Posterior capsular release is a biomechanically safe procedure to perform in total knee arthroplasty View Full Text


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Article Info

DATE

2018-08-09

AUTHORS

K. K. Athwal, P. E. Milner, G. Bellier, Andrew A. Amis

ABSTRACT

PURPOSE: Surgeons may attempt to strip the posterior capsule from its femoral attachment to overcome flexion contracture in total knee arthroplasty (TKA); however, it is unclear if this impacts anterior-posterior (AP) laxity of the implanted knee. The aim of the study was to investigate the effect of posterior capsular release on AP laxity in TKA, and compare this to the restraint from the posterior cruciate ligament (PCL). 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, a deep dished cruciate-retaining TKA was implanted and the tests were repeated. The PCL was then cut, followed by releasing the posterior capsule using a curved osteotome. RESULTS: With 0 N axial load applied, cutting the PCL as well as releasing the posterior capsule significantly increased posterior laxity compared to the native knee at all flexion angles, and CR TKA states at 30°, 60° and 90° (p < 0.05). However, no significant increase in laxity was found between cutting the PCL and subsequent PostCap release (n.s.). In anterior drawer, there was a significant increase of 1.4 mm between cutting the PCL and PostCap release at 0°, but not at any other flexion angles (p = 0.021). When a 710 N axial load was applied, there was no significant difference in anterior or posterior translation across the different knee states (n.s.). CONCLUSIONS: Posterior capsular release only caused a small change in AP laxity compared to cutting the PCL and, therefore, may not be considered detrimental to overall AP stability if performed during TKA surgery. LEVEL OF EVIDENCE: Controlled laboratory study. More... »

PAGES

1-8

References to SciGraph publications

  • 2018-05. Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2014-12. Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2017-08. An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2017-11. Influence of soft tissue balancing and distal femoral resection on flexion contracture in navigated total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 1998-04. In vitro testing protocols for the cruciate ligaments and ligament reconstructions in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2008-10. Changes in Knee Kinematics Reflect the Articular Geometry after Arthroplasty in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2018-06. Postoperative fixed flexion deformity greater than 10° lead to poorer functional outcome 10 years after unicompartmental knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2017-11. Anteroposterior translation and range of motion after total knee arthroplasty using posterior cruciate ligament-retaining versus posterior cruciate ligament-substituting prostheses in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00167-018-5094-0

    DOI

    http://dx.doi.org/10.1007/s00167-018-5094-0

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30094498


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        "description": "PURPOSE: Surgeons may attempt to strip the posterior capsule from its femoral attachment to overcome flexion contracture in total knee arthroplasty (TKA); however, it is unclear if this impacts anterior-posterior (AP) laxity of the implanted knee. The aim of the study was to investigate the effect of posterior capsular release on AP laxity in TKA, and compare this to the restraint from the posterior cruciate ligament (PCL).\nMETHODS: Eight cadaveric knees were mounted in a six degree of freedom testing rig and tested at 0\u00b0, 30\u00b0, 60\u00b0 and 90\u00b0 flexion with \u00b1\u2009150\u00a0N AP force, with and without a 710\u00a0N axial compressive load. After the native knee was tested, a deep dished cruciate-retaining TKA was implanted and the tests were repeated. The PCL was then cut, followed by releasing the posterior capsule using a curved osteotome.\nRESULTS: With 0\u00a0N axial load applied, cutting the PCL as well as releasing the posterior capsule significantly increased posterior laxity compared to the native knee at all flexion angles, and CR TKA states at 30\u00b0, 60\u00b0 and 90\u00b0 (p\u2009<\u20090.05). However, no significant increase in laxity was found between cutting the PCL and subsequent PostCap release (n.s.). In anterior drawer, there was a significant increase of 1.4\u00a0mm between cutting the PCL and PostCap release at 0\u00b0, but not at any other flexion angles (p\u2009=\u20090.021). When a 710\u00a0N axial load was applied, there was no significant difference in anterior or posterior translation across the different knee states (n.s.).\nCONCLUSIONS: Posterior capsular release only caused a small change in AP laxity compared to cutting the PCL and, therefore, may not be considered detrimental to overall AP stability if performed during TKA surgery.\nLEVEL OF EVIDENCE: Controlled laboratory study.", 
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    32 schema:description PURPOSE: Surgeons may attempt to strip the posterior capsule from its femoral attachment to overcome flexion contracture in total knee arthroplasty (TKA); however, it is unclear if this impacts anterior-posterior (AP) laxity of the implanted knee. The aim of the study was to investigate the effect of posterior capsular release on AP laxity in TKA, and compare this to the restraint from the posterior cruciate ligament (PCL). 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, a deep dished cruciate-retaining TKA was implanted and the tests were repeated. The PCL was then cut, followed by releasing the posterior capsule using a curved osteotome. RESULTS: With 0 N axial load applied, cutting the PCL as well as releasing the posterior capsule significantly increased posterior laxity compared to the native knee at all flexion angles, and CR TKA states at 30°, 60° and 90° (p < 0.05). However, no significant increase in laxity was found between cutting the PCL and subsequent PostCap release (n.s.). In anterior drawer, there was a significant increase of 1.4 mm between cutting the PCL and PostCap release at 0°, but not at any other flexion angles (p = 0.021). When a 710 N axial load was applied, there was no significant difference in anterior or posterior translation across the different knee states (n.s.). CONCLUSIONS: Posterior capsular release only caused a small change in AP laxity compared to cutting the PCL and, therefore, may not be considered detrimental to overall AP stability if performed during TKA surgery. LEVEL OF EVIDENCE: Controlled laboratory study.
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