Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty

Abstract Purpose Posterior capsular contracture causes stiffness during knee extension in knee osteoarthritis. Furthermore, in posterior-stabilized total knee arthroplasty (PS-TKA), a unique design such as the cam mechanism could conflict with the posterior capsule (PC) causing flexion contracture (...

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Autores principales:	Tomofumi Kinoshita, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Hiromasa Miura
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Posterior capsular release Osteoarthritis Flexion contracture Knee extension angle Cadaveric study Cadaveric knee Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/526ae392a01a428bb5163c5f5944ff81
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spelling	oai:doaj.org-article:526ae392a01a428bb5163c5f5944ff812021-11-08T10:57:52ZEfficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty10.1186/s40634-021-00422-22197-1153https://doaj.org/article/526ae392a01a428bb5163c5f5944ff812021-11-01T00:00:00Zhttps://doi.org/10.1186/s40634-021-00422-2https://doaj.org/toc/2197-1153Abstract Purpose Posterior capsular contracture causes stiffness during knee extension in knee osteoarthritis. Furthermore, in posterior-stabilized total knee arthroplasty (PS-TKA), a unique design such as the cam mechanism could conflict with the posterior capsule (PC) causing flexion contracture (FC). However, few studies have focused on the anatomical aspects of the PC. This study aimed to investigate the anatomical site and forms of posterior capsular attachment to the femoral cortex, and to evaluate the efficacy of posterior capsular release for FC by assessing changes in knee extension angles using a navigation system. Methods Attachment sites of the PC were investigated in 10 cadaveric knees using computed tomography. PS-TKA was performed in six cadaveric knees using a navigation system to evaluate the efficacy of posterior capsular release for FC. Posterior capsular release was performed stepwise at each part of the femoral condyle. Results The gastrocnemius tendon and PC were integrally attached to the femoral cortex at the medial and lateral condyles, whereas the PC at the intercondylar fossa was independently attached directly to the femoral cortex. Moreover, the PC at the intercondylar fossa was attached most distally among each femoral condyle. Posterior capsular release at the intercondylar fossa allowed 11.4° ± 2.8° improvement in knee extension. This angle was further improved by 5.5° ± 1.3°, after subsequent capsular release at the medial and lateral condyles. Conclusion The forms and sites of posterior capsular attachment differed based on the part of the femoral condyle. Stepwise posterior capsular release was effective for FC in PS-TKA. Level of evidence III.Tomofumi KinoshitaKazunori HinoTatsuhiko KutsunaKunihiko WatamoriTakashi TsudaHiromasa MiuraSpringerOpenarticlePosterior capsular releaseOsteoarthritisFlexion contractureKnee extension angleCadaveric studyCadaveric kneeOrthopedic surgeryRD701-811ENJournal of Experimental Orthopaedics, Vol 8, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Posterior capsular release Osteoarthritis Flexion contracture Knee extension angle Cadaveric study Cadaveric knee Orthopedic surgery RD701-811
spellingShingle	Posterior capsular release Osteoarthritis Flexion contracture Knee extension angle Cadaveric study Cadaveric knee Orthopedic surgery RD701-811 Tomofumi Kinoshita Kazunori Hino Tatsuhiko Kutsuna Kunihiko Watamori Takashi Tsuda Hiromasa Miura Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty
description	Abstract Purpose Posterior capsular contracture causes stiffness during knee extension in knee osteoarthritis. Furthermore, in posterior-stabilized total knee arthroplasty (PS-TKA), a unique design such as the cam mechanism could conflict with the posterior capsule (PC) causing flexion contracture (FC). However, few studies have focused on the anatomical aspects of the PC. This study aimed to investigate the anatomical site and forms of posterior capsular attachment to the femoral cortex, and to evaluate the efficacy of posterior capsular release for FC by assessing changes in knee extension angles using a navigation system. Methods Attachment sites of the PC were investigated in 10 cadaveric knees using computed tomography. PS-TKA was performed in six cadaveric knees using a navigation system to evaluate the efficacy of posterior capsular release for FC. Posterior capsular release was performed stepwise at each part of the femoral condyle. Results The gastrocnemius tendon and PC were integrally attached to the femoral cortex at the medial and lateral condyles, whereas the PC at the intercondylar fossa was independently attached directly to the femoral cortex. Moreover, the PC at the intercondylar fossa was attached most distally among each femoral condyle. Posterior capsular release at the intercondylar fossa allowed 11.4° ± 2.8° improvement in knee extension. This angle was further improved by 5.5° ± 1.3°, after subsequent capsular release at the medial and lateral condyles. Conclusion The forms and sites of posterior capsular attachment differed based on the part of the femoral condyle. Stepwise posterior capsular release was effective for FC in PS-TKA. Level of evidence III.
format	article
author	Tomofumi Kinoshita Kazunori Hino Tatsuhiko Kutsuna Kunihiko Watamori Takashi Tsuda Hiromasa Miura
author_facet	Tomofumi Kinoshita Kazunori Hino Tatsuhiko Kutsuna Kunihiko Watamori Takashi Tsuda Hiromasa Miura
author_sort	Tomofumi Kinoshita
title	Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty
title_short	Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty
title_full	Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty
title_fullStr	Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty
title_full_unstemmed	Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty
title_sort	efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/526ae392a01a428bb5163c5f5944ff81
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Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty

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