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Open AccessArticle

Elongation Patterns of the Posterior Cruciate Ligament after Total Knee Arthroplasty

1
Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland
2
Human Performance Lab, Schulthess Clinic, 8008 Zurich, Switzerland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2078; https://doi.org/10.3390/jcm9072078
Received: 27 April 2020 / Revised: 18 June 2020 / Accepted: 29 June 2020 / Published: 2 July 2020
(This article belongs to the Special Issue State-of-the-Art Research on Hip and Knee Arthroplasty)
This study aimed to understand the ability of fixed-bearing posterior cruciate ligament (PCL)-retaining implants to maintain functionality of the PCL in vivo. To achieve this, elongation of the PCL was examined in six subjects with good clinical and functional outcomes using 3D kinematics reconstructed from video-fluoroscopy, together with multibody modelling of the knee. Here, length-change patterns of the ligament bundles were tracked throughout complete cycles of level walking and stair descent. Throughout both activities, elongation of the anterolateral bundle exhibited a flexion-dependent pattern with more stretching during swing than stance phase (e.g., at 40° flexion, anterolateral bundle experienced 3.9% strain during stance and 9.1% during swing phase of stair descent). The posteromedial bundle remained shorter than its reference length (defined at heel strike of the level gait cycle) during both activities. Compared with loading patterns of the healthy ligament, postoperative elongation patterns indicate a slackening of the ligament at early flexion followed by peak ligament lengths at considerably smaller flexion angles. The reported data provide a novel insight into in vivo PCL function during activities of daily living that has not been captured previously. The findings support previous investigations reporting difficulties in achieving a balanced tension in the retained PCL. View Full-Text
Keywords: posterior cruciate ligament; knee implant; function; strain; dynamic activity; video-fluoroscopy posterior cruciate ligament; knee implant; function; strain; dynamic activity; video-fluoroscopy
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Hosseini Nasab, S.H.; Smith, C.; Schütz, P.; Postolka, B.; Ferguson, S.; Taylor, W.R.; List, R. Elongation Patterns of the Posterior Cruciate Ligament after Total Knee Arthroplasty. J. Clin. Med. 2020, 9, 2078.

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