGoogle Scholar
  • 14 Hamada D, Wada K, Takasago T. et al. Native rotational knee kinematics are lost in bicruciate-retaining total knee arthroplasty when the tibial component is replaced. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3249-3256
    CrossrefPubMedGoogle Scholar
  • 15 Yue B, Varadarajan KM, Rubash HE, Li G. In vivo function of posterior cruciate ligament before and after posterior cruciate ligament-retaining total knee arthroplasty. Int Orthop 2012; 36 (07) 1387-1392
    CrossrefPubMedGoogle Scholar
  • 16 Tsai T-Y, Liow MHL, Peng Y, Arauz P, Li G, Kwon Y-M. In-vivo elongation of anterior and posterior cruciate ligament in bi-cruciate retaining total knee arthroplasty. J Orthop Res 2018; 36 (12) 3239-3246
    CrossrefPubMedGoogle Scholar
  • 17 Dai Y, Cross MB, Angibaud LD, Hamad C, Jung A, Jenny J-Y. Posterior tibial slope impacts intraoperatively measured mid-flexion anteroposterior kinematics during cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3325-3332
    CrossrefPubMedGoogle Scholar
  • 18 Peng Y, Arauz P, An S, Limmahakhun S, Klemt C, Kwon Y-M. does component alignment affect patient reported outcomes following bicruciate retaining total knee arthroplasty? An in vivo three-dimensional analysis. J Knee Surg 2020; 33 (08) 798-803
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Todd MS, Lalliss S, Garcia E, DeBerardino TM, Cameron KL. The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med 2010; 38 (01) 63-67
    CrossrefPubMedGoogle Scholar
  • 20 Hashemi J, Chandrashekar N, Mansouri H. et al. Shallow medial tibial plateau and steep medial and lateral tibial slopes: new risk factors for anterior cruciate ligament injuries. Am J Sports Med 2010; 38 (01) 54-62
    CrossrefPubMedGoogle Scholar
  • 21 Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF. The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 2006; 22 (08) 894-899
    CrossrefPubMedGoogle Scholar
  • 22 Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society Knee Scoring System. Clin Orthop Relat Res 2012; 470 (01) 3-19
    CrossrefPubMedGoogle Scholar
  • 23 Davis AM, Perruccio AV, Canizares M. et al. The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative. Osteoarthritis Cartilage 2008; 16 (05) 551-559
    CrossrefPubMedGoogle Scholar
  • 24 Davis AM, Perruccio AV, Canizares M. et al. Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis Cartilage 2009; 17 (07) 843-847
    CrossrefPubMedGoogle Scholar
  • 25 Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH. Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2006; 22 (09) 1000-1006
    CrossrefPubMedGoogle Scholar
  • 26 Edwards A, Bull AMJ, Amis AA. The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: part 1: tibial attachment. Knee Surg Sports Traumatol Arthrosc 2007; 15 (12) 1414-1421
    CrossrefPubMedGoogle Scholar
  • 27 Tsai T-Y, Li J-S, Wang S. et al. A novel dual fluoroscopic imaging method for determination of THA kinematics: in-vitro and in-vivo study. J Biomech 2013; 46 (07) 1300-1304
    CrossrefPubMedGoogle Scholar
  • 28 Arabzadeh H, Amani M. Application of a novel ultrasonic technology to improve oil recovery with an environmental viewpoint. J Pet Environ Biotechnol 2017; 08: :2
    CrossrefPubMedGoogle Scholar
  • 29 Bergamini E, Pillet H, Hausselle J. et al. Tibio-femoral joint constraints for bone pose estimation during movement using multi-body optimization. Gait Posture 2011; 33 (04) 706-711
    CrossrefPubMedGoogle Scholar
  • 30 Hosseini A, Qi W, Tsai T-Y, Liu Y, Rubash H, Li G. In vivo length change patterns of the medial and lateral collateral ligaments along the flexion path of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 3055-3061
    CrossrefPubMedGoogle Scholar
  • 31 Kernkamp WA, Van de Velde SK, Hosseini A. et al. In vivo anterolateral ligament length change in the healthy knee during functional activities-a combined magnetic resonance and dual fluoroscopic imaging analysis. Arthroscopy 2017; 33 (01) 133-139
    CrossrefPubMedGoogle Scholar
