Influence of anteroposterior and mediolateral instability on range of motion after total knee arthroplasty: an ultrasonographic study.

Abstract

Ultrasonographically, the femoral component and the tibial plate of total knee prostheses are strongly echogenic, while the high-density polyethylene insert is hypoechoic. This study evaluated the influence of mediolateral and anteroposterior stability after total knee arthroplasty (TKA) on range of motion using real-time monitoring with ultrasound. Mediolateral stress translation, which is increased by horizontal resection of more bone at the ends of the femur or tibia for easy prosthesis implantation, was examined on coronal scans at the level of the collateral ligaments. Anteroposterior drawer was examined on sagittal scans at the level of the patellar tendon. Mediolateral translation (0-10 mm; mean 2.24 mm) did not correlate with range of motion, while anteroposterior drawer (2-10 mm, mean 5.05 mm) correlated well with range of motion. These ultrasonographic findings suggest that horizontal over-resection of the ends of the femur and tibia contributed to joint laxity, which would not result in better ROM. Rollback and sliding of the femoral component on the tibia, which is believed to be correlated with anteroposterior drawer, may be important in achieving better range of motion and obtaining excellent results in TKA.