Mikashima Y, Tomatsu T, Horikoshi M, Nakatani T, Saito S, Momohara S, Banks S A
Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
Clin Biomech (Bristol). 2010 Jan;25(1):83-7. doi: 10.1016/j.clinbiomech.2009.09.009.
Posterior-cruciate ligament retaining total knee arthroplasty designs have long been used with excellent clinical success, but often have shown kinematics and flexion performance that are significantly different from the natural knee. The purpose of this study was to compare deep-flexion knee kinematics in patients with two types of posterior-cruciate ligament retaining total knee arthroplasty.
One group received a traditional curved symmetric articular configuration, and one group received a design incorporating a lateral compartment which constrains the lateral condyle to the antero-posterior center of the tibial plateau in extension, but allows translation in flexion--roughly approximating the role of the anterior cruciate ligament. In vivo kinematics were analyzed using three-dimensional model registration and plain radiographs of kneeling and squatting activities in 20 knees in 18 patients.
Knees with the anterior cruciate ligament substituting design exhibited greater flexion, femoral antero-posterior translation and tibial internal rotation.
Geometric features intended to improve knee flexion, including greater antero-posterior stability, a more posterior tibial sulcus, and reshaped femoral condyles, do provide measurable and significant differences in deep-flexion knee kinematics.
保留后交叉韧带的全膝关节置换术设计长期以来临床应用效果良好，但常常表现出与自然膝关节显著不同的运动学和屈曲性能。本研究的目的是比较两种保留后交叉韧带的全膝关节置换术患者的屈膝位膝关节运动学。
一组接受传统的弯曲对称关节构型，另一组接受一种设计，该设计包含一个外侧间室，在伸直位时将外侧髁限制于胫骨平台的前后中心，但在屈曲时允许平移——大致近似前交叉韧带的作用。使用三维模型配准和18例患者20个膝关节的跪姿和蹲姿活动的X线平片分析体内运动学。
采用前交叉韧带替代设计的膝关节表现出更大的屈曲、股骨前后平移和胫骨内旋。
旨在改善膝关节屈曲的几何特征，包括更大的前后稳定性、更靠后的胫骨髁间沟和重塑的股骨髁，确实在屈膝位膝关节运动学上提供了可测量的显著差异。
