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Replication and Substitution of Anatomic Stabilizing Mechanisms in a Total Knee Design

[+] Author and Article Information
Peter S Walker

Department of Orthopaedics, Hospital for Joint Diseases, New York University Langone Medical Center
ptrswlkr@aol.com

Ilya Borukhov

Department of Orthopaedics, Hospital for Joint Diseases, New York University Langone Medical Center
Ilya.Borukhov@nyumc.org

1Corresponding author.

ASME doi:10.1115/1.4037261 History: Received April 14, 2017; Revised June 22, 2017

Abstract

Background While the majority of the total knees used today are of the cruciate retaining (CR) and cruciate substituting (PS) types, the results are not ideal in terms of satisfaction, function, and biomechanical parameters. It is proposed that a design which specifically substituted for the structures which provided stability could produce normal laxity behavior, which may be a path forward to improved outcomes. Methods Stabilizing structures of the anatomic knee were identified under conditions of low and high axial loading. The upwards slope of the anterior medial tibial plateau and the anterior cruciate, were particularly important under all loading conditions. A guided motion design was formulated based on this data, and then tested in a simulating machine which performed an enhanced ASTM constraint test to determine stability and laxity. Results The guided motion design showed much closer neutral path of motion and laxity in anterior-posterior an internal-external rotation, compared with the PS design. Particular features included absence of paradoxical anterior sliding in early flexion, and lateral rollback in higher flexion. Conclusions A total knee design which replicated the stabilizing structures of the anatomical knee is likely to provide more anatomical motion and may result in improved clinical outcomes.

Copyright (c) 2017 by ASME
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