Pearle Andrew D, Solomon Daniel J, Wanich Tony, Moreau-Gaudry Alexandre, Granchi Carinne C, Wickiewicz Thomas L, Warren Russell F
Hospital for Special Surgery, Sports Medicine and Shoulder Service, 535 East 70th Street, New York, NY 10021, USA.
Am J Sports Med. 2007 Aug;35(8):1315-20. doi: 10.1177/0363546507300821. Epub 2007 Apr 17.
Clinical examination remains empirical and may be confusing in the setting of rotatory knee instabilities. Computerized navigation systems provide the ability to visualize and quantify coupled knee motions during knee stability examination.
An image-free navigation system can reliably register and collect multiplanar knee kinematics during knee stability examination.
Controlled laboratory study.
Coupled knee motions were determined by a robotic/UFS testing system and by an image-free navigation system in 6 cadaveric knees that were subjected to (1) isolated varus stress and (2) combined varus and external rotation force at 0 degrees, 30 degrees, and 60 degrees. This protocol was performed in intact knees and after complete sectioning of the posterolateral corner (lateral collateral ligament, popliteus tendon, and popliteofibular ligament). The correlation between data from the surgical navigation system and the robotic positional sensor was assessed using the intraclass correlation coefficient. The 3-dimensional motion paths of the intact and sectioned knees were assessed qualitatively using the navigation display system.
Intraclass correlation coefficients between the robotic sensor and the navigation system for varus and external rotation at 0 degrees, 30 degrees, and 60 degrees were all statistically significant at P < .01. The overall intraclass correlation coefficient for all tests was 0.9976 (P < .0001). Real-time visualization of the coupled motions was possible with the navigation system. Post hoc analysis of the knee motion paths during loading distinguished distinct rotatory patterns.
Surgical navigation is a precise intraoperative tool to quantify knee stability examination and may help delineate pathologic multiplanar or coupled knee motions, particularly in the setting of complex rotatory instability patterns. Repeatability of load application during clinical stability testing remains problematic.
Surgical navigation may refine the diagnostic evaluation of knee instability.
临床检查仍基于经验，在旋转性膝关节不稳的情况下可能会造成混淆。计算机导航系统能够在膝关节稳定性检查期间可视化并量化膝关节的耦合运动。
无图像导航系统能够在膝关节稳定性检查期间可靠地记录并收集多平面膝关节运动学数据。
对照实验室研究。
通过机器人/UFS测试系统和无图像导航系统，对6具尸体膝关节进行以下操作来确定膝关节的耦合运动：（1）单独施加内翻应力；（2）在0度、30度和60度时施加内翻和外旋联合力。该操作在完整膝关节以及后外侧角（外侧副韧带、腘肌腱和腘腓韧带）完全切断后进行。使用组内相关系数评估手术导航系统与机器人位置传感器数据之间的相关性。使用导航显示系统定性评估完整和切断膝关节的三维运动路径。
机器人传感器与导航系统在0度、30度和60度时内翻和外旋的组内相关系数在P < .01时均具有统计学意义。所有测试的总体组内相关系数为0.9976（P < .0001）。利用导航系统可以实时可视化耦合运动。对加载过程中膝关节运动路径的事后分析区分出了不同的旋转模式。
手术导航是一种精确的术中工具，可用于量化膝关节稳定性检查，并可能有助于描绘病理性多平面或耦合膝关节运动，特别是在复杂旋转不稳模式的情况下。临床稳定性测试期间负荷施加的可重复性仍然存在问题。
手术导航可能会优化膝关节不稳的诊断评估。
