In Vivo Kinematics of Bicruciate-Retaining Total Knee Arthroplasty with Anatomical Articular Surface under High-Flexion Conditions
In Vivo Kinematics of Bicruciate-Retaining Total Knee Arthroplasty with Anatomical Articular Surface under High-Flexion Conditions
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DOI：
10.1055/s-0039-1696959
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发表时间：
2021-03-01
影响因子：
1.7
通讯作者：
Tanaka, Sakae
中科院分区：
文献类型：
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作者：
Kono, Kenichi;Inui, Hiroshi;Tanaka, Sakae
双交叉韧带保留型全膝关节置换术（BCR-TKA）通过保留前交叉韧带和后交叉韧带重建正常膝关节运动。然而，BCR-TKA与解剖型关节面的体内运动学仍然未知。本研究的目的是评价高屈曲活动期间BCR-TKA与解剖关节面的体内运动学。为此，对17例BCR-TKA后的膝关节进行了解剖关节面检查。在X线透视下，每例患者进行下蹲和盘腿坐姿运动。为了估计膝关节的空间位置和方向，使用了二维或三维配准技术。在每个屈曲角度下，评价股骨部件相对于胫骨部件的旋转、内翻-外翻角和内外侧接触点的前后平移。结果表明，在屈曲80 ° ~ 110 °范围内，下蹲时股骨外旋量显著大于盘腿坐时。在最大屈曲时，坐着时的膝关节比蹲着时的膝关节内翻对线明显更多。在下蹲期间，从最小屈曲度到10度屈曲度观察到内侧枢轴模式，超过10度屈曲度没有显著运动。相反，在盘腿坐着时，从最小屈曲度到60度屈曲度没有检测到显著的运动，内侧枢轴超过60度屈曲度。因此，在BCR-TKA后，膝关节显示出相对正常的运动学，关节面具有解剖学特征;然而，在高屈曲活动期间，其变化取决于活动。
Bicruciate-retaining total knee arthroplasty (BCR-TKA) recreates normal knee movement by preserving the anterior cruciate and posterior cruciate ligaments. However, in vivo kinematics of BCR-TKA with the anatomical articular surface remains unknown. The objective of this study was to evaluate in vivo kinematics of BCR-TKA with the anatomical articular surface during high-flexion activities. For this purpose, 17 knees after BCR-TKA with an anatomical articular surface were examined. Under fluoroscopy, each patient performed squatting and cross-legged sitting motions. To estimate the spatial position and orientation of the knee, a two-dimensional or three-dimensional registration technique was used. Rotation, varus-valgus angle, and anteroposterior translation of medial and lateral contact points of the femoral component relative to the tibial component were evaluated in each flexion angle. The results showed that from 80 to 110 degrees of flexion, the femoral external rotation during squatting was significantly larger than that during cross-legged sitting. At maximum flexion, the knees during sitting indicated significantly more varus alignment than during squatting. During squatting, a medial pivot pattern was observed from minimum flexion to 10 degrees flexion, with no significant movement beyond 10 degrees of flexion. Conversely, during cross-legged sitting, no significant movement was detected from minimum flexion to 60 degrees of flexion, with a medial pivot beyond 60 degrees of flexion. Therefore, the knees showed relatively normal kinematics after BCR-TKA with an anatomical articular surface; however, it varied during high-flexion activities depending on the activity.