Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty
Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty
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DOI：
10.1007/s00167-011-1691-x
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发表时间：
2012-08-01
影响因子：
3.8
通讯作者：
Iwamoto, Yukihide
中科院分区：
文献类型：
--
作者：
Tashiro, Yasutaka;Uemura, Munenori;Iwamoto, Yukihide
旋转对线对于全膝关节置换术（TKA）后髌骨轨迹、韧带平衡和胫股一致性非常重要。后髁轴通常被称为旋转对线标志。然而，由于基于CT的手术计划不考虑软骨厚度，仅位于内侧髁的关节软骨磨损可能会影响旋转的准确性。本研究旨在探讨后髁软骨厚度是否影响TKA术后的旋转对线。术前进行轴位切片MRI检查。控制扫描使横截面在冠状面上垂直于股骨的机械轴，在矢状面上垂直于股骨远端的切线，从而模拟实际股骨的手术切片。测量有无关节软骨的髁状突扭转角（CTA）。结果：无软骨CTA（6.8 ± A2.0A度）明显大于有软骨CTA（5.2 ± A2.0A度）（P < 0.01），12膝（30%）相差大于2度。MRI显示的软骨厚度与实际标本几乎相同，外侧髁明显增厚，未考虑关节软骨的TKA手术计划可能导致股骨植入物外旋错位。
Rotational alignment is important for patellar tracking, ligament balance, and tibiofemoral congruity after total knee arthroplasty (TKA). The posterior condylar axis is often referred to as a rotational alignment landmark. However, articular cartilage wear localized only in the medial condyle might affect the accuracy of rotation, because surgical planning based on CT does not consider the cartilage thickness. The purpose of this study was to clarify whether the cartilage thickness of the posterior condyle affects rotational alignment after TKA.A total of 40 osteoarthritis patients waiting for TKA were recruited. MRI of axial sections was performed preoperatively. Scans were controlled to make the cross section perpendicular to the mechanical axis of the femur on the coronal plane and to the tangent line of the distal femur on the sagittal plane, so that the surgical section of the actual femur could be simulated. The condylar twist angle (CTA) was measured with and without articular cartilage. The cartilage thickness on the medial and lateral posterior condyles was surveyed in both MRI images and surgical specimens.The CTA without cartilage (6.8 +/- A 2.0A degrees) was significantly larger than the CTA with cartilage (5.2 +/- A 2.0A degrees) (P < 0.01), and 12 knees (30%) demonstrated differences of more than 2 degrees. The cartilage depicted in MRI showed almost the same thickness as the actual specimens and was significantly thicker on the lateral condyles.Surgical planning for TKA not considering articular cartilage might lead to the externally rotated malposition of the femoral implant.II.