{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:32:26Z","timestamp":1790443946225,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,10,28]],"date-time":"2018-10-28T00:00:00Z","timestamp":1540684800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,10,28]],"date-time":"2018-10-28T00:00:00Z","timestamp":1540684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"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>The implant positioning for kinematically aligned total knee arthroplasty (TKA) differs fundamentally from conventional mechanically aligned TKA. This difference may affect patellofemoral (PF) biomechanics after TKA. This cadaveric study tested the hypothesis that kinematically aligned TKA would restore PF biomechanics to the native condition better than mechanically aligned TKA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seven pairs (14\u00a0knees) of fresh\u2010frozen cadavers were tested. All specimens were mounted on a customized knee\u2010testing system and digitized using a Microscribe 3DLX instrument (Revware Inc., Raleigh, NC, USA) to measure patellar kinematics in terms of patellar varus\/valgus rotation, medial\/lateral position, flexion\/extension rotation and proximal\/distal position at knee flexion angles of 0\u00b0, 30\u00b0, 60\u00b0, 90\u00b0, and 120\u00b0. The medial and lateral PF joint contact pressure distributions at 120\u00b0 of knee flexion were measured using a K\u2010scan system (Tekscan Inc., Boston, MA, USA). All patellae remained unresurfaced. For each pair, one knee was randomly assigned to kinematically aligned TKA and the other to mechanically aligned TKA performed using the conventional measured resection technique. During kinematically aligned TKA, the amount of femur and tibia resected was equivalent to implant thickness to maintain the patient\u2010specific joint line. All patellar kinematics were measured and compared between the native condition and after surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patellae of mechanically aligned TKA rotated more valgus and was positioned more laterally compared with those of kinematically aligned TKA at knee flexion angles \u2265\u200990\u00b0. Neither the patellar flexion\/extension rotation nor the proximal\/distal position differed between either prosthetic knee design and the native knee at all flexion angles. The contact pressure distribution between the medial and lateral PF joint after kinematically aligned TKA were similar to those of the native knee, while the lateral PF joint contact pressure after mechanically aligned TKA was higher than that of the native knee (<jats:italic>p<\/jats:italic>\u2009=\u20090.038).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Kinematically aligned TKA better restores patellar kinematics and PF contact pressure distribution to the native condition than mechanically aligned TKA during deep knee flexion. These findings provide clues to understand why kinematically aligned TKA is associated with less anterior knee pain and better PF functional performance compared to mechanically aligned TKA. Patients undergoing kinematically aligned TKA may experience a more normal feeling during deep knee flexion activities.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-018-5270-2","type":"journal-article","created":{"date-parts":[[2018,10,28]],"date-time":"2018-10-28T03:57:40Z","timestamp":1540699060000},"page":"1520-1528","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Kinematically aligned total knee arthroplasty reproduces native patellofemoral biomechanics during deep knee flexion"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7941-1587","authenticated-orcid":false,"given":"In Jun","family":"Koh","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery St. Paul\u2019s Hospital Wangsan\u2010ro 180, Dongdaemun\u2010gu 02559 Seoul Republic of Korea"},{"name":"<!--<label>3<\/label>--> Department of Orthopaedic Surgery, College of Medicine The Catholic University of Korea 06591 Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Il Jung","family":"Park","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Bucheon St. Mary\u2019s Hospital 14647 Bucheon Republic of Korea"},{"name":"<!--<label>3<\/label>--> Department of Orthopaedic Surgery, College of Medicine The Catholic University of Korea 06591 Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles C.","family":"Lin","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Orthopaedic Biomechanics Laboratory Tibor Rubin VA Medical Center Long Beach CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilay A.","family":"Patel","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Orthopaedic Biomechanics Laboratory Tibor Rubin VA Medical Center Long Beach CA USA"},{"name":"<!--<label>5<\/label>--> Department of Orthopaedic Surgery University of California Irvine CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christen E.","family":"Chalmers","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Orthopaedic Biomechanics Laboratory Tibor Rubin VA Medical Center Long Beach CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Maniglio","sequence":"additional","affiliation":[{"name":"<!--<label>6<\/label>--> Department of Orthopaedics and Traumatology Inselspital Bern, University Hospital Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle H.","family":"McGarry","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Orthopaedic Biomechanics Laboratory Tibor Rubin VA Medical Center Long Beach CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thay 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