Highlights
- •Anterior cruciate ligament deficient knees after unicompartmental knee replacement
- •Deficient and intact patient groups compared during step-up and lunge exercises
- •Deficient knee femurs were more posterior on tibia at 30–40° of flexion.
- •The deficient ligament group took longer to perform the activities.
- •Mobile unicompartmental knee replacement in a deficient knee not advised
Abstract
Background
There is a greater risk of tibial component loosening when mobile unicompartmental
knee replacement is performed in anterior cruciate ligament deficient knees. We previously
reported on a cohort of anterior cruciate ligament deficient patients (n = 46) who had undergone surgery, but no difference was found in implant survivorship
at a mean 5-year follow-up. The purpose of this study was to examine the kinematic
behaviour of a subcohort of these patients.
Methods
The kinematic behaviour of anterior cruciate deficient knees (n = 16) after mobile unicompartmental knee replacement was compared to matched intact
knees (n = 16). Sagittal plane knee fluoroscopy was taken while patients performed step-up and
forward lunge exercises. The patellar tendon angle, knee flexion angle and implant
position was calculated for each video frame.
Findings
The patellar tendon angle was 5° lower in the deficient group, indicating greater
anterior tibial translation compared to the intact group between 30 and 40° of flexion.
Large variability, particularly from 40–60° of flexion, was observed in the bearing
position of the deficient group, which may represent different coping mechanisms.
The deficient group took 38% longer to perform the exercises.
Interpretation
Kinematic differences were found between the deficient and intact knees after mobile
unicompartmental knee replacement; but these kinematic changes do not seem to affect
the medium-term clinical outcome. Whether these altered knee kinematics will have
a clinical impact is as yet undetermined, but more long-term outcome data is required
before mobile unicompartmental knee replacement can be recommended for an anterior
cruciate ligament deficient patient.
Keywords
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Article info
Publication history
Published online: October 12, 2015
Accepted:
October 5,
2015
Received:
January 6,
2015
Identification
Copyright
© 2015 Published by Elsevier Inc. All rights reserved.