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Steinbrueck, Arnd; Schröder, Christian; Woiczinski, Matthias; Glogaza, Alexander; Müller, Peter E.; Jansson, Volkmar and Fottner, Andreas (2018): A lateral retinacular release during total knee arthroplasty changes femorotibial kinematics: an in vitro study. In: Archives of Orthopaedic and Trauma Surgery, Vol. 138, No. 3: pp. 401-407

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Abstract

Lateral retinacular release (LRR) is a common procedure during total knee arthroplasty (TKA), especially if patellar maltracking is observed intraoperatively. The impact of LRR on patellofemoral kinematics is well-examined, but the influence on femorotibial kinematics requires more elucidation. Therefore, the aim of this study was to evaluate the effects of LRR on femorotibial kinematics in vitro. A fixed bearing TKA was implanted in six human knee specimens. Femorotibial kinematics were measured dynamically through the use of a custom-constructed knee rig which flexes the knee from 20A degrees to 120A degrees under weight bearing conditions. Measurements were performed before and after LRR. LRR was performed completely including transection of synovium, retinaculum and tractus fibers. For the registration of tibiofemoral kinematics a 3-dimensional-ultrasound-based motion analysis system was used. LRR revealed a significant reduction of femoral rollback at the lateral compartment (9.4 +/- 5.0 vs 7.8 +/- 9.4 mm;p < 0.01), whereas the present decrease of femoral rollback at the medial compartment was not significant (3.4 +/- 4.7 vs 2.3 +/- 5.9 mm;p = 0.34). Accordingly, LRR significantly reduced internal rotation of the tibia (0.8A degrees;p < 0.01). The results suggest that LRR significantly decreases lateral femoral rollback as well as internal rotation of the tibia, probably by changing the tension of the iliotibial band. When performing a LRR in clinical routine, surgeons should be aware of altering not only patellofemoral kinematics but also the femorotibial kinematics.

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