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      ACL status in arthroplasty patients, why not to preserve?

      1 , * , 1 , 1
      EDP Sciences
      Bicruciate retaining, Arthroplasty, ACL retaining, Knee replacement

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          Introduction: Only 70–85% of patients that had total knee arthroplasty (TKA) are satisfied with their knees. The need for a near to normal knee kinematics is crucial and maybe the solution to their needs. Addressing the cruciate ligaments during surgery along with the extent of arthrosis may give a solution to this problem.

          Material and methods: One hundred consecutive patients in whom a total knee arthroplasty was indicated and performed were prospectively documented. During the knee replacement surgery, the condition of the anterior and posterior cruciate ligaments and the degree of osteoarthritis (OA) in the medial and lateral compartments as well as in the patello-femoral joint were documented using the Outerbridge classification. The patients’ average age was 72.3 years, with the majority being female. In all patients, a total bi-compartmental knee replacement was indicated.

          Results: Our results showed that in 78% of all patients the anterior, and in 98% the posterior cruciate ligament was still intact. Seventy-one percent of cases suffered from grade 4 medial osteoarthritis, 19% from grade 3 and 10% from grade 2. Thirty-six of patients suffered from grade 4 lateral osteoarthritis, 36% from grade 3, 24% from grade 2 and 4% from grade 1. Grade 4 patello-femoral osteoarthritis was present in 32% of all patients, grade 3 in 60% and grade 2 in 8% of all patients.

          Discussion: The goal of arthroplasty is to approximate the function of a normal knee. The retention of the anterior cruciate ligament (ACL) allows for better knee, kinematics, improved proprioception, increased flexion and an overall improvement in knee function. The decreased constraint that is possible with retention of both cruciates may decrease implant stresses and improve the implant survivorship. The distribution of OA shows that the medial and patello-femoral compartments of the joint are primarily affected. This could also allow for a more conservative and patient-tailored prosthetic design.

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          Most cited references43

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          The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty.

          Satisfaction with the outcome of total knee arthroplasty is highly variable, with a small but significant percentage of patients reporting dissatisfaction with the procedure. The purpose of this study was to determine which factors contribute to patient satisfaction with total knee replacement (TKR), and their relative importance. At a minimum of 1 year post unilateral primary TKR, 253 patients completed a self-administered, validated "Knee Function Questionnaire," which examined each patient's participation in a broad range of activities involving the knee, their level of satisfaction, and the extent to which TKR had fulfilled their expectations. The association between function, expectation and satisfaction was examined using univariate and multivariate logistic regression. Seventy-five percent of patients were either "satisfied" or "very satisfied" with their knee replacement, while 14% were "dissatisfied" or "very dissatisfied." Satisfaction correlated significantly (p < 0.001) with age less than 60, absence of residual symptoms, fulfillment of expectations, and absence of functional impairment. Satisfaction with TKR is primarily determined by patients' expectations, and not their absolute level of function. Real improvements in the outcome of TKA must address prevention of residual pain, stiffness and swelling, and each patient's preoperative concept of the likely outcome of these procedures.
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            Total joint arthroplasties: current concepts of patient outcomes after surgery.

            Total hip and knee arthroplasties are effective surgical interventions for relieving hip pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all report gains or are satisfied after receiving total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis, and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no single patient-related or perioperative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.
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              Prevalence of radiographic osteoarthritis--it all depends on your point of view.

              Knee pain and disability in older people may occur in the apparent absence of radiographic osteoarthritis. However, the view chosen to define radiographic osteoarthritis may be critical. We have investigated the prevalence and compartmental distribution of radiographic osteoarthritis in people with knee pain using different combinations of three separate radiographic views. We performed a population-based study of 819 adults aged 50 yr and over with knee pain (part of the Clinical Assessment Study - Knee [CAS(K)]). Three radiographic views were obtained: weight-bearing posteroanterior (PA) semiflexed/metatarsophalangeal view; supine skyline; and supine lateral. Complete data for all three views were available on 777 subjects. The distribution of compartmental radiographic osteoarthritis was 314 (40%) combined tibiofemoral/patellofemoral, 186 (24%) isolated patellofemoral, 31 (4%) isolated tibiofemoral and 246 (32%) normal. Hence, the overall prevalence of radiographic osteoarthritis was 531/777 (68.3%) in this symptomatic population. Using a PA view alone (reflecting tibiofemoral osteoarthritis only) would identify 56.7% of the 531, whilst the addition of a skyline or lateral view increased this to 87.0%. When using both skyline and lateral views in addition to the PA view, 98.7% cases of radiographic osteoarthritis were identified. In addition to prevalence, compartmental distribution altered markedly when different combinations of views were used. Multiple views detect more radiographic osteoarthritis than single views alone. When different combinations of views are used, the prevalence and compartmental distribution of osteoarthritis changes and this may alter the accepted relationship, or lack of it, between symptoms and radiographic change.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                05 January 2018
                : 4
                : ( publisher-idID: sicotj/2018/01 )
                : 1
                [1 ] Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals Kilo 4.5 Ring Road 41111 Ismailia Egypt
                Author notes
                [* ]Corresponding author: ahmadbadie@ 123456hotmail.com
                sicotj170048 10.1051/sicotj/2017042
                © The Authors, published by EDP Sciences, 2018

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 16 April 2017
                : 17 July 2017
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 34, Pages: 5
                Original Article

                bicruciate retaining,arthroplasty,acl retaining,knee replacement


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