Evaluation of soft-tissue balance during total knee arthroplasty.
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PURPOSE: To evaluate soft-tissue balance during versus after total knee arthroplasty (TKA). METHODS: 18 men and 75 women aged 52 to 85 (mean, 68) years who had moderate-to-severe varus deformity underwent TKAs using the Scorpio non-restrictive geometry posterior-stabilised system (Stryker Howmedica Osteonics; Allendale, [NJ], USA). All surgeries were performed by a single surgeon using the medial parapatellar approach. After the bony and soft-tissue procedures, soft-tissue balance was measured intra-operatively using a tensor/balancer device. The coronal laxity--angles between the cut surfaces of the femur and tibia--were measured at 0 degree (in extension) and 90 degrees (in flexion). The central gap was also measured. Immediate postoperative soft-tissue balance was measured using an arthrometer, while anteroposterior stress radiographs were being taken. A valgus or varus force was applied just above the knee on the lateral or medial side, with the knee counter-supported and at 15 degrees flexion. RESULTS: Intra-operatively, the mean coronal laxity at 0 degree (in extension) and 90 degrees (in flexion) was 2.1 degrees and -1.6 degrees, and the mean central gaps were 21.2 and 23.5 mm, respectively. Immediate postoperative mean coronal laxity was 2.9 degrees, indicating that lateral laxity was greater than medial laxity. The postoperative coronal laxity was positively corrected to the intra-operative coronal laxity at 0 degree (r=0.304, p=0.003), but not to the intra-operative coronal laxity at 90 degrees (r= -0.07, p=0.47). CONCLUSION: Slightly greater lateral laxity was observed after TKA, although equal medial-lateral balance was achieved intra-operatively. (+info)
Modular necks improve the range of hip motion in cases with excessively anteverted or retroverted femurs in THA.
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Anterior opening wedge high tibial osteotomy: the effect of increasing posterior tibial slope on ligament strain.
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BACKGROUND: Although a previous study showed that anterior opening wedge high tibial osteotomy (HTO) for sagittal plane correction induced no increased strain in the anterior cruciate ligament (ACL), we hypothesized that other ligamentous restraints of the knee may be subjected to increased strain. METHODS: We mounted 6 cadaveric knees at 15 degrees flexion in a testing apparatus that provided compressive and anterior loading. We measured the strain in the ACL, posterior (PCL), medial (MCL) and lateral (LCL) ligaments for 6 randomized loading combinations and 3 conditions: intact, after anterior opening wedge HTO with a 5-mm plate and with a 10-mm plate. RESULTS: The mean ACL strain decreased from 0.84% (standard deviation [SD] 1.50%) at baseline to -6.28% (SD 5.40%) with a 5-mm anterior opening wedge osteotomy and to -6.77% (SD 4.79%) with a 10-mm osteotomy. Stepwise regressions yielded no significant effect of compression, anterior loading or osteotomy on PCL, MCL or LCL strain. CONCLUSION: Increasing the posterior slope via HTO did not increase strain in the PCL, MCL or LCL. (+info)
Rupture of the long head biceps tendon treated with tenodesis to the coracoid process. Results at more than 30 years.
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