Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty

Abstract Background Bi-cruciate retaining (BCR) total knee arthroplasty (TKA) is considered to provide improved clinical function and kinematics compared with conventional TKA, but it is unclear which factors affect clinical outcomes after BCR TKA. This study aimed to investigate whether rotational...

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Main Authors: Shine Tone, Yohei Naito, Hiroki Wakabayashi, Akihiro Sudo, Masahiro Hasegawa
Format: Article
Language:English
Published: BMC 2025-03-01
Series:BMC Musculoskeletal Disorders
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Online Access:https://doi.org/10.1186/s12891-025-08478-2
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author Shine Tone
Yohei Naito
Hiroki Wakabayashi
Akihiro Sudo
Masahiro Hasegawa
author_facet Shine Tone
Yohei Naito
Hiroki Wakabayashi
Akihiro Sudo
Masahiro Hasegawa
author_sort Shine Tone
collection DOAJ
description Abstract Background Bi-cruciate retaining (BCR) total knee arthroplasty (TKA) is considered to provide improved clinical function and kinematics compared with conventional TKA, but it is unclear which factors affect clinical outcomes after BCR TKA. This study aimed to investigate whether rotational alignment of the femoral and tibial components and rotational mismatch between the femoral and tibial components affected early clinical outcomes after BCR TKA, according to the 2011 version of the Knee Society Score (2011KSS). Methods This retrospective cohort study included 39 knees that underwent BCR TKA. Rotational alignment of the femoral and tibial components and rotational mismatch between the components were measured by computed tomography based three-dimensional evaluation software. 2011KSS was obtained at 3, 6, and 12 months postoperatively. The relationship of each of rotational alignment and rotational mismatch with 2011KSS was analyzed. Results Rotational alignment of the femoral and tibial components was not correlated with symptoms, patient satisfaction, patient expectations, or functional activities at 3, 6, or 12 months postoperatively. Rotational mismatch was negatively correlated with symptoms, patient satisfaction and functional activities at 3 months; negatively correlated with symptoms and functional activities at 6 months; and negatively correlated with symptoms, patient satisfaction, patient expectations and functional activities at 12 months postoperatively. Conclusions Rotational mismatch between the femoral and tibial components was negatively correlated with 2011KSS, whereas no relationship of rotational alignment of the femoral and tibial components with 2011KSS was observed. Excessive external rotation of the tibial component relative to the femoral component resulted in worse early clinical outcomes.
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spelling doaj-art-e54256c83fa94d56b287735c04abbd1a2025-08-20T03:01:54ZengBMCBMC Musculoskeletal Disorders1471-24742025-03-012611910.1186/s12891-025-08478-2Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplastyShine Tone0Yohei Naito1Hiroki Wakabayashi2Akihiro Sudo3Masahiro Hasegawa4Department of Orthopaedic Surgery, Graduate School of Medicine, Mie UniversityDepartment of Orthopaedic Surgery, Graduate School of Medicine, Mie UniversityDepartment of Orthopaedic Surgery, Graduate School of Medicine, Mie UniversityDepartment of Orthopaedic Surgery, Graduate School of Medicine, Mie UniversityDepartment of Orthopaedic Surgery, Graduate School of Medicine, Mie UniversityAbstract Background Bi-cruciate retaining (BCR) total knee arthroplasty (TKA) is considered to provide improved clinical function and kinematics compared with conventional TKA, but it is unclear which factors affect clinical outcomes after BCR TKA. This study aimed to investigate whether rotational alignment of the femoral and tibial components and rotational mismatch between the femoral and tibial components affected early clinical outcomes after BCR TKA, according to the 2011 version of the Knee Society Score (2011KSS). Methods This retrospective cohort study included 39 knees that underwent BCR TKA. Rotational alignment of the femoral and tibial components and rotational mismatch between the components were measured by computed tomography based three-dimensional evaluation software. 2011KSS was obtained at 3, 6, and 12 months postoperatively. The relationship of each of rotational alignment and rotational mismatch with 2011KSS was analyzed. Results Rotational alignment of the femoral and tibial components was not correlated with symptoms, patient satisfaction, patient expectations, or functional activities at 3, 6, or 12 months postoperatively. Rotational mismatch was negatively correlated with symptoms, patient satisfaction and functional activities at 3 months; negatively correlated with symptoms and functional activities at 6 months; and negatively correlated with symptoms, patient satisfaction, patient expectations and functional activities at 12 months postoperatively. Conclusions Rotational mismatch between the femoral and tibial components was negatively correlated with 2011KSS, whereas no relationship of rotational alignment of the femoral and tibial components with 2011KSS was observed. Excessive external rotation of the tibial component relative to the femoral component resulted in worse early clinical outcomes.https://doi.org/10.1186/s12891-025-08478-2Rotational mismatchRotational alignmentClinical outcomesBi-cruciate retainingTotal knee arthroplasty
spellingShingle Shine Tone
Yohei Naito
Hiroki Wakabayashi
Akihiro Sudo
Masahiro Hasegawa
Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty
BMC Musculoskeletal Disorders
Rotational mismatch
Rotational alignment
Clinical outcomes
Bi-cruciate retaining
Total knee arthroplasty
title Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty
title_full Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty
title_fullStr Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty
title_full_unstemmed Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty
title_short Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty
title_sort association between femorotibial rotational mismatch and early clinical outcomes after bi cruciate retaining total knee arthroplasty
topic Rotational mismatch
Rotational alignment
Clinical outcomes
Bi-cruciate retaining
Total knee arthroplasty
url https://doi.org/10.1186/s12891-025-08478-2
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