Lin Kun-Jhih, Wei Hung-Wen, Huang Chang-Hung, Liu Yu-Liang, Chen Wen-Chuan, McClean Colin Joseph, Cheng Cheng-Kung
Technology Translation Center for Medical Device, Chung Yuan Christian University, Chungli City, Taiwan.
Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
Knee Surg Sports Traumatol Arthrosc. 2016 Aug;24(8):2498-505. doi: 10.1007/s00167-014-3400-z. Epub 2014 Oct 30.
The primary intent of total knee arthroplasty is the restoration of normal knee kinematics, with ligamentous constraint being a key influential factor. Displacement of the joint line may lead to alterations in ligament attachment sites relative to knee flexion axis and variance of ligamentous constraints on tibiofemoral movement. This study aimed to investigate collaterals strains and tibiofemoral kinematics with different joint line levels.
A previously validated knee model was employed to analyse the change in length of the collateral ligaments and tibiofemoral motion during knee flexion. The models shifted the joint line by 3 and 5 mm both proximally and distally from the anatomical level. The data were captured from full extension to flexion 135°.
The elevated joint line revealed a relative increase in distance between ligament attachments for both collateral ligaments in comparison with the anatomical model. Also, tibiofemoral movement decreased with an elevation in the joint line. Conversely, lowering the joint line led to a significant decrease in distance between ligament attachments, but greater tibiofemoral motion.
Elevation of the joint line would strengthen the capacity of collateral ligaments for knee motion constraint, whereas a distally shifted joint line might have the advantage of improving tibiofemoral movement by slackening the collaterals. It implies that surgeons can appropriately change the joint line position in accordance with patient's requirement or collateral tensions. A lowered joint line level may improve knee kinematics, whereas joint line elevation could be useful to maintain knee stability.
V.
全膝关节置换术的主要目的是恢复正常的膝关节运动学，韧带约束是一个关键影响因素。关节线的移位可能导致韧带附着点相对于膝关节屈曲轴的改变以及胫股运动中韧带约束的变化。本研究旨在探讨不同关节线水平下的侧副韧带应变和胫股运动学。
采用一个先前验证过的膝关节模型来分析膝关节屈曲过程中侧副韧带长度的变化和胫股运动。模型将关节线从解剖学水平分别向近端和远端移动3毫米和5毫米。数据采集范围为从完全伸展到屈曲135°。
与解剖学模型相比，关节线上移显示两侧副韧带的韧带附着点之间的距离相对增加。此外，胫股运动随着关节线上移而减少。相反，关节线下移导致韧带附着点之间的距离显著减小，但胫股运动增加。
关节线上移会增强侧副韧带对膝关节运动的约束能力，而关节线向远端移位可能具有通过放松侧副韧带而改善胫股运动的优势。这意味着外科医生可以根据患者的需求或侧副韧带张力适当改变关节线位置。关节线水平降低可能改善膝关节运动学，而关节线上移可能有助于维持膝关节稳定性。
V级。
