Restoring more natural kinematics is crucial for the success of knee TKA. The relative size of the tibia to the femur may differ in each patient and requires the possibility to combine different tibia sizes for a given femur size. Therefore, TKA systems need to be designed to allow for different size combinations. In literature some report higher revision rates when the femoral size is greater than the tibia, while others find no impact of the size mismatch on the clinical outcome. The tibio-femoral kinematics resulting from different size combinations has not been analyzed yet. The Columbus Deep Dish implant (Aesculap, Tuttlingen, Germany) is designed to allow a full size compatibility. Therefore we hypothesized that the kinematics would not be affected by the different size combinations. The goal of this study was to investigate the impact on kinematics of different tibio-femoral size combinations with the Columbus Deep Dish implant. 6 fresh frozen cadavers were tested in a force controlled well established knee rig after implantation of a cruciate retaining, fixed bearing Columbus Deep Dish TKA (Aesculap, Tuttlingen, Germany). Femoro-tibial kinematics were recorded while performing a loaded squat from 30° to 130°. Specifically developed and manufactured inlays allowed simulating different tibia sizes on each bone/tibial implant. For each cadaver, a total of 4 different tibia sizes were tested (1 original size, 3 simulated different sizes). Tibio-femoral internal/external rotation and antero-posterior translation of the medial and of the lateral condyles were computed for all size combinations. The kinematics obtained with the simulated sizes were compared to the kinematics obtained with the original inlay. For each flexion angle from 30° to 130°, the difference between the rotation (resp. translation) obtained with the original inlay was subtracted from the rotation obtained with the simulated tibia size. The mean value and standard deviation of the differences were computed.Objectives
Methods
Treatment of massive rotator cuff tears can be challenging. Previous studies with irreparable rotator cuff tears showed good clinical results of tendon healing with the arthroscopic insertion of a protective biodegradable spacer balloon filled with saline solution between the repaired tendon and the acromion [1,2], but so far no scientific evidence has showed how the device alters pressures over the repaired tendon. This biomechanical study investigated the effects of a spacer inserted in the subacromial space on pressures over the repaired rotator cuff tendon in passive motion cycles typical for post-operative rehabilitation routines. Six human cadaveric shoulders were prepared with the humerus cut 15cm below the joint and embedded in a pot, while the scapula fixed at three points on a plate. A rotator cuff tear was simulated and repaired using a suture anchor and a Mason-Allen suture. The specimens were then mounted on a custom-made pneumatic testing rig to induce passive motion cycles of adduction-abduction (90–0°) and flexion-extension (0–40°) with constant glenohumeral and superior loads and tension is exerted on the supraspinatus tendon with weights. A pressure sensor was placed between the supraspinatus tendon and the acromion. After pressure measurements for 15 cycles of each motion type, the InSpace balloon (OrthoSpace, Inc, Israel) was inserted and the specimens tested and pressure measured again for 15 cycles. Statistically significant changes in peak pressures were then measured before and after balloon. Peak pressures were measured near 90 degrees abduction. No statistical differences were observed for internal-external rotation before and after balloon-shaped subacromial spacer was inserted. Mean pressures in abduction-adduction were significantly reduced from 121.7 ± 9.5 MPa to 51.5 ± 1.2 MPa. Peak pressures after repair were 1171.3 ± 99.5 MPa and 1749.6 ± 80.7 MPa in flexion-extension and abduction-adduction motion, respectively, and significantly decreased to 468.7 ± 16.0 MPa and 535.1 ± 27.6 MPa after spacer insertion (p<0.0001). The use of the spacer above the repaired tendon reduced peak pressures and distributed them more widely over the sensor during both abduction-adduction and flexion-extension motions and therefore can reduce the stress on the rotator cuff repair. The InSpace system may reduce the pressure on the repaired tendon, thus potentially protecting the repair. Further studies to investigate this phenomenon are warranted, in particular relating these changes to shoulder kinematics following tear repair and spacer insertion.
