Department of Orthopedic Surgery, Toho University School of Medicine, Ota City, Tokyo, Japan.
J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(2):2309499020915106. doi: 10.1177/2309499020915106.
Insall advocated that a successful clinical outcome of total knee arthroplasty (TKA) depends on soft tissue balance procedure. Spacer blocks, balancer, and instrumented tibial sensor (VERESENSE, OrthoSensor, Dania, Florida, USA) are the current methods of soft tissue balancing during TKA. The purpose of the study is to assess intraoperative medial and lateral tibiofemoral compressive force (TFCF) using novel insert sensor and investigate the relationship between TFCF and patient-reported outcome measurements (PROMs).
Twenty-five patients who underwent bicruciate stabilized (BCS) TKA were evaluated retrospectively. We measured intraoperative medial and lateral TFCF in neutral position as well as the force ratio (FR %:medial TFCF/medial + lateral TFCF) in varus and valgus position using the novel insert sensor throughout the range of motion (ROM) and assessed the relationship between intraoperative medial and lateral TFCF and PROM at 6 months after TKA.
Medial TFCF increased and lateral TFCF decreased throughout ROM. The mean FR was 0.44% ± 0.22 throughout ROM. Medial and lateral TFCF differences at 60° of ROM in neutral position showed a positive correlation with physical function in Western Ontario and McMaster Universities scores ( = 0.60, < 0.05). Medial and lateral TFCF differences at 30° and 140° of ROM in valgus stress test showed a positive correlation with symptoms in 2011 Knee Society Scores ( = 0.49, < 0.05; = 0.51, < 0.05).
The present study revealed that BCS TKA reproduces the coronal laxity, which is similar to healthy knee. These results suggest that intraoperative medial stability is important for function and symptoms, therefore, surgeons should not release medial soft tissue for achieving better clinical outcomes after BCS TKA.
II.
Insall 主张全膝关节置换术（TKA）的成功临床结果取决于软组织平衡术。在 TKA 过程中，目前使用的软组织平衡方法包括间隔块、平衡器和带仪器的胫骨传感器（VERESENSE，OrthoSensor，佛罗里达州达尼亚）。本研究的目的是使用新型插入式传感器评估术中内侧和外侧胫骨股骨压缩力（TFCF），并研究 TFCF 与患者报告的结果测量（PROM）之间的关系。
回顾性评估了 25 例接受双交叉稳定（BCS）TKA 的患者。我们使用新型插入式传感器在整个运动范围内测量中立位的术中内侧和外侧 TFCF 以及在内翻和外翻位的力比（FR %：内侧 TFCF/内侧+外侧 TFCF），并评估 TKA 后 6 个月时术中内侧和外侧 TFCF 与 PROM 之间的关系。
整个运动范围内，内侧 TFCF 增加，外侧 TFCF 减少。整个运动范围内的平均 FR 为 0.44%±0.22。中立位时，ROM 为 60°时的内侧和外侧 TFCF 差异与 Western Ontario 和 McMaster 大学评分的躯体功能呈正相关（=0.60，<0.05）。在外翻应力试验中，ROM 为 30°和 140°时的内侧和外侧 TFCF 差异与 2011 年膝关节协会评分的症状呈正相关（=0.49，<0.05；=0.51，<0.05）。
本研究表明，BCS TKA 可重现冠状松弛度，类似于健康膝关节。这些结果表明，内侧稳定性对于功能和症状很重要，因此，外科医生不应为了获得更好的 BCS TKA 临床结果而松解内侧软组织。
II 级。
