title: Influence of Medial Collateral Ligament Release for Internal Rotation of Tibia in Posterior-Stabilized Total Knee Arthroplasty: A Cadaveric Study.
abstract: Previous studies suggested that changes in kinematics in total knee arthroplasty (TKA) affected satisfaction level. The aim of this cadaveric study was to evaluate the effect of medial collateral ligament (MCL) release by multiple needle puncture on knee rotational kinematics in posterior-stabilized TKA.
  
  
  
  Six fresh, frozen cadaveric knees were included in this study. All TKA procedures were performed with an image-free navigation system using a 10-mm polyethylene insert. Tibial internal rotation was assessed to evaluate intraoperative knee kinematics. Multiple needle puncturing was performed 5, 10, and 15 times for the hard portion of the MCL at 90° knee flexion. Kinematic analysis was performed after every 5 punctures. After performing 15 punctures, a 14-mm polyethylene insert was inserted, and kinematic analysis was performed.
  
  
  
  The tibial internal rotation angle at maximum knee flexion without multiple needle puncturing was significantly larger (9.42°) than that after 15 punctures (3°). Negative correlation (Pearson r = -0.715, P < .001) between tibial internal rotation angle at maximum knee flexion and frequency of puncture was observed. The tibial internal rotation angle with a 14-mm insert was significantly larger (7.25°) compared with the angle after 15 punctures.
  
  
  
  Tibial internal rotation during knee flexion was reduced by extensive MCL release using multiple needle puncturing and was recovered by increasing of medial tightness. From the point of view of knee kinematics, medial tightness should be allowed to maintain the internal rotation angle of the tibia during knee flexion which might lead to patient satisfaction.
authors.affiliation: Department of Orthopedics, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Orthopedics, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hamada
authors.affiliation: Department of Orthopedics, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tamaki
authors.affiliation: Department of Orthopedics, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Higashino
authors.affiliation: Department of Orthopedics, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukui
authors.affiliation: Department of Orthopedics, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sairyo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D001696:Biomechanical Phenomena; D017885:Collateral Ligaments / Q000601:surgery; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D007719:Knee Joint / Q000502:physiology* / Q000601:surgery; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000601:surgery*; D008875:Middle Aged; D009339:Needles; D020370:Osteoarthritis, Knee / Q000601:surgery; D020959:Polyethylene; D011677:Punctures; D016059:Range of Motion, Articular; D012399:Rotation; D013977:Tibia / Q000502:physiology* / Q000601:surgery
chemical_list: D020959:Polyethylene
keywords: medial collateral ligament; medial release; multiple needle puncturing; navigation system; rotational kinematics; total knee arthroplasty