Non-anatomical placement adversely affects the functional performance of the meniscal implant: a finite element study
Non-anatomical placement adversely affects the functional performance of the meniscal implant: a finite element study
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DOI：
10.1007/s10237-021-01440-w
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发表时间：
2021-03-04
影响因子：
3.5
通讯作者：
Subburaj, Karupppasamy
中科院分区：
文献类型：
--
作者：
Shriram, Duraisamy;Yamako, Go;Subburaj, Karupppasamy
在膝关节植入物的手术植入过程中可能发生非解剖放置，其对膝关节生物力学的影响尚未得到系统研究。本研究的目的是评价在一个完整的步行周期中，膝关节上非解剖放置膝关节假体植入物的生物力学效应。基于从磁共振图像开发的模型和从健康男性受试者的步态模式导出的载荷条件，针对以下生理条件，对膝关节进行三维有限元（FE）分析：（i）具有完整的天然半月板的膝关节，（ii）内侧半月板切除的膝关节，（iii）具有解剖学上放置的半月板植入物的膝关节，和（iv）膝关节，其中膝关节植入物放置在四个不同的体外确定的非解剖学位置。当使用非线性超弹性Holzapfel-Gasser-Ogden（HGO）本构模型对天然骨进行建模时，使用各向同性超弹性neo-Hookean模型对骨植入物进行建模。在非解剖学的侧后方和侧前方位置放置髋臼假体显著增加了内侧间室的峰值接触压力。在非解剖位置放置股骨假体显著改变了胫骨旋转运动学，并增加了作用于股骨角的总作用力。结果表明，在非解剖位置放置假体植入物可能会抑制其软骨保护能力，并可能引发或加速软骨退变。总之，临床医生应奋进可能将植入物放置在离解剖位置最近的位置，以恢复正常的膝关节生物力学。
Non-anatomical placement may occur during the surgical implantation of the meniscal implant, and its influence on the resulting biomechanics of the knee joint has not been systematically studied. The purpose of this study was to evaluate the biomechanical effects of non-anatomical placement of the meniscal implant on the knee joint during a complete walking cycle. Three-dimensional finite element (FE) analyses of the knee joint were performed, based on the model developed from magnetic resonance images and the loading conditions derived from the gait pattern of a healthy male subject, for the following physiological conditions: (i) knee joint with intact native meniscus, (ii) medial meniscectomized knee joint, (iii) knee joint with anatomically placed meniscal implant, and (iv) knee joint with the meniscal implant placed in four different in vitro determined non-anatomical locations. While the native menisci were modeled using the nonlinear hyperelastic Holzapfel-Gasser-Ogden (HGO) constitutive model, the meniscal implant was modeled using the isotropic hyperelastic neo-Hookean model. Placement of the meniscal implant in the non-anatomical lateral-posterior and lateral-anterior locations significantly increased the peak contact pressure in the medial compartment. Placement of the meniscal implant in non-anatomical locations significantly altered the tibial rotational kinematics and increased the total force acting at the meniscal horns. Results suggest that placement of the meniscal implant in non-anatomical locations may restrain its ability to be chondroprotective and may initiate or accelerate cartilage degeneration. In conclusion, clinicians should endeavor to place the implant as closest as possible to the anatomical location to restore the normal knee biomechanics.