Medial unicompartmental knee arthroplasty to patients with a ligamentous deficiency can cause biomechanically poor outco
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Medial unicompartmental knee arthroplasty to patients with a ligamentous deficiency can cause biomechanically poor outcomes Hyuck Min Kwon1 · Kyoung‑Tak Kang2 · Jung Hwan Kim1 · Kwan Kyu Park1 Received: 12 March 2019 / Accepted: 16 July 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose The aims of this study were to investigate the biomechanical effects of the deficiency of the collateral ligament and cruciate ligament in medial unicompartmental knee arthroplasty in normal and varus knee patients using computational simulation. Methods Validated finite-element (FE) models for conditions of various cruciate and collateral ligament deficiencies were developed to evaluate the biomechanical effects of ligamentous deficiency in UKA for normal and varus knee patients. Contact stresses on the polyethylene (PE) insert, contact stresses on the lateral articular cartilage, and quadriceps force were analyzed under gait-loading conditions. Results Contact stresses on the PE insert and lateral articular cartilage as well as quadriceps force in a normal knee UKA FE model were increased in the order of anterior cruciate ligament (ACL) deficiency, medial collateral ligament (MCL) deficiency, lateral collateral ligament (LCL) deficiency, and posterior cruciate ligament (PCL) deficiency in the stance phase of gait cycle, as compared with those in the model without ligamentous deficiency. In two or more multiple ligamentous deficiencies, contact stresses on the PE insert and articular lateral cartilage and quadriceps force were significantly increased versus in the case of single-ligament deficiency. Conclusion Poor outcomes of medial UKA in patients with ACL or MCL deficiency can be predicted. Care should be taken to extend the indications when performing medial UKA in patients with ligamentous deficiency, especially when varus knee with ACL or MCL deficiency is present. Keywords Finite-element analysis · Unicompartmental knee replacement · Medial unicompartmental knee arthroplasty · Ligament · Contact stress
Introduction In general, the ideal candidate for medial UKA is the medial unicompartmental knee osteoarthritic patient with an intact anterior cruciate ligament (ACL), an intact posterior cruciate ligament (PCL), an intact medial collateral ligament (MCL), and an intact lateral collateral ligament (LCL). In * Kwan Kyu Park [email protected] 1
Department of Orthopedic Surgery, Yonsei University College of Medicine, 50‑1 Yonsei‑ro, Seodaemun‑Gu, Seoul 03722, Republic of Korea
Department of Mechanical Engineering, Yonsei University, 50 Yonsei‑ro, Seodaemun‑gu, Seoul 03722, Republic of Korea
2
addition, preserved range of motion, comparable young age (> 60 years), low weight, and low activity are considered to represent indications for medial UKA [1, 11–13]. Due to the excellent surgical outcomes and widespread use of medial UKA, some authors have extended the indication for medial UKA to patients with a deficiency of ACL [2, 4, 14, 18, 21]. Some orthopedic s
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