In vivo comparison of medialized dome and anatomic patellofemoral geometries using subject-specific computational modeling.
In vivo comparison of medialized dome and anatomic patellofemoral geometries using subject-specific computational modeling.
复制标题
DOI：
10.1002/jor.23865
复制
发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Shelburne KB
中科院分区：
文献类型：
--
作者：
Ali AA;Mannen EM;Rullkoetter PJ;Shelburne KB
全膝关节置换术 (TKA) 与髌骨表面置换后的成功结果部分取决于髌股 (PF) 功能的恢复和股四头肌机制的恢复。目前的研究比较了两种髌骨 TKA 几何形状（内侧圆顶和解剖学），以确定它们对 PF 力学和股四头肌功能的影响。在体内，使用顺序实验和建模方法评估受试者特定的髌骨力学。首先，为进行膝关节伸展和弓步的 TKA 患者（10 名圆顶型、10 名解剖型）收集立体放射线摄影、基于标记的运动捕捉和测力板数据。其次，为每个受试者和活动创建了受试者特定的全身肌肉骨骼模型，包括 6 自由度 (DOF) 膝关节运动学，以预测股四头肌力。最后，创建每个受试者和活动的有限元模型来预测 PF 运动学、髌骨负载、力臂和髌腱角度。圆顶患者和解剖患者之间的力学差异在负重（弓步）活动期间凸显出来。与圆顶受试者相比，解剖受试者在弓步期间表现出更大的 PF 屈曲角度（平均 11±3°）。与自然膝关节相似，在解剖学受试者中，当膝关节弯曲时，髌骨上的接触位置从下向上迁移，但在圆顶受试者中仍然相对较高。运动学和接触位置的差异可能导致力学变化，解剖学受试者在深度屈曲（>75°）时从股四头肌到髌腱的负载转移更大，而圆顶受试者在弓步期间表现出更大的接触力。尽管患者存在很大差异，但 PF 力学评估表明股四头肌功能得到改善，解剖设计中的运动学更加自然。
Successful outcome following total knee arthroplasty (TKA) with patella resurfacing is partly determined by the restoration of patellofemoral (PF) function and recovery of the quadriceps mechanism. The current study compared two patellar TKA geometries (medialized dome and anatomic) to determine their impact on PF mechanics and quadriceps function. In-vivo, subject-specific patellar mechanics were evaluated using a sequential experimental and modeling approach. First, stereo radiography, marker-based motion capture, and force plate data were collected for TKA patients (10 dome, 10 anatomic) performing a knee extension and lunge. Second, subject-specific, whole-body, musculoskeletal models, including 6 degrees-of-freedom (DOF) knee joint kinematics, were created for each subject and activity to predict quadriceps forces. Lastly, finite element models of each subject and activity were created to predict PF kinematics, patellar loading, moment arm, and patellar tendon angle. Differences in mechanics between dome and anatomic patients were highlighted during load-bearing (lunge) activity. Anatomic subjects demonstrated greater PF flexion angles (avg. 11±3°) compared to dome subjects during lunge. Similar to the natural knee, contact locations on the patella migrated inferior to superior as the knee flexed in anatomic subjects, but remained relatively superior in dome subjects. Differences in kinematics and contact location likely contributed to altered mechanics with anatomic subjects presenting greater load transfer from the quadriceps to the patellar tendon in deep flexion (>75°), and dome subjects demonstrating larger contact forces during lunge. Although there was substantial patient variability, evaluations of PF mechanics suggested improved quadriceps function and more natural kinematics in the anatomic design.
登录
查看更多内容
影响因子：
2.4
作者：
Halloran, JP;Petrella, AJ;Rullkoetter, PJ
通讯作者：
Rullkoetter, PJ
影响因子：
2.8
作者：
Fitzpatrick, Clare K.;Steensen, Robert N.;Rullkoetter, Paul J.
通讯作者：
Rullkoetter, Paul J.
影响因子：
5.3
作者：
Kurtz, S;Mowat, F;Halpern, M
通讯作者：
Halpern, M
影响因子：
2.8
作者：
Amis, Andrew A.;Senavongse, Wongwit;Bull, Anthony M. J.
通讯作者：
Bull, Anthony M. J.
影响因子：
3.5
作者：
Churchill, DL;Incavo, SJ;Beynnon, BD
通讯作者：
Beynnon, BD