Changes in knee kinematics reflect the articular geometry after arthroplasty
Changes in knee kinematics reflect the articular geometry after arthroplasty
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DOI：
10.1007/s11999-008-0440-z
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发表时间：
2008-10-01
影响因子：
4.2
通讯作者：
Amis, Andrew A.
中科院分区：
文献类型：
--
作者：
Bull, Anthony M. J.;Kessler, Oliver;Amis, Andrew A.
我们假设TKA后旋转和平移的变化，采用固定支承的前交叉韧带（ACL）-牺牲但后交叉韧带（PCL）-保留设计，具有相同尺寸的圆形股骨髁，反映了关节几何结构的变化。使用8个尸体膝关节，我们比较了正常膝关节和TKA在标准导航位置和规定载荷下的运动学。在膝关节屈曲-伸展期间，四头肌被拉紧，并施加力矩和抽屉力，同时使用导航系统记录运动学。TKA导致螺钉复位丢失;屈曲胫骨保持在正常全膝伸展的外旋位置，外旋从63度显著增加至11度伸展。内-外旋范围从30度外移到20度外伸。从40度屈曲到90度屈曲，胫骨后平移较小。TKA后内翻-外翻对线和松弛度没有变化。因此，导航TKA提供了良好的冠状面对线，但仍丢失了某些生理活动。胫骨螺钉复位的丢失与对称的股骨髁相关，但屈曲时的后平移与TKA后的预期变化相反，PCL完整，ACL切除。因此，这些数据证实了我们关于旋转的假设，而不是关于平移的假设。尚不清楚标准导航位置是否提供与生理运动学的最佳匹配。
We hypothesized changes in rotations and translations after TKA with a fixed-bearing anterior cruciate ligament (ACL)-sacrificing but posterior cruciate ligament (PCL)-retaining design with equal-sized, circular femoral condyles would reflect the changes of articular geometry. Using 8 cadaveric knees, we compared the kinematics of normal knees and TKA in a standardized navigated position with defined loads. The quadriceps was tensed and moments and drawer forces applied during knee flexion-extension while recording the kinematics with the navigation system. TKA caused loss of the screw-home; the flexed tibia remained at the externally rotated position of normal full knee extension with considerably increased external rotation from 63 degrees to 11 degrees extension. The range of internal-external rotation was shifted externally from 30 degrees to 20 degrees extension. There was a small tibial posterior translation from 40 degrees to 90 degrees flexion. The varus-valgus alignment and laxity did not change after TKA. Thus, navigated TKA provided good coronal plane alignment but still lost some aspects of physiologic motion. The loss of tibial screw-home was related to the symmetric femoral condyles, but the posterior translation in flexion was opposite the expected change after TKA with the PCL intact and the ACL excised. Thus, the data confirmed our hypothesis for rotations but not for translations. It is not known whether the standard navigated position provides the best match to physiologic kinematics.