Maderbacher Guenther, Baier Clemens, Springorum Hans R, Zeman Florian, Grifka Joachim, Keshmiri Armin
Department of Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach, Germany.
Center of Clinical Studies, University Medical Center Regensburg, Regensburg, Germany.
J Arthroplasty. 2016 Sep;31(9):2038-42. doi: 10.1016/j.arth.2016.02.049. Epub 2016 Mar 3.
During flexion, normal knee kinematics consists of a complex combination of rolling, gliding, and rotation between femur and tibia. Although in vivo studies have shown wide interindividual variability, we hypothesized that knee kinematics is either correlated to the anatomy of the individual knee joint or to the anatomic alignment of the entire lower extremity.
The passive kinematics of 10 healthy knees was assessed in whole cadavers using a commercial computed tomography-free navigation device with intracortical pins. Rotational limb alignment or local anatomic parameters obtained by computed tomography scan or within a navigational procedure were correlated to tibial internal rotation and tibiofemoral abduction during flexion.
Mean tibial adduction in full extension was 3.3° (range -2.2° to 7.8°). Tibial abduction and internal rotation showed significant interindividual variability, measuring 3.9° (range -0.8° to 9.7°) and 4.9° (range -3.5° to 14.8°) during flexion. An increase in both the mechanical tibiofemoral axis and the mechanical lateral distal femoral angle correlated with increased tibial internal rotation, whereas a decrease in the mechanical medial proximal tibial angle and an increase in the mechanical tibiofemoral axis were associated with increased tibial adduction.
The main finding of the present study is that knee kinematics is influenced by both intra-articular and extra-articular parameters. These results may be of interest in component alignment in total knee arthroplasty, correction of deformities, and malalignment after fracture healing of the lower extremity. Possible relationships should be investigated in future studies.
在屈膝过程中，正常膝关节的运动学表现为股骨与胫骨之间滚动、滑动和旋转的复杂组合。尽管体内研究显示个体间存在广泛差异，但我们推测膝关节运动学与个体膝关节的解剖结构或整个下肢的解剖对线相关。
使用带有皮质内钢针的商用无计算机断层扫描导航设备，在10具完整尸体上评估10个健康膝关节的被动运动学。通过计算机断层扫描或在导航过程中获得的旋转肢体对线或局部解剖参数，与屈膝过程中的胫骨内旋和胫股外展相关联。
完全伸展时胫骨内收的平均值为3.3°（范围为-2.2°至7.8°）。胫骨外展和内旋显示出显著的个体间差异，屈膝时分别为3.9°（范围为-0.8°至9.7°）和4.9°（范围为-3.5°至14.8°）。机械性胫股轴线和机械性股骨远端外侧角的增加与胫骨内旋增加相关，而机械性胫骨近端内侧角的减小和机械性胫股轴线的增加与胫骨内收增加相关。
本研究的主要发现是膝关节运动学受关节内和关节外参数的影响。这些结果可能对全膝关节置换术中的假体对线、畸形矫正以及下肢骨折愈合后的对线不良情况具有意义。未来的研究应探讨可能的关系。
