Native Knee Laxities at 0°, 45°, and 90° of Flexion and Their Relationship to the Goal of the Gap-Balancing Alignment Method of Total Knee Arthroplasty.
BACKGROUND
Gap-balancing is an alignment method for total knee arthroplasty with the goal of creating uniform tension in the periarticular soft-tissue restraints and equal laxities throughout the arc of flexion. However, there is little evidence that achieving equal laxities prevents either overly tight or overly loose soft-tissue restraints after total knee arthroplasty. Accordingly, the purpose of the present study was to determine whether the laxities at 0°, 45°, and 90° of flexion are equal in the native knee.


METHODS
Seven different laxities were measured at 0°, 45°, and 90° of flexion in ten fresh-frozen native cadaveric knees (with intact menisci, cartilage, and ligaments) by applying loads of ±5 Nm in varus-valgus rotation, ±3 Nm in internal-external rotation, 100 N in distraction, and ±45 N in anterior-posterior translation with use of a six-degrees-of-freedom load application system.


RESULTS
The mean laxities (and standard deviations) at 45° of flexion were 1.7° ± 0.6° greater in varus, 0.9° ± 0.4° greater in valgus, 10.2° ± 2.7° greater in internal rotation, 10.1° ± 2.0° greater in external rotation, 1.7 ± 1.0 mm greater in distraction translation, and 3.3 ± 1.5 mm greater in anterior translation than those at 0° of flexion. The mean laxities at 90° of flexion were 2.5° ± 0.8° greater in varus, 1.0° ± 0.5° greater in valgus, 10.0° ± 4.6° greater in internal rotation, 10.1° ± 4.5° greater in external rotation, 1.8 ± 0.7 mm greater in distraction, and 1.6 ± 1.2 mm greater in anterior translation than those at 0° of flexion. The mean anterior translation at 90° of flexion was 1.7 ± 0.9 mm less than that at 45° of flexion.


CONCLUSIONS
Because five of the seven laxities were at least 1.7° or 1.6 mm greater at both 45° and 90° of flexion than those at 0° of flexion, the laxities of the native knee measured in this study are unequal at these flexion angles and therefore do not support the goal of gap-balancing in total knee arthroplasty.


CONCLUSIONS
One possible disadvantage of changing the native laxities at 45° and 90° of flexion to match those at 0° of flexion in a total knee arthroplasty is the overly tight soft-tissue restraints relative to those of the native knee, which patients may perceive as pain, stiffness, and/or limited flexion.
Department of Mechanical and Aerospace Engineering (S.M.H. and M.L.H.) and Biomedical Engineering Graduate Group (J.D.R., S.M.H., and M.L.H.), University of California, Davis, 1 Shields Avenue, Davis, CA 95616. E-mail address for M.L. Hull: mlhull@ucdavis.edu.
Joshua D
JD
Roth
Department of Mechanical and Aerospace Engineering (S.M.H. and M.L.H.) and Biomedical Engineering Graduate Group (J.D.R., S.M.H., and M.L.H.), University of California, Davis, 1 Shields Avenue, Davis, CA 95616. E-mail address for M.L. Hull: mlhull@ucdavis.edu.
Stephen M
SM
Howell
Department of Mechanical and Aerospace Engineering (S.M.H. and M.L.H.) and Biomedical Engineering Graduate Group (J.D.R., S.M.H., and M.L.H.), University of California, Davis, 1 Shields Avenue, Davis, CA 95616. E-mail address for M.L. Hull: mlhull@ucdavis.edu.
Maury L
ML
Hull
D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena / Q000502:physiology; D006801:Humans; D007717:Knee / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation