Sekiguchi K, Nakamura S, Kuriyama S, Nishitani K, Ito H, Tanaka Y, Watanabe M, Matsuda S
Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan; Medical Staff, Yawata Central Hospital, Yawata, Japan.
Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
Bone Joint Res. 2019 Apr 2;8(3):126-135. doi: 10.1302/2046-3758.83.BJR-2018-0208.R2. eCollection 2019 Mar.
Unicompartmental knee arthroplasty (UKA) is one surgical option for treating symptomatic medial osteoarthritis. Clinical studies have shown the functional benefits of UKA; however, the optimal alignment of the tibial component is still debated. The purpose of this study was to evaluate the effects of tibial coronal and sagittal plane alignment in UKA on knee kinematics and cruciate ligament tension, using a musculoskeletal computer simulation.
The tibial component was first aligned perpendicular to the mechanical axis of the tibia, with a 7° posterior slope (basic model). Subsequently, coronal and sagittal plane alignments were changed in a simulation programme. Kinematics and cruciate ligament tensions were simulated during weight-bearing deep knee bend and gait motions. Translation was defined as the distance between the most medial and the most lateral femoral positions throughout the cycle.
The femur was positioned more medially relative to the tibia, with increasing varus alignment of the tibial component. Medial/lateral (ML) translation was smallest in the 2° varus model. A greater posterior slope posteriorized the medial condyle and increased anterior cruciate ligament (ACL) tension. ML translation was increased in the > 7° posterior slope model and the 0° model.
The current study suggests that the preferred tibial component alignment is between neutral and 2° varus in the coronal plane, and between 3° and 7° posterior slope in the sagittal plane. Varus > 4° or valgus alignment and excessive posterior slope caused excessive ML translation, which could be related to feelings of instability and could potentially have negative effects on clinical outcomes and implant durability.: K. Sekiguchi, S. Nakamura, S. Kuriyama, K. Nishitani, H. Ito, Y. Tanaka, M. Watanabe, S. Matsuda. 2019;8:126-135. DOI: 10.1302/2046-3758.83.BJR-2018-0208.R2.
单髁膝关节置换术（UKA）是治疗有症状的内侧骨关节炎的一种手术选择。临床研究已表明UKA的功能益处；然而，胫骨假体的最佳对线仍存在争议。本研究的目的是使用肌肉骨骼计算机模拟来评估UKA中胫骨冠状面和矢状面对线对膝关节运动学和交叉韧带张力的影响。
首先将胫骨假体与胫骨的机械轴垂直对齐，后倾7°（基础模型）。随后，在模拟程序中改变冠状面和矢状面的对线。在负重深屈膝和步态运动期间模拟运动学和交叉韧带张力。平移定义为整个周期中股骨最内侧位置与最外侧位置之间的距离。
随着胫骨假体内翻对线增加，股骨相对于胫骨向内侧移位。在2°内翻模型中，内侧/外侧（ML）平移最小。更大的后倾角度使内侧髁后移并增加前交叉韧带（ACL）张力。在大于7°后倾模型和0°模型中，ML平移增加。
当前研究表明，在冠状面中，胫骨假体的首选对线在中立位和2°内翻之间，在矢状面中，后倾角度在3°至7°之间。内翻>4°或外翻对线以及过度的后倾角度会导致过度的ML平移，这可能与不稳定感有关，并可能对临床结果和植入物耐久性产生负面影响。：K. Sekiguchi、S. Nakamura、S. Kuriyama、K. Nishitani、H. Ito、Y. Tanaka、M. Watanabe、S. Matsuda。2019年；8:126 - 135。DOI: 10.1302/2046 - 3758.83.BJR - 2018 - 0208.R2 。
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