Lee Jin-Ah, Koh Yong-Gon, Kim Paul Shinil, Kang Ki Won, Kwak Yoon Hae, Kang Kyoung-Tak
Department of Mechanical Engineering, Yonsei University, Seoul, South Korea.
Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea.
Bone Joint Res. 2020 Sep 23;9(9):593-600. doi: 10.1302/2046-3758.99.BJR-2020-0128.R1. eCollection 2020 Sep.
Unicompartmental knee arthroplasty (UKA) has become a popular method of treating knee localized osteoarthritis (OA). Additionally, the posterior cruciate ligament (PCL) is essential to maintaining the physiological kinematics and functions of the knee joint. Considering these factors, the purpose of this study was to investigate the biomechanical effects on PCL-deficient knees in medial UKA.
Computational simulations of five subject-specific models were performed for intact and PCL-deficient UKA with tibial slopes. Anteroposterior (AP) kinematics and contact stresses of the patellofemoral (PF) joint and the articular cartilage were evaluated under the deep-knee-bend condition.
As compared to intact UKA, there was no significant difference in AP translation in PCL-deficient UKA with a low flexion angle, but AP translation significantly increased in the PCL-deficient UKA with high flexion angles. Additionally, the increased AP translation became decreased as the posterior tibial slope increased. The contact stress in the PF joint and the articular cartilage significantly increased in the PCL-deficient UKA, as compared to the intact UKA. Additionally, the increased posterior tibial slope resulted in a significant decrease in the contact stress on PF joint but significantly increased the contact stresses on the articular cartilage.
Our results showed that the posterior stability for low flexion activities in PCL-deficient UKA remained unaffected; however, the posterior stability for high flexion activities was affected. This indicates that a functional PCL is required to ensure normal stability in UKA. Additionally, posterior stability and PF joint may reduce the overall risk of progressive OA by increasing the posterior tibial slope. However, the excessive posterior tibial slope must be avoided.Cite this article: 2020;9(9):593-600.
单髁膝关节置换术（UKA）已成为治疗膝关节局限性骨关节炎（OA）的常用方法。此外，后交叉韧带（PCL）对于维持膝关节的生理运动学和功能至关重要。考虑到这些因素，本研究的目的是探讨内侧UKA中PCL缺失膝关节的生物力学影响。
对五个特定受试者模型进行完整和PCL缺失且带有胫骨坡度的UKA的计算机模拟。在屈膝状态下评估髌股（PF）关节和关节软骨的前后（AP）运动学及接触应力。
与完整UKA相比，低屈曲角度的PCL缺失UKA在AP平移上无显著差异，但高屈曲角度的PCL缺失UKA中AP平移显著增加。此外，随着胫骨后倾坡度增加，增加的AP平移减小。与完整UKA相比，PCL缺失UKA中PF关节和关节软骨的接触应力显著增加。此外，增加的胫骨后倾坡度导致PF关节接触应力显著降低，但关节软骨接触应力显著增加。
我们的结果表明，PCL缺失UKA中低屈曲活动的后稳定性未受影响；然而，高屈曲活动的后稳定性受到影响。这表明功能性PCL对于确保UKA中的正常稳定性是必需的。此外，后稳定性和PF关节可能通过增加胫骨后倾坡度降低进行性OA的总体风险。然而，必须避免过度的胫骨后倾坡度。引用本文：2020；9（9）：593 - 600。
