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Using a patella reduced technique while balancing a TKA results in restored physiological strain in the collateral ligaments: an ex vivo kinematic analysis

  • Knee Arthroplasty
  • Published:
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Abstract

Introduction

Poor soft tissue balance in total knee arthroplasty (TKA) often results in patient dissatisfaction and reduced joint longevity. Patella-in-place balancing (PIPB) is a novel technique which aims to restore native collateral ligament behavior without collateral ligament release, while restoring post-operative patellar position. This study aimed to assess the effectiveness of this novel technique through a detailed ex vivo biomechanical analysis by comparing post-TKA tibiofemoral kinematics and collateral ligament behavior to the native condition.

Materials and methods

Eight fresh-frozen cadaveric legs (89.2 ± 6 years) were tested on a validated dynamic knee simulator, following computed tomography imaging. Specimens were subjected to passive flexion (10–120°), squatting (35–100°), and varus/valgus laxity testing (10 Nm at 0°, 30°, 60°, 90° flexion). An optical motion capture system recorded markers affixed rigidly to the femur, tibia, and patella, while digital extensometers longitudinally affixed to the superficial medial collateral ligament (MCL) and lateral collateral ligament (LCL) collected synchronized strain data. Following native testing, a Stryker Triathlon CR TKA (Stryker, MI, USA) was performed on each specimen and the identical testing protocol was repeated. Statistical analyses were performed using a linear mixed model for functional motor tasks, while Wilcoxon signed-rank test was used for laxity tests (p < 0.05).

Results

Postoperative laxity was lower than the native condition at all flexion angles while post-operative ligament strain was lowered only for MCL at 30° (p = 0.017) and 60° (p = 0.011). Postoperative femoral rollback patterns were comparable to the native condition in passive flexion but demonstrated a more pronounced medial pivot during squatting.

Conclusions

Balancing a TKA with the PIPB technique resulted in reduced joint laxity, while restoring collateral ligament strains. The technique also seemed to restore kinematics and strains, especially in passive flexion.

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Acknowledgements

The project was funded by Lazirush BVBA, Belgium. The funders have no role in study design, data collection, and analyses. The authors declare that there are no other conflicts of interest. We thank Margaux Delporte for assistance in statistical analyses. We also thank Kristof Reyniers and Jo Verbinnen for support in specimen preparation.

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Author notes

  1. Ignace Ghijselings, Orcun Taylan and Hendrik Pieter Delport: share first authorship.

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, AZ Alma, Ringlaan 15, Eeklo, Belgium

    Ignace Ghijselings, Hans Van den Wyngaert & Alex Demurie

  2. Institute for Orthopedic Research and Training (IORT), KU Leuven, UZ Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    Orcun Taylan, Hendrik Pieter Delport, Josh Slane & Lennart Scheys

  3. Division of Orthopedics, University Hospitals Leuven, Leuven, Belgium

    Hendrik Pieter Delport & Lennart Scheys

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  1. Ignace Ghijselings
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Contributions

All listed authors have contributed to the study design, acquisition, analysis, and interpretation of the data. Moreover, all authors have reviewed, and confirmed the accuracy of the whole text and approved the final manuscript.

Corresponding author

Correspondence to Hendrik Pieter Delport.

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Conflict of interest

The study, including personnel cost—Josh Slane and Orcun Taylan—, specimens and supplies, was funded by Lazirush BVBA, Belgium, which was founded by Ignace Ghijselings. Moreover, author Hendrik Pieter Delport, Hans Van den Wyngaert, Alex Demurie and Lennart Scheys declare they have no financial interest. Apart from above-mentioned statements, the authors have no relevant financial or non-financial interests to disclose. The authors declare that submitted manuscript do not contain scientific dishonesty and/or manipulated data, and/or plagiarized material and investigations were conducted in conformity with ethical principles of research. In addition, no funding was received to assist with the study design and/or manuscript preparation. The material and instruments for total knee arthroplasty was donated by Stryker, MI, USA. Ignace Ghijselings has contributed to the surgical procedure, data acquisition, interpretation of the data and writing. Orcun Taylan has contributed to the study design, data acquisition, analysis, interpretation of the data and writing. Hendrik Pieter Delport has contributed to the study design, surgical procedure, interpretation of the data and writing. Josh Slane has contributed to the study design, data acquisition and writing. Hans Van den Wyngaert and Alex Demurie have contributed to interpretation of the data and writing. Lennart Scheys has contributed to the study design, data acquisition, interpretation of the data and writing.

Ethical approval

Ethical approval was obtained from KU Leuven Ethical Committee (H019 2015-11-04). This work was performed at the Institute for Orthopedic Research and Training, KU Leuven, Belgium.

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Ghijselings, I., Taylan, O., Delport, H.P. et al. Using a patella reduced technique while balancing a TKA results in restored physiological strain in the collateral ligaments: an ex vivo kinematic analysis. Arch Orthop Trauma Surg 142, 1633–1644 (2022). https://doi.org/10.1007/s00402-021-04010-y

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