Correlation of intraoperative ligament stability with functional outcomes following total knee arthroplasty

doi:10.3969/j.issn.2095-4344.0281

Abstract

Abstract:

BACKGROUND: The extent of ligament laxity should be achieved during total knee arthroplasty (TKA) and the relationship between ligament laxity and knee function are still uncertain.
OBJECTIVE: To investigate association of the intraoperative ligament laxity and functional outcomes after TKA.

METHODS: Medial and lateral ligament laxities were measured intraoperatively in extension 0°and flexion 30°, and the patients were then divided into seven groups based on the ligament laxity, group 1 (0-1.0 mm), group 2 (1.0-2.0 mm), group 3 (2.0-3.0 mm), group 4 (3.0- 4.0 mm), group 5 (4.0-5.0 mm), group 6 (5.0-6.0 mm) and group 7 (> 6.0 mm). The knee function was evaluated by Knee Injury and Osteoarthritis Outcome Score (KOOS), the Knee Society Clinical Rating System (KSS) and the Oxford Knee Score (OKS) at baseline and 2 years postoperatively.

RESULTS AND CONCLUSION: (1) Totally 362 patients completed the 2-year follow-up. (2) The postoperative KOOS, KSS and OKS scores were significantly improved compared with the baseline. (3) There was a significant difference in the KSS score among groups (F=16.273, P=0.000), and the scores were best in the groups 3 and 4. The postoperative OKS scores showed significant difference among groups (F=3.103, P=0.006), and the scores were lowest in the group 3. Medial and lateral ligament laxity 1.0-2.0 mm in extension 0° and ligament laxity 2.0-3.0 mm/3.0-4.0 mm in flexion 30° showed the optimal KSS and OKS scores. (4) The range of motion of the knee joint exhibited significant difference among groups (F=4.227, P=0.000), which was largest in the groups 6 and 7. (5) Group 3 exhibited good functional outcome under activities of daily living and quality of life subscores in KOOS. (6) To conclude, in order to improve the functional results after TKA, orthopedic surgeons should monitor ligament laxity intraoperatively 1.0-2.0 mm in extension and 2.0-3.0 mm in flexion 30°.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Knee, Ligaments, Osteoarthritis, Tissue Engineering

CLC Number:

R318

Liu Qing-kuan, Wang Guo-dong, Wang Cheng-qun, Kong Ying, Niu Shuai-shuai, Ma Long-fei. Correlation of intraoperative ligament stability with functional outcomes following total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(19): 2968-2973.

Figures/Tables 2

2.1 参与者数量分析 387例患者符合纳入标准，随访时间为2年，最终获得随访的患者有362例，失访率为6.5%，失访原因包括迁移去外地(12例)、因合并症治疗(8例)及联系不到(5例)等，见图1。 2.2 术前各组功能评分根据术中韧带松弛度分组，回溯术前各组患者的KSS评分(F=1.507，P=0.175)、OKS评分(F=1.926，P=0.076)，各组间差异无显著性意义；术前各组患者的活动度各组间差异无显著性意义(F=1.092，P=0.366)，见表1；术前KOOS评分不同维度下各组间差异无显著性意义(图2)。 2.3 术后各组功能评分术后患者的膝关节功能评分(KSS及OKS评分)均较术前有明显改善(表1)。术后KSS评分各组间差异有显著性意义(F=16.273，P=0.000)，LSD检验两两比较见表2，评分最高的2组为组3(2.0-3.0 mm)和组4(3.0-4.0 mm)，分别为85.85±10.36 和79.59±9.44；术后OKS评分，各组间差异有显著性意义(F=3.103，P=0.006)，LSD检验两两比较见表3，评分最低的组3(2.0-3.0mm)为17.94±4.98，其余各组差异不大；术后膝关节活动度，各组间差异有显著性意义(F=4.227，P=0.000)，LSD检验两两比较见表4，活动度最大的是组6和组7，分别为(114.26±13.63)°和(116.19±9.51)°，这2组间差异无显著性意义。 2.4 术后KOOS评分术后患者的KOOS评分各维度均较术前明显改善(图3)。术后KOOS疼痛及体育娱乐时膝关节功能评分各组间差异无显著性意义；僵硬等其他症状，AVONA显示各组间差异有显著性意义(F=9.285，P=0.000)，LSD两两比较，评分最低的是组1(0-1.0 mm)，为77.47±4.39，与其他各组间差异均有显著性意义(P < 0.05)；评分最高的是组6和组7，分别为84.87±4.89和83.95±3.76，与其他各组间差异均有显著性意义(P < 0.05)；膝关节的日常生活活动评分，AVONA显示各组间差异有显著性意义(F=3.215，P=0.004)，LSD两两比较，评分最高的是组3(2.0-3.0 mm)，为73.05±4.74，与组4-7之间的差异均有显著性意义(P < 0.05)。膝关节有关的日常生活质量评分，AVONA显示各组间差异有显著性意义(F=2.997，P=0.007)，LSD两两比较，评分最高的是组3(2.0-3.0 mm)，为89.00±3.10，与其余各组之间的差异均有显著性意义(P < 0.05)。"

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