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ACL/PCL Retaining TKR Restores Normal Rotational Movement of the Tibia in Relation to the Femur During Flexion-Extension.
Author(s):
Feranec M. (Czech Republic)
,
Feranec M. (Czech Republic)
Affiliations:
Hart R.
,
Hart R.
Affiliations:
Bu###ek F.
Bu###ek F.
Affiliations:
ESSKA Academy. Feranec M. 05/09/18; 209550; P09-128 Topic: Joint Replacement
Martin Feranec
Martin Feranec
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Abstract
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Objectives: Pathologic kinematics can be a cause of the knee pain after the total knee replacement (TKR). The objective of this prospective biomechanical study was to analyse rotational movement of the tibia in relation to the femur during flexion-extension in healthy knees, arthrotic knees and after different types of condylar TKR

Methods: Healthy volunteers and patients undergoing TKR were evaluated using computer navigation system during the surgery in "time zero". There were created these groups: volunteers with healthy knees (50 cases) and patients undergoing TKR who were evaluated before and after the surgery. TKRs included all types of condylar replacements (PCL retaining /standard platform/, PCL retaining /dished platform/, PCL retaining /rotating-platform/, ACL/PCL retaining, PCL sacrifing). Every TKR group consisted of 30 cases. Computer software recorded the passive rotational kinematics of the tibia during flexion-extension and afterwards curves were created using an another computer software. The knee rotational stability was also assessed by the computer in 0°, 30°, 60°, 90°, and 120° flexion.

Results: In the healthy knee the tibia is in mild external rotation in relation to the femur in extension ("screw-home" mechanism). During knee flexion between 0°- 30°, the tibia reaches internal rotation of 10°- 15°. With increasing flexion the tibial rotation remains in the same extent. Arthrotic knees and all but one types of TKRs have very different patterns of tibial movement. The most similar curve to the healthy knee draws the tibia after the ACL/PCL retaining TKR.

Conclusions: Tibial rotational movements in arthrotic conditions and after most TKR types significantly differ from native knee joints. Only ACL/PCL TKR restores the normal tibial kinematics.

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