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Elongation of the collateral ligaments after cruciate retaining total knee arthroplasty and the maximum flexion of the knee

 Kwan Kyu Park  ;  Ali Hosseinia  ;  Tsung-Yuan Tsai  ;  Young-Min Kwon  ;  Guoan Li 
 JOURNAL OF BIOMECHANICS, Vol.48(3) : 418-424, 2015 
Journal Title
Issue Date
Aged ; Arthroplasty, Replacement, Knee* ; Biomechanical Phenomena ; Humans ; Knee Joint/physiopathology* ; Lateral Ligament, Ankle/physiopathology* ; Medial Collateral Ligament, Knee/physiopathology* ; Middle Aged ; Osteoarthritis/surgery ; Range of Motion, Articular ; Weight-Bearing
Collateral ligament ; In vivo Biomechanics ; Total knee arthroplasty
The mechanisms that affect knee flexion after total knee arthroplasty (TKA) are still debatable. This study investigated the elongation of the superficial medial (sMCL) and lateral collateral ligaments (LCL) before and after a posterior cruciate retaining (CR) TKA. We hypothesized that overstretching of the collateral ligaments in high flexion after TKA could reduce maximal flexion of the knee. Three-dimensional models of 11 osteoarthritic knees of 11 patients including the insertions of the collateral ligaments were created using MR images. Each ligament was divided into three equal portions: anterior, middle and posterior portions. The shortest 3D wrapping length of each ligament portion was determined before and after the TKA surgery along a weight-bearing, single leg flexion path. The relationship between the changes of ligament elongation and the changes of the maximal knee flexion after TKAs was quantitatively analyzed. The sMCL showed significant increases in length only at low flexion after TKA; the LCL showed decreases in length at full extension, but increases with further flexion after TKA. The amount of increases of the maximum flexion angle after TKA was negatively correlated with the increases of the elongations of the anterior portion (p=0.010, r=0.733) and middle portion (p=0.049, r=0.604) of the sMCL as well as the anterior portion (p=0.010, r=0.733) of the LCL at maximal flexion of the knee. The results indicated that the increases of the length of the collateral ligaments at maximal flexion after TKA were associated with the decreases of the maximal flexion of the knee. Our data suggest that collateral ligament management should also be evaluated at higher knee flexion angles in order to optimize maximal flexion of the knee after TKAs.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Kwan Kyu(박관규) ORCID logo https://orcid.org/0000-0003-0514-3257
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