Navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure: A cadaveric study
Abstract Purpose Gap‐balanced total knee arthroplasty (TKA) technique relies on initial ligament evaluation, particularly in patient‐specific implantation using computer‐assisted technologies. This cadaveric study aimed to compare the reproducibility and reliability of medial and lateral gap measure...
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| Format: | Article |
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Wiley
2025-01-01
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| Series: | Journal of Experimental Orthopaedics |
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| Online Access: | https://doi.org/10.1002/jeo2.70107 |
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| author | François Boux de Casson Laurent Angibaud Florian Kerveillant Faustine Nogaret Joris Ruffin Léonard Duporté Gérard Giordano Louis Dagneaux |
| author_facet | François Boux de Casson Laurent Angibaud Florian Kerveillant Faustine Nogaret Joris Ruffin Léonard Duporté Gérard Giordano Louis Dagneaux |
| author_sort | François Boux de Casson |
| collection | DOAJ |
| description | Abstract Purpose Gap‐balanced total knee arthroplasty (TKA) technique relies on initial ligament evaluation, particularly in patient‐specific implantation using computer‐assisted technologies. This cadaveric study aimed to compare the reproducibility and reliability of medial and lateral gap measurements between manual stress testing and dynamic ligament balancer. Methods Initial gap acquisitions were assessed from eight cadaveric knees (four specimens) during the same navigated TKA procedure by five differently skilled surgeons (three seniors and two juniors). Medial and lateral gaps were sequentially acquired from extension to maximum knee flexion, applying manual stress prior to any bone cuts (conventional technique), and using intra‐articular tensioning device placed between the tibial cut and the native femur (instrumented technique). Reproducibility was assessed using intraclass correlation coefficient (ICC), stratified by the measurement technique, the type of gaps and the operator experience. Differences in gaps (mm) between techniques were assessed using the Bland and Altmann method. Results The instrumented technique showed higher ICCs than the conventional technique for medial and lateral gaps (0.87 vs. 0.60, P = 0.002, and 0.92 vs. 0.25, p < 0.0001, respectively), and showed no difference in ICCs between medial and lateral gap acquisitions (0.87 vs. 0.92, p = 0.8). Senior surgeons achieved higher ICCs than juniors, while non‐significant with both techniques. Differences in gaps between techniques increased with knee flexion angle (0.8, 2.8 and 3.5 mm at 10°, 45° and 90° of flexion angle, respectively) and decreased with the operator experience (p = 0.003). Conclusion The instrumented balancing technique offered better reproducibility than using manual valgus and varus stress, when measuring medial and lateral gaps. Tensioning devices may play a significant role in enhancing initial gap acquisition, disregarding the flexion angle and the operator experience. Level of Evidence Level IV (observational study involving cadaveric specimens). |
| format | Article |
| id | doaj-art-be3b90a651f5489ca900b4e7d6649164 |
| institution | DOAJ |
| issn | 2197-1153 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj-art-be3b90a651f5489ca900b4e7d66491642025-08-20T03:13:07ZengWileyJournal of Experimental Orthopaedics2197-11532025-01-01121n/an/a10.1002/jeo2.70107Navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure: A cadaveric studyFrançois Boux de Casson0Laurent Angibaud1Florian Kerveillant2Faustine Nogaret3Joris Ruffin4Léonard Duporté5Gérard Giordano6Louis Dagneaux7Blue‐Ortho Meylan FranceExactech Inc Gainesville Florida USABlue‐Ortho Meylan FranceDepartment of Orthopaedic Surgery and Trauma University Center of Montpellier, University of Montpellier Montpellier FranceDepartment of Orthopaedic Surgery and Trauma University Center of Montpellier, University of Montpellier Montpellier FranceDepartment of Orthopaedic Surgery and Trauma University Center of Montpellier, University of Montpellier Montpellier FranceJoseph Ducuing Hospital Toulouse FranceDepartment of Orthopaedic Surgery and Trauma University Center of Montpellier, University of Montpellier Montpellier FranceAbstract Purpose Gap‐balanced total knee arthroplasty (TKA) technique relies on initial ligament evaluation, particularly in patient‐specific implantation using computer‐assisted technologies. This cadaveric study aimed to compare the reproducibility and reliability of medial and lateral gap measurements between manual stress testing and dynamic ligament balancer. Methods Initial gap acquisitions were assessed from eight cadaveric knees (four specimens) during the same navigated TKA procedure by five differently skilled surgeons (three seniors and two juniors). Medial and lateral gaps were sequentially acquired from extension to maximum knee flexion, applying manual stress prior to any bone cuts (conventional technique), and using intra‐articular tensioning device placed between the tibial cut and the native femur (instrumented technique). Reproducibility was assessed using intraclass correlation coefficient (ICC), stratified by the measurement technique, the type of gaps and the operator experience. Differences in gaps (mm) between techniques were assessed using the Bland and Altmann method. Results The instrumented technique showed higher ICCs than the conventional technique for medial and lateral gaps (0.87 vs. 0.60, P = 0.002, and 0.92 vs. 0.25, p < 0.0001, respectively), and showed no difference in ICCs between medial and lateral gap acquisitions (0.87 vs. 0.92, p = 0.8). Senior surgeons achieved higher ICCs than juniors, while non‐significant with both techniques. Differences in gaps between techniques increased with knee flexion angle (0.8, 2.8 and 3.5 mm at 10°, 45° and 90° of flexion angle, respectively) and decreased with the operator experience (p = 0.003). Conclusion The instrumented balancing technique offered better reproducibility than using manual valgus and varus stress, when measuring medial and lateral gaps. Tensioning devices may play a significant role in enhancing initial gap acquisition, disregarding the flexion angle and the operator experience. Level of Evidence Level IV (observational study involving cadaveric specimens).https://doi.org/10.1002/jeo2.70107alignmentexperimental modeljoint laxitykinematicsligamenttensor |
| spellingShingle | François Boux de Casson Laurent Angibaud Florian Kerveillant Faustine Nogaret Joris Ruffin Léonard Duporté Gérard Giordano Louis Dagneaux Navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure: A cadaveric study Journal of Experimental Orthopaedics alignment experimental model joint laxity kinematics ligament tensor |
| title | Navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure: A cadaveric study |
| title_full | Navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure: A cadaveric study |
| title_fullStr | Navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure: A cadaveric study |
| title_full_unstemmed | Navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure: A cadaveric study |
| title_short | Navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure: A cadaveric study |
| title_sort | navigated instrumentation and ligament tensioning device enhances initial gap acquisition during total knee arthroplasty procedure a cadaveric study |
| topic | alignment experimental model joint laxity kinematics ligament tensor |
| url | https://doi.org/10.1002/jeo2.70107 |
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