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Popliteus impingement after TKA may occur with well-sized prostheses

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Abstract
To determine the mechanisms and extents of popliteus impingements before and after TKA and to investigate the influence of implant sizing. The hypotheses were that (1) popliteus impingements after TKA may occur at both the tibia and the femur, and (2) even with an apparently well-sized prosthesis, popliteal tracking during knee flexion is modified compared to the preoperative situation. The location of the popliteus in three cadaver knees was measured using computed tomography, before and after implantation of plastic TKA replicas, by injecting the tendon with radiopaque liquid. The pre- and post-operative positions of the popliteus were compared from full extension to deep flexion using normosized, oversized, and undersized implants (one size increments). At the tibia, TKA caused the popliteus to translate posteriorly, mostly in full extension: 4.1 +/- 2 mm for normosized implants, and 15.8 +/- 3 mm with oversized implants, but no translations were observed when using undersized implants. At the femur, TKA caused the popliteus to translate laterally at deeper flexion angles, peaking between 80A degrees and 120A degrees: 2 +/- 0.4 mm for normosized implants and 2.6 +/- 0.5 mm with oversized implants. Three-dimensional analysis revealed prosthetic overhang at the posterosuperior corner of normosized and oversized femoral components (respectively, up to 2.9 mm and 6.6 mm). A well-sized tibial component modifies popliteal tracking, while an undersized tibial component maintains more physiologic patterns. Oversizing shifts the popliteus considerably throughout the full arc of motion. This study suggests that both femoro- and tibio-popliteus impingements could play a role in residual pain and stiffness after TKA.
Keywords
Popliteus tendon, TKA pain, TKA sizing, TKA impingement, TOTAL KNEE ARTHROPLASTY, POSTERIOR CRUCIATE LIGAMENT, TIBIAL COMPONENT, ROTATIONAL ALIGNMENT, FEMORAL CONDYLES, WEIGHT-BEARING, TENDON INJURY, DISTAL FEMUR, RISK-FACTORS, LIVING KNEE

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Citation

Please use this url to cite or link to this publication:

Chicago
Bonnin, Michel, Arnoud de Kok, Matthias Verstraete, Tom Van Hoof, Catherine Van Der Straeten, Mo Saffarini, and Jan Victor. 2017. “Popliteus Impingement After TKA May Occur with Well-sized Prostheses.” Knee Surgery Sports Traumatology Arthroscopy 25 (6): 1720–1730.
APA
Bonnin, Michel, de Kok, A., Verstraete, M., Van Hoof, T., Van Der Straeten, C., Saffarini, M., & Victor, J. (2017). Popliteus impingement after TKA may occur with well-sized prostheses. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 25(6), 1720–1730.
Vancouver
1.
Bonnin M, de Kok A, Verstraete M, Van Hoof T, Van Der Straeten C, Saffarini M, et al. Popliteus impingement after TKA may occur with well-sized prostheses. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 2017;25(6):1720–30.
MLA
Bonnin, Michel, Arnoud de Kok, Matthias Verstraete, et al. “Popliteus Impingement After TKA May Occur with Well-sized Prostheses.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 25.6 (2017): 1720–1730. Print.
@article{8502772,
  abstract     = {To determine the mechanisms and extents of popliteus impingements before and after TKA and to investigate the influence of implant sizing. The hypotheses were that (1) popliteus impingements after TKA may occur at both the tibia and the femur, and (2) even with an apparently well-sized prosthesis, popliteal tracking during knee flexion is modified compared to the preoperative situation. 
The location of the popliteus in three cadaver knees was measured using computed tomography, before and after implantation of plastic TKA replicas, by injecting the tendon with radiopaque liquid. The pre- and post-operative positions of the popliteus were compared from full extension to deep flexion using normosized, oversized, and undersized implants (one size increments). 
At the tibia, TKA caused the popliteus to translate posteriorly, mostly in full extension: 4.1 +/- 2 mm for normosized implants, and 15.8 +/- 3 mm with oversized implants, but no translations were observed when using undersized implants. At the femur, TKA caused the popliteus to translate laterally at deeper flexion angles, peaking between 80A degrees and 120A degrees: 2 +/- 0.4 mm for normosized implants and 2.6 +/- 0.5 mm with oversized implants. Three-dimensional analysis revealed prosthetic overhang at the posterosuperior corner of normosized and oversized femoral components (respectively, up to 2.9 mm and 6.6 mm). 
A well-sized tibial component modifies popliteal tracking, while an undersized tibial component maintains more physiologic patterns. Oversizing shifts the popliteus considerably throughout the full arc of motion. This study suggests that both femoro- and tibio-popliteus impingements could play a role in residual pain and stiffness after TKA.},
  author       = {Bonnin, Michel and de Kok, Arnoud and Verstraete, Matthias and Van Hoof, Tom and Van Der Straeten, Catherine and Saffarini, Mo and Victor, Jan},
  issn         = {0942-2056},
  journal      = {KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY},
  language     = {eng},
  number       = {6},
  pages        = {1720--1730},
  title        = {Popliteus impingement after TKA may occur with well-sized prostheses},
  url          = {http://dx.doi.org/10.1007/s00167-016-4330-8},
  volume       = {25},
  year         = {2017},
}

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