We used buckle transducers in conjunction with a mathematical model to
investigate the mechanics of the cruciate ligaments during flexion of knees
containing prostheses with differing component geometries. With normal
component placement and both cruciate ligaments intact, the full range of
flexion is restricted in a knee with the conforming, single
radius-of-curvature geometric prosthesis because of large constraint forces
in the posterior cruciate ligament. Ligament incompatibility is avoided
with multicurvature designs, as represented by the kinematic prosthesis.
Low conformity of components allows anterior-posterior displacements to
accompany flexion, which provides for a full range of flexion and allows
cruciate ligament forces to approach those of a normal knee. Clinical
Relevance: This analysis points out that special precautions must be taken
to avoid ligament constraint forces (and potential loosening) if an implant
with highly conforming components is used when both cruciate ligaments are
intact. The information presented here, relating implant geometry to
cruciate ligament mechanics, must be considered when choosing an
appropriate prosthetic design to ensure ligament compatibility in the
presence of one, both, or no cruciate ligaments.