Introduction. The effect of each step of medial soft tissue releases on the external rotation angle of the femoral component was assessed during posterior stabilized total knee arthroplasty (PS-TKA) with modified gap control technique. Methods. Consecutive 840 knees were assessed. During PS-TKA, medial soft tissue release was done to obtain rectangular gap in extension using tensors/balancers. The deep fiber of
Controversy remains regarding the optimal treatment for iatrogenic injury to the
When dealing with a flexion contracture, a surgeon first should consider all potential causes, specifically ligament contracture and osteophytes. Then consider the size of the femoral component and its position proximal to distal and also the posterior slope of the tibial component. Most knee flexion contractures are caused by osteophytes and tight ligaments, and once these problems are corrected, no further work needs to be done on the knee. So when the bone surface cuts are made, in general, little compensation is done in terms of positioning the femoral component proximal or distal, or in terms of sloping the tibial component (beyond the normal 3–4 degrees posterior slope), before the ligaments or osteophytes are managed. If the deep
The use of constrained condylar components (CCK) in primary total knee arthroplasty is infrequent and unusual. The usual indications are a severe fixed valgus deformity with a stretched or incompetent
Adequate soft tissue balance at the time of total knee arthroplasty (TKA) prevents early failure. In cases of varus deformity, once the medial osteophytes have been resected, a progressive release of the medial soft tissue sleeve (MSS) from the proximal medial tibia is needed to achieve balance. The “classic” medial soft tissue release technique, popularised by John Insall et al., consists of a sharp subperiosteal dissection from the proximal medial tibia that includes superficial and deep
Controversy remains regarding the optimal treatment for iatrogenic injury to the
Introduction. The acquisition of proper soft tissue balance is one of the crucial factors for preventing long-term failure and obtaining successful treatment outcomes of total knee arthroplasty (TKA).
Introduction. In total knee arthroplasty (TKA), component realignment with bone-based surgical correction (BBSC) can provide soft tissue balance and avoid the unpredictability of soft tissue releases (STR) and potential for more post-operative pain. Robotic-assisted TKA enhances the ability to accurately control bone resection and implant position. The purpose of this study was to identify preoperative and intraoperative predictors for soft tissue release where maximum use of component realignment was desired. Methods. This was a retrospective, single center study comparing 125 robotic-assisted TKAs quantitatively balanced using load-sensing tibial trial components with BBSC and/or STR. A surgical algorithm favoring BBSC with a desired final mechanical alignment of between 3° varus and 2° valgus was utilized. Component realignment adjustments were made during preoperative planning, after varus/valgus stress gaps were assessed after removal of medial and lateral osteophytes (pose capture), and after trialing. STR was performed when a BBSC would not result in knee balance within acceptable alignment parameters. The predictability for STR was assessed at four steps of the procedure: Preoperatively with radiographic analysis, and after assessing static alignment after medial and lateral osteophyte removal, pose capture, and trialing. Cutoff values predictive of release were obtained using receiver operative curve analysis. Results. STR was necessary in 43.5% of cases with
Traditional medial soft tissue release for balancing of the varus knee in total knee arthroplasty can lead to an inconsistent reduction in medial tension. The purpose of this study is to establish whether sequential needle puncturing of the
Controversy remains regarding the optimal treatment for iatrogenic injury to the
Introduction. Many factors can influence post-operative kinematics after total knee arthroplasty (TKA). These factors include intraoperative surgical conditions such as ligament release or quantity of bone resection as well as differences in implant design. Release of the
Purpose:. Biomechanical knowledge of the
During the ligament balancing for the severe medial contracture in varus knee TKA, complete distal release of the
Lubricin is a proteoglycan that is a boundary lubricant in synovial joints and both a surface and collagen inter-fascicular lubricant in ligaments. The purpose of this study was to characterise the mRNA levels for lubricin in the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL),
Passive knee stability is provided by the soft tissue envelope which resists abnormal motion. There is a consensus amongst orthopedic surgeons that a good outcome in TKA requires equal tension in the medial and the lateral compartment of the knee joint, as well as equal tension in the flexion and extension gap. The purpose of this study was to quantify the ligament laxity in the normal non-arthritic knee before and after standard posterior-stabilized total knee arthroplasty (PS-TKA). We hypothesized that the
Instability is reported to account for around 20% of early TKR revisions. The concept of restoring the “Envelope of Laxity” (EoL) mandates a balanced knee through a continuous arc of functional movement. We therefore hypothesised that a single radius (SR) design should confer this stability since it has been proposed that the SR promotes normal
Introduction. Many factors can influence post-operative kinematics after total knee arthroplasty (TKA). These factors include intraoperative surgical conditions such as ligament release or quantity of bone resection as well as differences in implant design. Release of the
Enhanced appreciation of normal knee kinematics and the inability to replicate these in the replaced total knee has led to increased enthusiasm for partial knee arthroplasty by some. These arthroplasties more closely replicate normal kinematics since they inherently preserve the anterior cruciate ligament (ACL). Indications for medial UKA are: anteromedial osteoarthritis with an intact ACL, posterior cruciate ligament, and
Introduction. Knee injuries are common amongst footballers. The aim of this study was to establish frequency and variation of knee injuries within one English Premier League (EPL) professional football club over two seasons, to assess number of days missed due to injury, and analyse current treatment regimen for each injury type. Method. Data was collected prospectively for injuries suffered by players between 2009 and 2011, spanning two EPL seasons at one EPL club. Demographics were recorded along with various factors influencing injury, including playing surface, pitch condition, dominant side, type of injury, ability to continue playing, and mechanism of injury. Time taken for return to play, and treatment received was recorded. Results. 35 injuries occurred that were severe enough to cause players to miss at least one competitive match. The commonest injury was to the
Quantitative knowledge on the anatomy of the