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Kinematically aligned total knee arthroplasty restores more native medial collateral ligament strain than mechanically aligned total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Kinematically aligned total knee arthroplasty (KA TKA) targets restoration of patient-specific alignment and soft tissue laxity. However, whether KA TKA reproduces native soft tissue strain remains unclear. This cadaveric study tested the hypothesis that KA TKA would better restore the quantitative strain and strain distribution of medial collateral ligament (MCL) to the native healthy knee compared to mechanically aligned (MA) TKA.

Methods

Twenty-four fresh-frozen cadaver knees (12 pairs) were mounted on a customized knee squatting simulator to measure MCL strain during flexion. For each pair, one knee was assigned to KA TKA and the other to MA TKA. During KA TKA, the amount of femur and tibia resected was equivalent to implant thickness without MCL release using the calipered measuring technique. MA TKA was performed using conventional measured resection techniques. MCL strain was measured using a video extensometer (Mercury® RT RealTime tracking system, Sobriety s.r.o, Czech Republic). MCL strain and strain distribution during knee flexion were measured, and the measurements compared between native and post-TKA conditions.

Results

Mean and peak MCL strain were similar between KA TKA and native knees at all flexion angles (p > 0.1 at all flexion angles) while mean strain at all flexion angles and peak strain at ≥ 60º of MA TKA were approximately twice those of the native knees (p < 0.05 at ≥ 60º of flexion). In addition, greater MCL strain was observed in 4 of 12 regions of interest (ROI) after MA TKA (M1, M2, P1 and P2) compared to the native knee, whereas after KA TKA, MCL strain measurements were similar at all but 1 ROI (P2).

Conclusions

KA TKA restored a more native amount and distribution of MCL strain compared to MA TKA. These findings provide clues for understanding why patients may experience better performance and more normal knee sensations after KA TKA compared to MA TKA.

Level of evidence

Therapeutic study, Level I.

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Acknowledgements

We thank Smith+Nephew, Korea for kindly providing all surgical instruments used in this study. We thank Su Gu Chai, B.S., Seung Jun Lee, P.R.S., of Smith+Nephew, Korea, and Ki Joon Yoo, B.A., Jae Young Sung, B.S., and Hyunggu Han, B.A., of Daon HealthCare, Korea for their assistance in the testing of specimens. We also thank the cadaver donors and their families.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2019 R1F1A 1057842 and No. 2017M3A9E9073545). The funding source did not play any scientific role in performing this study.

Author information

Author notes

  1. Dohyung Lim and Dai-Soon Kwak have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Mechanical Engineering, Sejong University, Seoul, 05006, Republic of Korea

    Dohyung Lim, Minji Kim, Seoyeong Kim & Jae Hyuk Choi

  2. Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea

    Dai-Soon Kwak & Ho-Jung Cho

  3. Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul, 03312, Republic of Korea

    In Jun Koh

  4. Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea

    In Jun Koh

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  1. Dohyung Lim
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Contributions

DL: conducted the test, drafted the manuscript, supervised the project. D-SK: conducted the test, drafted the manuscript. MKim: conducted the test, acquired and analyzed the data, drafted the manuscript. SK: conducted the test. H-JC: conducted the test. JHC: conducted the test. IJK: conceptualized the study, designed the study, conducted the test, acquired and analyzed the data, drafted the manuscript, supervised the project.

Corresponding author

Correspondence to In Jun Koh.

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Lim, D., Kwak, DS., Kim, M. et al. Kinematically aligned total knee arthroplasty restores more native medial collateral ligament strain than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 2815–2823 (2022). https://doi.org/10.1007/s00167-021-06680-y

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