Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees - Winner of the AGA-DonJoy Award 2004
Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees - Winner of the AGA-DonJoy Award 2004
复制标题
DOI：
10.1007/s00402-004-0728-8
复制
发表时间：
2004-11-01
影响因子：
2.3
通讯作者：
Lobenhoffer, P
中科院分区：
文献类型：
--
作者：
Agneskirchner, JD;Hurschler, C;Lobenhoffer, P
引言：胫骨高位外翻截骨术是治疗单髁内翻骨关节炎的一种既定治疗方法。然而，关于矢状面截骨术对生物力学参数如软骨压力和关节运动学的影响知之甚少。本研究在人尸体模型中研究胫骨高位屈曲截骨术的效果。材料和方法：7个新鲜人尸体膝关节在矢状面上进行胫骨近端开放楔形截骨术。截骨口向前打开，逐渐增加标本的胫骨倾斜度。在运动学膝关节模拟器中模拟等速屈伸运动。使用电子压敏胶片记录内侧关节间隙的接触压力和局部压力分布。同时通过超声跟踪系统对胫骨平台的运动进行三维分析。连续测量由模拟器施加到股四头肌肌腱的用于关节伸展的牵引力。实验是在完整韧带的情况下进行的，然后连续切割后交叉韧带和前交叉韧带。结果：胫骨屈曲截骨导致胫骨平台压力分布的显著改变。胫股接触面积和接触压力向前移动，导致平台后半部分减压。此外，斜率的增加导致胫骨平台相对于股骨髁的显著向前和上级平移。截骨术完全中和了后交叉韧带切断后胫骨头的后半脱位。坡度的增加导致股四头肌力量显著增加，这是完全膝关节伸展所必需的。结论：我们从这些结果中得出结论，胫骨倾斜度的变化对膝关节的软骨压力和运动学有很大的影响。在治疗上，屈曲截骨术可用于对平台后部的退化软骨进行减压，例如，在关节镜下部分后部椎间盘切除术后。如果外翻截骨术与胫骨近端屈曲部件相结合，则可以在一次手术中解决由后内侧软骨损伤和后外侧和后外侧不稳定组成的复杂膝关节病变，这有助于这些患者更快地康复。
Introduction: Valgus high tibial osteotomy is an established treatment for unicompartmental varus osteoarthritis. However, only little is known about the effect of osteotomy in the sagittal plane on biomechanical parameters such as cartilage pressure and joint kinematics. This study investigated the effects of high tibial flexion osteotomy in a human cadaver model. Materials and methods: Seven fresh human cadaveric knees underwent an opening wedge osteotomy of the proximal tibia in the sagittal plane. The osteotomy was opened anteriorly, and the tibial slope of the specimen was increased gradually. An isokinetic flexion-extension motion was simulated in a kinematic knee simulator. The contact pressure and topographic pressure distribution in the medial joint space was recorded using an electronic pressure-sensitive film. Simultaneously the motion of the tibial plateau was analyzed three-dimensionally by an ultrasonic tracking system. ne traction force to the quadriceps tendon which was applied by the simulator for extension of the joint was continuously measured. The experiments were carried out with intact ligaments and then after successively cutting the posterior and anterior cruciate ligaments. Results: The results demonstrate that tibial flexion osteotomy leads to a significant alteration in pressure distribution on the tibial plateau. The tibiofemoral contact area and contact pressure was shifted anteriorly, which led to decompression of the posterior half of the plateau. Moreover, the increase in the slope resulted in a significant anterior and superior translation of the tibial plateau with respect to the femoral condyles. Posterior subluxation of the tibial head after cutting the posterior cruciate ligament was completely neutralized by the osteotomy. The increase in slope resulted in a significant higher quadriceps strength which was necessary for full knee extension. Conclusions: We conclude from these results that changes in tibial slope have a strong effect on cartilage pressure and kinematics of the knee. Therapeutically a flexion osteotomy may be used for decompression of the degenerated cartilage in the posterior part of the plateau, for example, after arthroscopic partial posterior meniscectomy. If a valgus osteotomy is combined with a flexion component of the proximal tibia, complex knee pathologies consisting of posteromedial cartilage damage and posterior and posterolateral instability can be addressed in one procedure, which facilitates a quicker rehabilitation of these patients.