Abstract
Purpose
The popliteus tendon is crucial to postero-lateral stability and prone to iatrogenic injury intra-operatively. Its role in the stability of the replaced knee remains contentious. The aim of this study was to use computer navigation to quantify the effect of popliteus sectioning on the ‘envelope of laxity’ (EoL) offered by a posterior-stabilised (PS) total knee arthroplasty (TKA) and compare with that of the native knee.
Methods
Loaded cadaveric legs were mounted on a purpose built rig. EoL was measured in 3 degrees of freedom using computer navigation. Knees were subjectively stressed in varus/valgus, internal/external rotation and anterior draw. This was performed preoperatively, during TKA and after sectioning of the popliteus tendon. Real-time data were recorded at 0°, 30°, 60° and 90° of flexion as the operating surgeon stressed the knee in 3 degrees of freedom to its subjective endpoint. Mixed-effect modelling was used to quantify the effects of intervention on degree of laxity.
Results
In all conditions, there was an increase in laxity with knee flexion. Insertion of a PS TKA resulted in increased constraint, particularly in rotation. Sectioning of the popliteus did not result in a significant increase in knee laxity to 90º of knee flexion. However, at deeper flexion angles, tendon sectioning overcame the constraints of the implant resulting in a significant increase in rotatory and varus/valgus laxity towards the native condition.
Conclusion
These findings support the view that certain current designs of PS knee replacement can constrain the knee in flexion in the absence of postero-lateral deficiency. For this implant, isolated sectioning of the popliteus tendon did not substantially generate abnormal knee laxity.
Similar content being viewed by others
References
Bull AM, Kessler O, Alam M, Amis AA (2008) Changes in knee kinematics reflect the articular geometry after arthroplasty. Clin Orthop Relat Res 466:2491–2499
Delport HP, Banks SA, De Schepper J, Bellemans J (2006) A kinematic comparison of fixed and mobile-bearing knee replacements. J Bone Joint Surg (Br) 88B(8):1016–1021
Elfring R, de la Fuente M, Radermacher K (2010) Assessment of optical localizer accuracy for computer aided surgery systems. Comput Aided Surg 15:1–12
Farahmand F, Senavongse W, Amis AA (1998) Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res 16:136–143
Ferrari DA, Wilson DR, Hayes WC (2003) The effect of release of the popliteus and quadriceps force on rotation of the knee. Clin Orthop Relat Res 412:225–233
Ghosh KM, Blain AP, Longstaff L, Rushton S, Amis AA, Deehan DJ (2014) Can we define envelope of laxity during navigated knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 22:1736–1743
Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA (2010) The effect of femoral component rotation on the extensor retinaculum of the knee. J Orthop Res 28:1136–1141
Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA (2009) Length change patterns of the extensor retinaculum and the effect of total knee replacement. J Orthop Res 27:865–870
Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105:133–144
Hunt NC, Ghosh KM, Blain AP, Athwal KK, Rushton SP, Amis AA, Longstaff LM, Deehan DJ (2014) How does laxity after single radius total knee arthroplasty compare with the native knee? J Orthop Res 32:1208–1213
Kanamiya T, Whiteside LA, Nakamura T, Mihalko WM, Steiger J, Naito M (2002) Ranawat Award paper. Effect of selective lateral ligament release on stability in knee arthroplasty. Clin Orthop Relat Res 404:24–31
Kesman TJ, Kaufman KR, Trousdale RT (2011) Popliteus tendon resection during total knee arthroplasty: an observational report. Clin Orthop Relat Res 469:76–81
Krackow KA, Mihalko WM (1999) Flexion-extension joint gap changes after lateral structure release for valgus deformity correction in total knee arthroplasty: a cadaveric study. J Arthroplasty 14:994–1004
