Laxity and contact forces of total knee designed for anatomic motion: A cadaveric study

Total knee designs that attempt to reproduce more physiological knee kinematics are gaining attention given their possible improvement in functional outcomes. This study examined if a total knee designed for anatomic motion, where the soft tissue balancing was intended to replicate anatomical tibiofemoral contact forces, can more closely reproduce the laxity of the native knee.

In an ex-vivo setting, the laxity envelope of the knees from nine lower extremity specimens was measured using a rig that reproduced surgical conditions. The rig allowed application of a constant varus/valgus (V/V) and internal-external (I/E) torque through the range of motion. After testing the native knee, total knee arthroplasty (TKA) was performed using the Journey II bi-cruciate substituting implant. Soft tissue balancing was guided by targeting anatomical compressive forces in the lateral and medial tibiofemoral joints with an instrumented tibial trial. After TKA surgery, the laxity tests were repeated and compared to the native condition.

The TKA knee closely reproduced the coronal laxity of the native knee, except for a difference at 90° of flexion for valgus laxity. Looking at the rotational laxity, the implant constrained the internal rotation relative to the native knee at 45 and 60° of flexion. The forces on the tibial trial for the neutral path of motion showed higher values on the medial side as the knee flexed.

This study suggested that when using an anatomically-designed knee, the soft tissue balancing should also aim for anatomical contact forces, which will result in close to normal laxity patterns.