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Balancing UKA: overstuffing leads to high medial collateral ligament strains

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Balancing unicondylar knee arthroplasty (UKA) is challenging. If not performed properly, it may lead to implant loosening or progression of osteoarthritis in the preserved compartment. This study was aimed to document the biomechanical effects of improper balancing. We hypothesised that overstuffing would lead to more valgus, higher strain in the medial collateral ligament (sMCL), and higher lateral contact force.

Methods

Six fresh-frozen cadaver specimens were mounted in a kinematic rig. Three motion patterns were applied with the native knee and following medial UKA (passive motion, open-chain extension, and squatting), while infrared cameras recorded the trajectories of markers attached to femur and tibia. Three inlay thicknesses were tested (8, 9, 10 mm).

Results

Overstuffed knees were in more valgus and showed less tibial rotation and higher strains in the sMCL (p < 0.05). Lateral contact forces were higher in some specimens and lower in others. Stiffening of the medial compartment by UKA, even well balanced, already leads to a knee more in valgus with a more stressed sMCL. Overstuffing increases these effects. Knees with a tight sMCL may even see lower lateral contact force. Biomechanics were closest to the native knee with understuffing.

Conclusion

The first two hypotheses were confirmed, but not the latter. This underlines the importance of optimal balancing. Overstuffing should certainly be avoided. Although kinematics is only slightly affected, contact forces and ligament strains are considerably changed and this might be of more clinical importance. It is advisable to use thinner inlays, if stability is not compromised.

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Acknowledgments

The study was performed in the European Centre for Knee Research, Leuven, Belgium, and funded by Smith and Nephew. Ronny de Corte is an employee of Smith and Nephew, and Thomas J. Heyse is a consultant to and receives research support from Smith and Nephew and Biomet.

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Authors and Affiliations

  1. Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Thomas J. Heyse, Bilal F. El-Zayat & Susanne Fuchs-Winkelmann

  2. Smith & Nephew, Zaventem, Belgium

    Ronny De Corte

  3. Department of Orthopaedics, Katholieke Universiteit Leuven, Louvain, Belgium

    Lennart Scheys

  4. Klinikum Großhadern, Orthopädische Klinik und Poliklinik, Labor für Biomechanik und Experimentelle Orthopädie, Munich, Germany

    Yan Chevalier

  5. Mechanical Engineering Technology TC, KU Leuven, Geel, Belgium

    Luc Labey

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  1. Thomas J. Heyse
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  2. Bilal F. El-Zayat
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  3. Ronny De Corte
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  4. Lennart Scheys
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  6. Susanne Fuchs-Winkelmann
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  7. Luc Labey
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Correspondence to Thomas J. Heyse.

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Heyse, T.J., El-Zayat, B.F., De Corte, R. et al. Balancing UKA: overstuffing leads to high medial collateral ligament strains. Knee Surg Sports Traumatol Arthrosc 24, 3218–3228 (2016). https://doi.org/10.1007/s00167-015-3848-5

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  • DOI: https://doi.org/10.1007/s00167-015-3848-5

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