Weight-bearing condyle motion of the knee before and after cruciate-retaining TKA: In-vivo surgical transepicondylar axis and geometric center axis analyses
Weight-bearing condyle motion of the knee before and after cruciate-retaining TKA: In-vivo surgical transepicondylar axis and geometric center axis analyses
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DOI：
10.1016/j.jbiomech.2016.04.033
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发表时间：
2016-06-14
影响因子：
2.4
通讯作者：
Li, Guoan
中科院分区：
文献类型：
--
作者：
Dimitriou, Dimitris;Tsai, Tsung-Yuan;Li, Guoan
屈曲和伸展时膝关节高度相等对于优化全膝关节置换术（TKA）后的软组织平衡至关重要。然而，关于体内膝关节高度行为的数据很少。本研究使用两个屈曲轴（手术经上髁轴（sTEA）和几何中心轴（GCA））评估了交叉韧带保留（CR）-TKA之前和之后内侧和外侧股骨髁的体内高度和前后（AP）平移。11名膝关节骨性关节炎（OA）患者在负重单腿弓步期间进行了研究，使用经验证的双透视成像系统（DFIS）为基础的跟踪技术。8名健康受试者作为对照。结果表明，TKA后，中度屈曲时股骨内侧和外侧髁高度不相等（15-45 °，内侧髁比外侧髁低至少2.4 mm，p < 0.01），尽管膝关节在0 °和90 °时平衡良好。虽然股骨髁高度从术前值增加（平均增加> 2 mm，p < 0.05），但它们与完整膝关节相似，只是内侧sTEA在0和90之间低于完整内侧髁。在深屈曲（> 90 °）时，两个髁突均显著高于健康膝关节（> 2 mm，p < 0.01）。在中度屈曲时，TKA膝关节的股骨前平移更明显，而在深度屈曲时发现有限的后平移。这些数据表明，术中膝关节平衡良好可能不一定会导致功能性负重运动期间的中度屈曲和深度屈曲平衡，这意味着膝关节的中度屈曲不稳定和深度屈曲紧张。(C)2016爱思唯尔有限公司版权所有
An equal knee joint height during flexion and extension is of critical importance in optimizing soft-tissue balancing following total knee arthroplasty (TKA). However, there is a paucity of data regarding the in-vivo knee joint height behavior. This study evaluated in-vivo heights and anterior-posterior (AP) translations of the medial and lateral femoral condyles before and after a cruciate-retaining (CR)-TKA using two flexion axes: surgical transepicondylar axis (sTEA) and geometric center axis (GCA). Eleven osteoarthritis (OA) knee patients were studied during a weight-bearing single leg lunge, using a validated dual fluoroscopic imaging system (DFIS) based tracking technique. Eight healthy subjects were recruited as controls. The results demonstrated that following TKA, the medial and lateral femoral condyle heights were not equal at mid-flexion (15-45 degrees, medial condyle lower then lateral by 2.4 mm at least, p < 0.01), although the knees were well-balanced at 0 degrees and 90 degrees. While the femoral condyle heights increased from the pre-operative values (> 2 mm increase on average, p < 0.05), they were similar to the intact knees except that the medial sTEA was lower than the intact medial condyle between 0 and 90. At deep flexion (> 90 degrees), both condyles were significantly higher ( > 2 mm, p < 0.01) than the healthy knees. Anterior femoral translation of the TKA knee was more pronounce at mid-flexion, whereas limited posterior translation was found at deep flexion. These data suggest that a well-balanced knee intra-operatively might not necessarily result in mid-flexion and deep flexion balance during functional weight-bearing motion, implying mid-flexion instability and deep flexion tightness of the knee. (C) 2016 Elsevier Ltd. All rights reserved.