Mean distraction force applied in tension-controlled ligament-balanced total knee arthroplasty: A systematic review and meta-analysis.

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-02-26 DOI:10.1002/ksa.12629

Roland Becker, Maximilan Voss, Jonathan Lettner, Robert Hable, Mahmut Enes Kayaalp, Reha Tandogan, Pier Indelli, Nikolai Ramadanov

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引用次数: 0

Abstract

Background: Proper tension of the collateral ligaments is the key to success in total knee arthroplasty (TKA). The study aimed to identify the distraction force for the medial and lateral femorotibial compartments in tension-controlled ligament-balanced TKA at 0° and 90° of knee flexion.

Methods: A literature search was conducted in PubMed up to 31 December 2024 to identify studies that reported exact values of the distraction force applied in tension-controlled ligament-balanced TKA. Mean distraction force at 0° and 90° of knee flexion were calculated for the native knee, cadaver knee, and computer model/artificial knee groups. Differences between groups were calculated using Kruskal-Wallis and Mann-Whitney U tests, with p ≤ 0.05 considered significant. A frequentist meta-analysis of subgroup analysis between native and cadaver knee studies was performed using a random effects model with inverse variance and the Sidik-Jonkman heterogeneity estimator with Hartung-Knapp adjustment to calculate participant age and sex.

Results: Out of 116 included primary studies involved, a total of 6869 participants had distraction force measurements during TKA. The mean distraction force was 149.9 N (35.0-320.0 N) at 0° knee extension and 139.5 N (14.7-244.7 N) at 90° of flexion. Using the Kruskal-Wallis test or the Mann-Whitney U test, there were no significant differences in distraction force between native knee, cadaver knee, computer model/artificial knee studies at extension (p = 0.2480 and p = 0.1130) and at 90° of knee flexion (p = 0.8439 and p = 0.6241).

Conclusion: This meta-analysis is the first to quantify distraction force in TKA, providing essential reference values of 149.9 N at 0° extension and 139.5 N at 90° flexion. These findings offer valuable guidelines for intraoperative soft tissue management during TKA procedures. The consistency of distraction force across different experimental models suggests that these values are broadly applicable. However, it remains unclear whether a more personalized distraction force should be considered for gap preparation.

Level of evidence: Level IV.

查看原文本刊更多论文

张力控制韧带平衡全膝关节置换术中平均牵引力的应用：系统回顾和荟萃分析。

背景：侧副韧带的适当张力是全膝关节置换术（TKA）成功的关键。本研究旨在确定在膝关节屈曲0°和90°时张力控制韧带平衡TKA中股胫间室内侧和外侧的牵张力。方法：到2024年12月31日，在PubMed上进行文献检索，以确定报道张力控制韧带平衡TKA中牵张力精确值的研究。计算天然膝关节、尸体膝关节和计算机模型/人工膝关节组膝关节屈曲0°和90°时的平均牵引力。采用Kruskal-Wallis检验和Mann-Whitney U检验计算组间差异，以p≤0.05为显著性。使用随机效应模型和Sidik-Jonkman异质性估计器（Hartung-Knapp校正）计算参与者的年龄和性别，对原生研究和尸体膝关节研究之间的亚组分析进行频率元分析。结果：在116项纳入的初步研究中，共有6869名参与者在TKA期间进行了分心力测量。膝关节伸展0°时平均牵张力为149.9 N (35.0 ~ 320.0 N)，膝关节屈曲90°时平均牵张力为139.5 N （14.7 ~ 244.7 N）。采用Kruskal-Wallis检验或Mann-Whitney U检验，在膝关节伸展（p = 0.2480和p = 0.1130）和膝关节屈曲90°（p = 0.8439和p = 0.6241）时，天然膝关节、尸体膝关节、计算机模型/人工膝关节研究之间的牵开力无显著差异。结论：该荟萃分析首次量化了TKA的牵张力，提供了0°伸展时149.9 N和90°屈曲时139.5 N的基本参考值。这些发现为TKA术中软组织管理提供了有价值的指导。在不同的实验模型中抽离力的一致性表明这些值是广泛适用的。然而，目前尚不清楚是否应该考虑在间隙准备中使用更个性化的分散力。证据等级：四级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).