Galvin Catherine R, Perriman Diana M, Newman Phillip M, Lynch Joseph T, Smith Paul N, Scarvell Jennie M
Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Garran, ACT, 2605, Australia.
Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; The Australian National University, Acton, ACT 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Garran, ACT, 2605, Australia.
Knee. 2018 Aug;25(4):514-530. doi: 10.1016/j.knee.2018.04.015. Epub 2018 May 24.
Understanding healthy deep flexion kinematics will inform the design of conservative clinical rehabilitation strategies for knee osteoarthritis and contribute to improved knee prosthesis design. This study is a systematic review and meta-analysis of the kinematic outcomes measured at the healthy tibiofemoral joint during loaded deep knee flexion.
A computerised literature search and bibliography review without date restriction identified twelve studies with 164 participants aged 25-61 years in-vivo, and 69-93 years in-vitro. Flexion higher than 120° was achieved by squatting, lunging or kneeling. Measurement technologies in-vivo included radiographs, open MRI and 2D-3D MRI or CT image registration on fluoroscopy. Microscribe was used in-vitro.
Outcomes were either six degrees-of-freedom based on femur movement or contact patterns on the tibial plateau. The meta-analysis demonstrated that in-vivo, between 120° and 135° of flexion, the tibia internally rotated (mean difference (MD) = 4.6°, 95% CI 3.55° to 5.64°). Both the medial-femoral-condyle and lateral-femoral-condyle translated posteriorly, (MD = 10.4 mm, 95% CI 6.9 to 13.9 mm) and (MD = 5.55 mm, 95% CI 4.64 to 6.46 mm) respectively. There was some evidence of femoral medial translation (3.8 mm) and adduction (1.9° to 3.3°), together with medial compression (1.7 mm) and lateral distraction (1.9) mm.
Across the in-vivo studies, consistent kinematic patterns emerged; despite the various measurement technologies and reference methods. In contrast, in-vivo and in-vitro results were contradictory.
This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25 February 2017 (registration number: 42017057614).
了解健康状态下的深度屈膝运动学，将为膝关节骨关节炎的保守临床康复策略设计提供依据，并有助于改进膝关节假体设计。本研究是一项关于在负重深度屈膝过程中，对健康胫股关节所测量到的运动学结果的系统评价和荟萃分析。
通过不受日期限制的计算机文献检索和参考文献回顾，确定了12项研究，其中有164名年龄在25 - 61岁的体内研究参与者以及69 - 93岁的体外研究参与者。通过深蹲、弓步或跪姿实现大于120°的屈膝。体内测量技术包括X线片、开放式磁共振成像以及荧光透视下的二维 - 三维磁共振成像或CT图像配准。体外使用了三维数字化仪。
结果要么是基于股骨运动的六个自由度，要么是胫骨平台上的接触模式。荟萃分析表明，在体内，屈膝120°至135°之间时，胫骨内旋（平均差值（MD）= 4.6°，95%置信区间3.55°至5.64°）。股骨内侧髁和外侧髁均向后平移，分别为（MD = 10.4 mm，95%置信区间6.9至13.9 mm）和（MD = 5.55 mm，95%置信区间4.64至6.46 mm）。有一些证据表明股骨有内侧平移（3.8 mm）和内收（1.9°至3.3°），同时伴有内侧压缩（1.7 mm）和外侧牵张（1.9 mm）。
在各项体内研究中，尽管测量技术和参考方法各不相同，但一致的运动学模式还是出现了。相比之下，体内和体外结果相互矛盾。
本系统评价方案于2017年2月25日在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：42017057614）。