  • 32 Lorenz S, Elser F, Brucker PU, Obst T, Imhoff AB. Radiological evaluation of the anterolateral and posteromedial bundle insertion sites of the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2009; 17 (06) 683-690
    CrossrefPubMedGoogle Scholar
  • 33 Nosrati M, Dey D, Mehrani A. et al. Functionally critical residues in the aminoglycoside resistance-associated methyltransferase RmtC play distinct roles in 30S substrate recognition. J Biol Chem 2019; 294 (46) 17642-17653
    CrossrefPubMedGoogle Scholar
  • 34 Sadat AR, Pashaei A, Tohidi S. A novel SVM-DTC method of in-wheel switched reluctance. Int J Technical Phys Problems Eng 2016; 8 (04) 19-25
    PubMedGoogle Scholar
  • 35 Yue B, Varadarajan KM, Moynihan AL, Liu F, Rubash HE, Li G. Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty. J Orthop Res 2011; 29 (01) 40-46
    CrossrefPubMedGoogle Scholar
  • 36 Medalla GA, Moonot P, Peel T, Kalairajah Y, Field RE. Cost-benefit comparison of the Oxford Knee score and the American Knee Society score in measuring outcome of total knee arthroplasty. J Arthroplasty 2009; 24 (04) 652-656
    CrossrefPubMedGoogle Scholar
  • 37 Halewood C, Risebury M, Thomas NP, Amis AA. Kinematic behaviour and soft tissue management in guided motion total knee replacement. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3074-3082
    CrossrefPubMedGoogle Scholar
  • 38 Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br 1994; 76 (05) 745-749
    CrossrefPubMedGoogle Scholar
  • 39 Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P. Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 2004; 124 (09) 575-584
    CrossrefPubMedGoogle Scholar
  • 40 Stijak L, Herzog RF, Schai P. Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee Surg Sports Traumatol Arthrosc 2008; 16 (02) 112-117
    CrossrefPubMedGoogle Scholar
  • 41 Shelburne KB, Kim H-J, Sterett WI, Pandy MG. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res 2011; 29 (02) 223-231
    CrossrefPubMedGoogle Scholar
  • 42 Shao Q, MacLeod TD, Manal K, Buchanan TS. Estimation of ligament loading and anterior tibial translation in healthy and ACL-deficient knees during gait and the influence of increasing tibial slope using EMG-driven approach. Ann Biomed Eng 2011; 39 (01) 110-121
    CrossrefPubMedGoogle Scholar
  • 43 Fujimoto E, Sasashige Y, Tomita T, Iwamoto K, Masuda Y, Hisatome T. Significant effect of the posterior tibial slope on the weight-bearing, midflexion in vivo kinematics after cruciate-retaining total knee arthroplasty. J Arthroplasty 2014; 29 (12) 2324-2330
    CrossrefPubMedGoogle Scholar
  • 44 Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am 2004; 86 (03) 506-511
    CrossrefPubMedGoogle Scholar
  • 45 Migaud H, De Ladoucette A, Dohin B, Cloutier JM, Gougeon F, Duquennoy A. Influence of the tibial slope on tibial translation and mobility of non-constrained total knee prosthesis. Rev Chir Orthop Repar Appar Mot 1996; 82 (01) 7-13
    PubMedGoogle Scholar
  • 46 Hasegawa A, Otsuki S, Pauli C. et al. Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis. Arthritis Rheum 2012; 64 (03) 696-704
    CrossrefPubMedGoogle Scholar
  • 47 Castile RM, Skelley NW, Babaei B, Brophy RH, Lake SP. Microstructural properties and mechanics vary between bundles of the human anterior cruciate ligament during stress-relaxation. J Biomech 2016; 49 (01) 87-93
    CrossrefPubMedGoogle Scholar
  • 48 Peng Y, Arauz P, Desai P, Byers A, Klemt C, Kwon Y-M. In vivo kinematic analysis of patients with robotic-assisted total hip arthroplasty during gait at 1-year follow-up. Int J Med Robot 2019; 15 (05) e2021
    CrossrefPubMedGoogle Scholar
  • 49 Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB. Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res 2003; (416) 37-57
    CrossrefPubMedGoogle Scholar
  • 50 Stiehl JB, Dennis DA, Komistek RD, Keblish PA. In vivo kinematic analysis of a mobile bearing total knee prosthesis. Clin Orthop Relat Res 1997; (345) 60-66
    PubMedGoogle Scholar