The influence of femoral rollback on patellofemoral contact loads in total knee arthroplasty
The influence of femoral rollback on patellofemoral contact loads in total knee arthroplasty
复制标题
DOI：
10.1054/arth.2001.24445
复制
发表时间：
2001-10-01
影响因子：
3.5
通讯作者：
Beynnon, BD
中科院分区：
文献类型：
--
作者：
Churchill, DL;Incavo, SJ;Beynnon, BD
在全膝关节置换术（TKA）中，增加屈曲时的股骨后滚被认为可以减少髌股接触载荷。本研究的目的是量化髌骨载荷对后滚的依赖性，并评估后交叉韧带（PCL）保留、PCL牺牲和PCL替代TKA类型在产生后滚方面的有效性。9具尸体膝关节在模拟蹲下进行了测试。评价了6例预期会产生不同程度股骨后滚的TKA：PCL保留TKA、PCL牺牲TKA、市售PCL替代TKA和3例改良PCL替代TKA，其中胫骨立柱的前后位置不同。记录运动负荷、股四头肌负荷和髌股接触负荷。在30 °至90 °屈曲范围内观察到回滚的显著差异。PCL牺牲TKA产生的回滚最少。保留PCL的TKA产生了更大的回滚，但变异性最大。PCL替代TKA产生了最大和最可重现的回滚。向后移动胫骨立柱进一步增加了后滚。后滚增加与髌骨载荷降低相关（-2.2%/mm）。观察到髌骨载荷降低17.6%。通过增加后滚减少四头肌负荷，但程度较小（-0.9%/mm）。回滚主要影响髌骨负荷，而不是股四头肌负荷或效率。
Increasing femoral rollback in flexion is thought to reduce patellofemoral contact load in total knee arthroplasty (TKA). The objectives of this study were to quantify the dependence of patellar load on rollback and to assess the effectiveness of posterior cruciate ligament (PCL)-retaining, PCL-sacrificing, and PCL-substituting TKA types in generating rollback. Nine cadaver knees were tested in simulated squatting. Six TKAs that were expected to produce varying amounts of femoral rollback were evaluated: PCL-retaining TKA, PCL-sacrificing TKA, a commercially available PCL-substituting TKA, and 3 modified PCL- substituting TKAs in which the anteroposterior position of the tibial post was varied. Kinematics, quadriceps loads, and patellofemoral contact loads were recorded. Significant differences in rollback were observed in the 30 degrees to 90 degrees flexion range. PCL-sacrificing TKAs generated the least rollback. PCL-retaining TKAs produced greater rollback but had the most variability. PCL-substituting TKAs produced the greatest and most reproducible rollback. Moving the tibial post posteriorly further increased rollback. Increased rollback correlated with reduced patellar load (-2.2%/mm). Reductions in patellar load of 17.6% were observed. Quadriceps loads were reduced by increasing rollback but to a smaller degree (-0.9%/mm). Rollback primarily affects patellar load rather than quadriceps load or efficiency.