Cargando…

Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study

Background: Recent evidence supports that restoration of the pre-arthritic condition via total knee arthroplasty (TKA) is associated with improved post-TKA performance and patient satisfaction. However, whether the restored pre-arthritic joint line simulates the native mid-flexion biomechanics remai...

Descripción completa

Detalles Bibliográficos
Autores principales: Kwak, Dai-Soon, Kim, Yong Deok, Cho, Nicole, In, Yong, Kim, Man Soo, Lim, Dohyung, Koh, In Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9598272/
https://www.ncbi.nlm.nih.gov/pubmed/36290532
http://dx.doi.org/10.3390/bioengineering9100564
_version_ 1784816291988635648
author Kwak, Dai-Soon
Kim, Yong Deok
Cho, Nicole
In, Yong
Kim, Man Soo
Lim, Dohyung
Koh, In Jun
author_facet Kwak, Dai-Soon
Kim, Yong Deok
Cho, Nicole
In, Yong
Kim, Man Soo
Lim, Dohyung
Koh, In Jun
author_sort Kwak, Dai-Soon
collection PubMed
description Background: Recent evidence supports that restoration of the pre-arthritic condition via total knee arthroplasty (TKA) is associated with improved post-TKA performance and patient satisfaction. However, whether the restored pre-arthritic joint line simulates the native mid-flexion biomechanics remains unclear. Objective: We performed a matched-pair cadaveric study to explore whether restoration of the joint line via kinematically aligned (KA) TKA reproduced native knee biomechanics more accurately than the altered joint line associated with mechanically aligned (MA) TKA. Methods: Sixteen fresh-frozen cadaveric knees (eight pairs) were affixed onto a customized knee-squatting simulator for measurement of femoral rollback and medial collateral ligament (MCL) strain during mid-flexion. One knee from each cadaver was randomly designated to the KA TKA group (with the joint line restored to the pre-arthritic condition) and the other to the MA TKA group (with the joint line perpendicular to the mechanical axis). Optical markers were attached to all knees and rollback was analyzed using motion capture cameras. A video extensometer measured real-time variations in MCL strain. The kinematics and MCL strain prior to and following TKA were measured for all specimens. Results: KA TKA was better for restoring the knee kinematics to the native condition than MA TKA. The mid-flexion femoral rollback and axial rotation after KA TKA were consistently comparable to those of the native knee. Meanwhile, those of MA TKA were similar only at ≤40° of flexion. Furthermore, KA TKA better restored the mid-flexion MCL strain to that of the native knee than MA TKA. Over the entire mid-flexion range, the MCL strain of KA TKA and native knees were similar, while the strains of MA TKA knees were more than twice those of native knees at >20° of flexion. Conclusions: The restored joint line after KA TKA effectively reproduced the native mid-flexion rollback and MCL strain, whereas the altered joint line after MA TKA did not. Our findings may explain why patients who undergo KA TKA experience superior outcomes and more natural knee sensations during daily activities than those treated via MA TKA.
format Online
Article
Text
id pubmed-9598272
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-95982722022-10-27 Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study Kwak, Dai-Soon Kim, Yong Deok Cho, Nicole In, Yong Kim, Man Soo Lim, Dohyung Koh, In Jun Bioengineering (Basel) Article Background: Recent evidence supports that restoration of the pre-arthritic condition via total knee arthroplasty (TKA) is associated with improved post-TKA performance and patient satisfaction. However, whether the restored pre-arthritic joint line simulates the native mid-flexion biomechanics remains unclear. Objective: We performed a matched-pair cadaveric study to explore whether restoration of the joint line via kinematically aligned (KA) TKA reproduced native knee biomechanics more accurately than the altered joint line associated with mechanically aligned (MA) TKA. Methods: Sixteen fresh-frozen cadaveric knees (eight pairs) were affixed onto a customized knee-squatting simulator for measurement of femoral rollback and medial collateral ligament (MCL) strain during mid-flexion. One knee from each cadaver was randomly designated to the KA TKA group (with the joint line restored to the pre-arthritic condition) and the other to the MA TKA group (with the joint line perpendicular to the mechanical axis). Optical markers were attached to all knees and rollback was analyzed using motion capture cameras. A video extensometer measured real-time variations in MCL strain. The kinematics and MCL strain prior to and following TKA were measured for all specimens. Results: KA TKA was better for restoring the knee kinematics to the native condition than MA TKA. The mid-flexion femoral rollback and axial rotation after KA TKA were consistently comparable to those of the native knee. Meanwhile, those of MA TKA were similar only at ≤40° of flexion. Furthermore, KA TKA better restored the mid-flexion MCL strain to that of the native knee than MA TKA. Over the entire mid-flexion range, the MCL strain of KA TKA and native knees were similar, while the strains of MA TKA knees were more than twice those of native knees at >20° of flexion. Conclusions: The restored joint line after KA TKA effectively reproduced the native mid-flexion rollback and MCL strain, whereas the altered joint line after MA TKA did not. Our findings may explain why patients who undergo KA TKA experience superior outcomes and more natural knee sensations during daily activities than those treated via MA TKA. MDPI 2022-10-17 /pmc/articles/PMC9598272/ /pubmed/36290532 http://dx.doi.org/10.3390/bioengineering9100564 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kwak, Dai-Soon
Kim, Yong Deok
Cho, Nicole
In, Yong
Kim, Man Soo
Lim, Dohyung
Koh, In Jun
Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study
title Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study
title_full Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study
title_fullStr Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study
title_full_unstemmed Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study
title_short Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study
title_sort restoration of the joint line configuration reproduces native mid-flexion biomechanics after total knee arthroplasty: a matched-pair cadaveric study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9598272/
https://www.ncbi.nlm.nih.gov/pubmed/36290532
http://dx.doi.org/10.3390/bioengineering9100564
work_keys_str_mv AT kwakdaisoon restorationofthejointlineconfigurationreproducesnativemidflexionbiomechanicsaftertotalkneearthroplastyamatchedpaircadavericstudy
AT kimyongdeok restorationofthejointlineconfigurationreproducesnativemidflexionbiomechanicsaftertotalkneearthroplastyamatchedpaircadavericstudy
AT chonicole restorationofthejointlineconfigurationreproducesnativemidflexionbiomechanicsaftertotalkneearthroplastyamatchedpaircadavericstudy
AT inyong restorationofthejointlineconfigurationreproducesnativemidflexionbiomechanicsaftertotalkneearthroplastyamatchedpaircadavericstudy
AT kimmansoo restorationofthejointlineconfigurationreproducesnativemidflexionbiomechanicsaftertotalkneearthroplastyamatchedpaircadavericstudy
AT limdohyung restorationofthejointlineconfigurationreproducesnativemidflexionbiomechanicsaftertotalkneearthroplastyamatchedpaircadavericstudy
AT kohinjun restorationofthejointlineconfigurationreproducesnativemidflexionbiomechanicsaftertotalkneearthroplastyamatchedpaircadavericstudy