{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:17:14Z","timestamp":1780964234185,"version":"3.54.1"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T00:00:00Z","timestamp":1533772800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T00:00:00Z","timestamp":1533772800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Surgeons may attempt to strip the posterior capsule from its femoral attachment to overcome flexion contracture in total knee arthroplasty (TKA); however, it is unclear if this impacts anterior\u2013posterior (AP) laxity of the implanted knee. The aim of the study was to investigate the effect of posterior capsular release on AP laxity in TKA, and compare this to the restraint from the posterior cruciate ligament (PCL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eight cadaveric knees were mounted in a six degree of freedom testing rig and tested at 0\u00b0, 30\u00b0, 60\u00b0 and 90\u00b0 flexion with \u00b1\u2009150\u00a0N AP force, with and without a 710\u00a0N axial compressive load. After the native knee was tested, a deep dished cruciate\u2010retaining TKA was implanted and the tests were repeated. The PCL was then cut, followed by releasing the posterior capsule using a curved osteotome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With 0\u00a0N axial load applied, cutting the PCL as well as releasing the posterior capsule significantly increased posterior laxity compared to the native knee at all flexion angles, and CR TKA states at 30\u00b0, 60\u00b0 and 90\u00b0 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). However, no significant increase in laxity was found between cutting the PCL and subsequent PostCap release (n.s.). In anterior drawer, there was a significant increase of 1.4\u00a0mm between cutting the PCL and PostCap release at 0\u00b0, but not at any other flexion angles (<jats:italic>p<\/jats:italic>\u2009=\u20090.021). When a 710\u00a0N axial load was applied, there was no significant difference in anterior or posterior translation across the different knee states (n.s.).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Posterior capsular release only caused a small change in AP laxity compared to cutting the PCL and, therefore, may not be considered detrimental to overall AP stability if performed during TKA surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Controlled laboratory study.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-018-5094-0","type":"journal-article","created":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T09:56:50Z","timestamp":1533808610000},"page":"1587-1594","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Posterior capsular release is a biomechanically safe procedure to perform in total knee arthroplasty"],"prefix":"10.1002","volume":"27","author":[{"given":"K. K.","family":"Athwal","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Mechanical Engineering Imperial College London Exhibition Road SW7 2AZ London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. E.","family":"Milner","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Mechanical Engineering Imperial College London Exhibition Road SW7 2AZ London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Bellier","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Cabinet Goethe 23 Avenue Niel 75017 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"Amis","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Mechanical Engineering Imperial College London Exhibition Road SW7 2AZ London UK"},{"name":"<!--<label>3<\/label>--> Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine Charing Cross Hospital W6 8RF London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,9]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.75B5.8376447"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010016\u20104087\u20100"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.23477"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000238791.36725.c5"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000238801.90090.59"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001670050226"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010008\u20100440\u2010z"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104427\u20108"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010198769020\u201000010"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.85B5.13771"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2018.03.042"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2010.10.002"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010016\u20104257\u20100"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010016\u20104269\u20109"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200704000-00009"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199903000\u201000029"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010200301000\u201000023"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509348742"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20102858\u2010z"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2009.05.030"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.94B11.30512"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198911000-00021"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010200211000\u201000031"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104749\u20106"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.20362"}],"container-title":["Knee 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February 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 August 2018","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2018","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Professor Amis declares that he acts as an expert advisor, holds research grants at Imperial College London, receives royalties from a patent licensed through Imperial Innovations, and has received payment for lecturing from Smith & Nephew Ltd. Dr Athwal declares that his salary is supported by a research grant to Imperial College London from Smith & Nephew Ltd. The other authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"This study was approved by REC Wales 12\/WA\/0196, ICHTB HTA licence 12275, application number R13066-2A. E-mail address tissuebank@imperial.ac.uk.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}