Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea.
Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea.
Arthroscopy. 2017 Aug;33(8):1537-1550. doi: 10.1016/j.arthro.2017.02.011. Epub 2017 Apr 25.
To compare the forces exerted on the cruciate ligaments and the contact stresses on the tibiofemoral (TF) and patellofemoral (PF) joints with respect to 3 different tibial- and fibular-based posterolateral corner (PLC) reconstructions under dynamic loading conditions.
A subject-specific finite element knee model was developed by using 3-dimensional anatomic data from motion captures in gait and squat activities, including in vivo knee joint kinematics and muscle forces for the single subject. Cruciate ligament forces and contact stresses on the TF and PF joints under 3 PLC reconstruction techniques (tibial-based, TBR; modified fibular-based, mFBR; conventional fibular-based, cFBR) and PLC-deficient models were compared with those of the intact model in gait and squat loading conditions.
The cruciate ligament forces in the 3 surgical models differed from those in the intact model. The greatest differences in ligament forces from the intact model were found in the cFBR model, whereas there were no remarkable differences between the TBR and mFBR models in both gait and squat loading conditions. Contact stresses on the lateral TF and PF joints of the 3 surgical models were greater than those of the intact model under the squat loading condition.
The biomechanical effects achieved using the anatomic reconstruction technique were found to be improved compared with those using nonanatomic reconstruction techniques. However, the ligament forces and contact stresses under normal conditions could not be restored through any of the 3 techniques.
Anatomic TBR and FBR for grade III PLC injuries could restore better biomechanics in the knee joint compared with nonanatomic reconstruction. However, discrepancy with the normal condition requires further modification of surgical techniques.
比较 3 种不同胫骨和腓骨后外侧角（PLC）重建技术在动态加载条件下对交叉韧带施加的力和胫骨股骨（TF）和髌股（PF）关节的接触压力。
通过使用来自步态和下蹲活动中运动捕捉的 3 维解剖数据，为单个受试者开发了一个特定于主题的有限元膝关节模型，包括体内膝关节运动学和肌肉力。在步态和下蹲加载条件下，比较了 3 种 PLC 重建技术（胫骨基础，TBR；改良腓骨基础，mFBR；传统腓骨基础，cFBR）和 PLC 缺失模型下的交叉韧带力和 TF 和 PF 关节的接触压力与完整模型的比较。
3 种手术模型中的交叉韧带力与完整模型不同。在 cFBR 模型中，韧带力与完整模型的差异最大，而在步态和下蹲加载条件下，TBR 和 mFBR 模型之间没有明显差异。在下蹲加载条件下，3 种手术模型的 TF 和 PF 关节外侧接触压力大于完整模型。
与非解剖重建技术相比，使用解剖重建技术所达到的生物力学效果有所改善。然而，在任何情况下，通过这 3 种技术都无法恢复韧带力和接触压力。
对于 III 级 PLC 损伤，解剖 TBR 和 FBR 可使膝关节的生物力学恢复更好。然而，与正常情况的差异需要进一步修改手术技术。
