Anterior cruciate ligament reconstruction and cartilage contact forces--A 3D computational simulation.
Anterior cruciate ligament reconstruction and cartilage contact forces--A 3D computational simulation.
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DOI：
10.1016/j.clinbiomech.2015.08.007
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Li G
中科院分区：
文献类型：
--
作者：
Wang L;Lin L;Feng Y;Fernandes TL;Asnis P;Hosseini A;Li G
临床结果研究表明前交叉韧带重建后膝骨关节炎的发生率很高。异常的关节运动学和负载条件被假定为风险因素。然而，人们对手术后软骨接触力知之甚少。使用经过验证的计算模型来模拟解剖和跨胫单束前十字韧带重建。每次重建模拟两个移植物固定角度（0°和30°）。当膝关节在 0°、30°、60° 和 90° 屈曲时承受 134N 前负荷和 400N 股四头肌负荷时，研究了在完整、前十字韧带缺陷和重建条件下膝关节的生物力学。计算胫骨平移和旋转、移植物力、内侧和外侧接触力。当移植物固定在 0° 时，与完整膝关节相比，解剖重建导致 0° 处的横向接触力稍大，而经胫骨技术导致在肌肉负荷下 0° 和 30° 处的接触力更高。当移植物固定在 30° 时，解剖重建使膝关节在 0° 处过度应变，接触力较大，而经胫骨技术导致 30° 处接触力稍大。这项研究表明，解剖重建和跨胫骨重建都不能一致地恢复不同屈曲角度下的正常膝关节生物力学。解剖重建可以更好地恢复移植物固定在0°的前后稳定性和接触力。经胫骨技术可以更好地恢复膝关节前后稳定性和关节接触力，并将移植物固定在30°的屈曲位置。
Clinical outcome studies showed a high incidence of knee osteoarthritis after anterior cruciate ligament reconstruction. Abnormal joint kinematics and loading conditions were assumed as risking factors. However, little is known on cartilage contact forces after the surgery. A validated computational model was used to simulate anatomic and transtibial single-bundle anterior cruciate ligament reconstructions. Two graft fixation angles (0° and 30°) were simulated for each reconstruction. Biomechanics of the knee was investigated in intact, anterior cruciate ligament deficient and reconstructed conditions when the knee was subjected to 134N anterior load and 400N quadriceps load at 0°, 30°, 60° and 90° of flexion. The tibial translation and rotation, graft forces, medial and lateral contact forces were calculated. When the graft was fixed at 0°, the anatomic reconstruction resulted in slightly larger lateral contact force at 0° compared to the intact knee while the transtibial technique led to higher contact force at both 0° and 30° under the muscle load. When graft was fixed at 30°, the anatomic reconstruction overstrained the knee at 0° with larger contact forces, while the transtibial technique resulted in slightly larger contact forces at 30°. This study suggests that neither the anatomic nor the transtibial reconstruction can consistently restore normal knee biomechanics at different flexion angles. The anatomic reconstruction may better restore anteroposterior stability and contact force with the graft fixed at 0°. The transtibial technique may better restore knee anteroposterior stability and articular contact force with the graft fixed at 30° of flexion.