Computational and Mathematical Methods in Medicine
Volume 2012 (2012), Article ID 652865, 11 pages
Research Article

A Computational Modeling Approach for Investigating Soft Tissue Balancing in Bicruciate Retaining Knee Arthroplasty

1Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada V5Z 1M9
2Centre for Hip Health and Mobility, Robert H. N. Ho Research Centre, 799-2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9

Received 22 April 2012; Revised 23 June 2012; Accepted 1 July 2012

Academic Editor: Fabio Galbusera

Copyright © 2012 Shahram Amiri and David R. Wilson. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Bicruciate retaining knee arthroplasty, although has shown improved functions and patient satisfaction compared to other designs of total knee replacement, remains a technically demanding option for treating severe cases of arthritic knees. One of the main challenges in bicruciate retaining arthroplasty is proper balancing of the soft tissue during the surgery. In this study biomechanics of soft tissue balancing was investigated using a validated computational model of the knee joint with high fidelity definitions of the soft tissue structures along with a Taguchi method for design of experiments. The model was used to simulate intraoperative balancing of soft tissue structures following the combinations suggested by an orthogonal array design. The results were used to quantify the corresponding effects on the laxity of the joint under anterior-posterior, internal-external, and varus-valgus loads. These effects were ranked for each ligament bundle to identify the components of laxity which were most sensitive to the corresponding surgical modifications. The resulting map of sensitivity for all the ligament bundles determined the components of laxity most suitable for examination during intraoperative balancing of the soft tissue. Ultimately, a sequence for intraoperative soft tissue balancing was suggested for a bicruciate retaining knee arthroplasty.