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Posterior capsular release is a biomechanically safe procedure to perform in total knee arthroplasty
Author(s):
Athwal K. (United Kingdom)
,
Athwal K. (United Kingdom)
Affiliations:
Milner P.
,
Milner P.
Affiliations:
Bellier G.
,
Bellier G.
Affiliations:
Amis A.
Amis A.
Affiliations:
ESSKA Academy. Athwal K. 05/09/18; 209535; P09-623 Topic: Joint Replacement
Dr. Kiron Athwal
Dr. Kiron Athwal
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Abstract
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Objectives: The posterior aspect of the knee has been rarely documented anatomically, and even less well described biomechanically. Surgeons may choose to overcome flexion contracture in total knee arthroplasty (TKA) by stripping the posterior capsule from its femoral attachment, as an alternative to further distal femoral cuts. It is unknown, however, if this has an impact on anterior-posterior (AP) stability of the implanted knee. The aim of the study was to investigate the effect of posterior capsular release on AP stability in TKA, and compare this to the restraint offered by the cruciate ligaments as well as different TKA inserts.

Methods: Eight cadaveric knees were mounted in a six degree of freedom testing rig and tested at 0°, 30°, 60° and 90° flexion with ±150 N AP force, with and without a 710 N axial compressive load. After the native knee was tested with and without the anterior cruciate ligament (ACL), a cruciate-retaining TKA was implanted and the tests repeated. The following stages were then performed: replacing with a deep dished insert, cutting the posterior cruciate ligament (PCL), releasing the posterior capsule using a curved osteotome, replacing with a posterior-stabilised implant and finally using a more-constrained insert.

Results: In anterior drawer, only cutting the anterior cruciate ligament caused a significant increase in laxity (p < 0.05) compared to the native state. In posterior drawer with no compressive load, cutting the PCL significantly increased laxity at 30°, 60° and 90°, however additional release of the posterior capsule did not produce further significant laxity. At 30°, 60° and 90°, posterior stability was significantly restored by introducing a posterior-stabilised insert. When a compressive load was applied, the overall laxity of all stages was reduced, however a similar trend to the unloaded tests in posterior drawer was found at 60° and 90°.

Conclusions: Releasing the posterior capsule did not cause a significant difference in AP laxity when put into context with different TKA inserts and the PCL. Therefore, the procedure to restore extension during TKA surgery could be considered a safe option to perform. If the PCL is resected and other structures have been damaged, it has been confirmed that introducing a posterior-stabilised insert can restore posterior stability, particularly in mid to late flexion.

Keywords:
knee replacement, posterior capsule, stability
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