Kwak SD, Ahmad CS, Gardner TR et al (2000) Hamstrings and iliotibial band forces affect knee kinematics and contact pattern. J Orthop Res 18:101–108
LaPrade RF, Wozniczka JK, Stellmaker MP, Wijdicks CA (2010) Analysis of the static function of the popliteus tendon and evaluation of an anatomic reconstruction: the “fifth ligament” of the knee. Am J Sports Med 38:543–549
Li G, DeFrate LE, Zayontz S, Park SE, Gill TJ (2004) The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads. J Orthop Res 22:801–806
Li G, Rudy TW, Sakane M, Kanamori A, Ma CB, Woo SL (1999) The importance of quadriceps and hamstring muscle loading on knee kinematics and in situ forces in the ACL. J Biomech 32:395–400
Li G, Zayontz S, Most E, Otterberg E, Sabbag E, Rubash HE (2001) Cruciate-retaining and cruciate-substituting total knee arthroplasty: an in vitro comparison of kinematics under muscle loads. J Arthroplasty 16:150–156
Matsueda M, Gengerke TR, Murphy M, Lew WD, Gustilo RB (1999) Soft tissue release in total knee arthroplasty cadaver study using knees without deformities. Clin Orthop Relat Res 366:264–273
Mesfar W, Shirazi-Adl A (2006) Knee joint mechanics under quadriceps–hamstrings muscle forces a influenced by tibial restraint. Clin Biomech 21:841–848
Merican AM, Amis AA (2009) Iliotibial band tension affects patellofemoral and tibiofemoral kinematics. J Biomech 42:1539–1546
Most E, Li G, Schule S, Sultan P, Park SE, Zayontz S, Rubash H (2003) The kinematics of fixed and mobile bearing total knee arthroplasty. Clin Orthop Relat Res 416:197–207
Nagamine R, White SE, McCarthy DS, Whiteside LA (1995) Effect of rotational malposition of the femoral component on knee stability kinematics after total knee arthroplasty. J Arthroplasty 10:265–270
Peters CL, Mohr RA, Bachus KN (2001) Primary total knee arthroplasty in the valgus knee: creating a balanced soft tissue envelope. J Arthroplasty 16:721–729
Pinheiro JC, Bates DM (2000) Mixed-effects models in S and S-PLUS. Springer, New York
de Simone V, Demey G, Magnussen RA, Lustig S, Servien E, Neyret P (2012) Iatrogenic popliteus tendon injury during total knee arthroplasty results in decreased knee function two to three years postoperatively. Int Orthop 36:2061–2065
Romero J, Duronio JF, Sohrabi A, Alexander N, MacWilliams BA, Jones LC, Hungerford DS (2002) Varus and valgus flexion laxity of total knee alignment methods in loaded cadaveric knees. Clin Orthop Relat Res 394:243–253
Stoddard JE, Deehan DJ, Bull AM, McCaskie AW, Amis AA (2013) The kinematics and stability of single-radius versus multi-radius femoral components related to mid-range instability after TKA. J Orthop Res 31:53–58
Tantavisut S, Tanavalee A, Ngarmukos S, Limtrakul A, Wilairatana V, Wangroongsub Y (2012) Gap changes after popliteus-tendon resection in PS-TKA: a cadaveric study in Thai female knees. Knee 19:597–600
Thaunat M, Pioger C, Chatellard R, Conteduca J, Khaleel A, Sonnery-Cottet B (2014) The arcuate ligament revisited: role of the posterolateral structures in providing static stability in the knee joint. Knee Surg Sports Traumatol Arthrosc 22:2121–2127
Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172
Yamamoto Y, Hsu WH, Fisk JA, Van Scyoc AH, Miura K, Woo SL (2006) Effect of the iliotibial band on knee biomechanics during a simulated pivot shift test. J Orthop Res 24:967–973
Acknowledgments
This work was supported through educational grants from Stryker Europe Research and Newcastle Hospital Charitable Trustees. Technical support was provided by the Newcastle Surgical Training Centre (NSTC) and Tom Steele (Stryker, UK).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ghosh, K.M., Hunt, N., Blain, A. et al. Isolated popliteus tendon injury does not lead to abnormal laxity in posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23, 1763–1769 (2015). https://doi.org/10.1007/s00167-014-3488-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3488-1