Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.
Department of Orthopedic Surgery, Kobe Rehabilitation Center Hospital, 1070 Akebono, Nishi, Kobe, 651-2181, Japan.
Knee Surg Sports Traumatol Arthrosc. 2020 Sep;28(9):2816-2822. doi: 10.1007/s00167-019-05624-x. Epub 2019 Jul 19.
To investigate the correlation between intraoperative tibiofemoral anteroposterior changes at 90° of flexion and postoperative maximum flexion angles in navigated cruciate-substituting TKA. The hypothesis of this study was that intraoperative tibiofemoral anteroposterior changes at 90° of flexion indirectly reflect posterior cruciate ligament (PCL) function and associate with postoperative maximum flexion angles.
Fifty-five consecutive patients with varus osteoarthritis treated with primary TKA were retrospectively analysed. All patients received the same type of implant, placed with an image-free navigation system. The PCL was retained, and cruciate-substituting inserts were used in all cases. The mean follow-up was 44 ± 8 months. The preoperative and postoperative kinematics were measured intraoperatively with a navigation system, and the preoperative and postoperative tibiofemoral anteroposterior positions at 90° of flexion were determined. The correlation between intraoperative anteroposterior position changes and postoperative maximum flexion angles was investigated. The correlation between the change of anteroposterior position and tibiofemoral rotational angles was also assessed.
The intraoperative anteroposterior position change was -1.7 ± 3.4 mm (a positive value indicates tibial posterior shift). Flexion angle improvement was negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R = 0.17, p < 0.005). Postoperative maximum flexion angles were also negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R = 0.09, p < 0.05). The postoperative amount of tibial internal rotation was positively correlated with the preoperative amount (R = 0.60, p < 0.0001); however, the intraoperative anteroposterior position change was not correlated with the postoperative amount of tibial internal rotation (n.s.).
A navigation system may be able to indirectly evaluate PCL function and predict the postoperative flexion angles in cruciate-substituting TKA. Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting TKA.
Level 3, retrospective comparative study.
探讨导航辅助全膝关节置换术中膝关节 90°屈曲时的胫骨前后向变化与术后最大屈曲角度之间的相关性。本研究的假设是，术中膝关节 90°屈曲时胫骨前后向的变化间接反映后交叉韧带（PCL）的功能，并与术后最大屈曲角度相关。
回顾性分析了 55 例接受初次 TKA 治疗的内翻性骨关节炎患者。所有患者均接受同种类型的植入物治疗，采用无图像导航系统。保留了 PCL，并在所有病例中使用了交叉韧带替代物。平均随访时间为 44±8 个月。术前和术后的运动学通过导航系统在术中进行测量，并确定了膝关节 90°屈曲时的术前和术后胫骨前后位置。研究了术中前后位置变化与术后最大屈曲角度之间的相关性。还评估了前后位置变化与胫股旋转角度之间的相关性。
术中前后位置变化为-1.7±3.4mm（正值表示胫骨后移）。屈曲角度的改善与术中胫骨前后位置变化呈负相关（R=0.17，p<0.005）。术后最大屈曲角度也与术中胫骨前后位置变化呈负相关（R=0.09，p<0.05）。术后胫骨内旋量与术前量呈正相关（R=0.60，p<0.0001）；然而，术中胫骨前后位置变化与术后胫骨内旋量无相关性（n.s.）。
导航系统可以间接评估 PCL 的功能，并预测交叉韧带替代 TKA 术后的屈曲角度。膝关节 90°屈曲时胫骨的后移可能预示着交叉韧带替代 TKA 术后的屈曲角度较差。
3 级，回顾性比较研究。
