Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Bone Joint J. 2020 Jun;102-B(6_Supple_A):59-65. doi: 10.1302/0301-620X.102B6.BJJ-2019-1552.R2.
The removal of the cruciate ligaments in total knee arthroplasty (TKA) has been suggested as a potential contributing factor to patient dissatisfaction, due to alteration of the in vivo biomechanics of the knee. Bicruciate retaining (BCR) TKA allows the preservation of the cruciate ligaments, thus offering the potential to reproduce healthy kinematics. The aim of this study was to compare in vivo kinematics between the operated and contralateral knee in patients who have undergone TKA with a contemporary BCR design.
A total of 29 patients who underwent unilateral BCR TKA were evaluated during single-leg deep lunges and sit-to-stand tests using a validated computer tomography and fluoroscopic imaging system. In vivo six-degrees of freedom (6DOF) kinematics were compared between the BCR TKA and the contralateral knee.
During single-leg deep lunge, BCR TKAs showed significantly less mean posterior femoral translation (13 mm; standard deviation (SD) 4) during terminal flexion, compared with the contralateral knee (16.6 mm, SD 3.7; p = 0.001). Similarly, BCR TKAs showed significantly less mean femoral rollback (11.6 mm (SD 4.5) vs 14.4 mm (SD 4.6); p < 0.043) during sit-to-stand. BCR TKAs showed significantly reduced internal rotation during many parts of the strenuous flexion activities particularly during high-flexion lunge (4° (SD 5.6°) vs 6.5° (SD 6.1°); p = 0.051) and during sit-to-stand (4.5° (SD 6°) vs 6.9° (SD 6.3°); p = 0.048).
The contemporary design of BCR TKA showed asymmetrical flexion-extension and internal-external rotation, suggesting that the kinematics are not entirely reproduced during strenuous activities. Future studies are required to establish the importance of patient factors, component orientation and design, in optimizing kinematics in patients who undergo BCR TKA. Cite this article: 2020;102-B(6 Supple A):59-65.
全膝关节置换术中前交叉韧带（ACL）的切除被认为是导致患者不满意的一个潜在因素，因为它改变了膝关节的体内生物力学。保留双交叉韧带（BCR）的全膝关节置换术可以保留交叉韧带，从而有可能恢复健康的运动学。本研究的目的是比较接受当代 BCR 设计的 TKA 患者手术侧和对侧膝关节的体内运动学。
共评估了 29 例接受单侧 BCR TKA 的患者，在单腿深蹲和从座位站起测试中使用经过验证的计算机断层扫描和透视成像系统。比较了 BCR TKA 和对侧膝关节的体内 6 自由度（6DOF）运动学。
在单腿深蹲中，BCR TKA 在终末屈曲时的股骨后向平移平均明显小于对侧膝关节（13mm；标准差（SD）4）（16.6mm，SD3.7；p=0.001）。同样，BCR TKA 在从座位站起时的股骨滚动回位平均明显小于对侧膝关节（11.6mm（SD4.5）vs14.4mm（SD4.6）；p<0.043）。BCR TKA 在许多剧烈屈伸活动中，特别是在高屈曲深蹲（4°（SD5.6°）vs6.5°（SD6.1°）；p=0.051）和从座位站起时（4.5°（SD6°）vs6.9°（SD6.3°）；p=0.048）的内旋明显减少。
当代 BCR TKA 的设计表现出不对称的屈伸和内外旋转，表明在剧烈活动中运动学并未完全恢复。未来的研究需要确定患者因素、部件方向和设计在优化接受 BCR TKA 的患者运动学中的重要性。
2020;102-B(6 Supple A):59-65.
