Factors affecting knee motion after total knee arthroplasty: a cadaveric study of the collateral ligament

Many of the factors affecting postoperative knee motion are related to collateral ligament imbalance. In a cadaveric knee model, the center of origin of either the medial or lateral collateral ligament was found to be located at the center of the quarter circle of the posterior femoral condyle. Two distances were identified: OD (from the center of origin of the collateral ligament to the distal tibiofemoral articulation) and OP (from the center of origin of the collateral ligament to the posterior tibiofemoral articulation). The effect of the collateral ligaments on knee motion was demonstrated by stimulating joint line elevation and ligamentous stretching in a cadaveric knee model. In the knee with an elevated joint line without concomitant anterior displacement (OD reduced, OP unchanged), the flexion limit was reduced. When the collateral ligaments were stretched in a knee with constant OD and OP, both the flexion and extension limits were reduced. A correct joint level can be achieved by measuring the OD, OP and the tension of the collateral ligaments during total knee arthroplasty.