Western University, London, Ontario, Canada.
Western University, London, Ontario, Canada.
Knee. 2020 Dec;27(6):1735-1745. doi: 10.1016/j.knee.2020.09.022. Epub 2020 Nov 13.
The standard of care for total knee arthroplasty (TKA) is a medial parapatellar approach (MPA). We aimed to study a novel lateral subvastus lateralis approach (SLA), which offers the benefit of keeping the extensor mechanism and medial soft tissues intact. To ensure the approach could be used safely in vivo, a biomechanical study was performed to assess whether the joint kinematics would be preserved after performing a TKA.
A biomechanical study was conducted using 14 fresh-frozen cadaveric knees, with seven specimens each for the MPA and SLA. After a single radius, cemented cruciate retaining TKA was performed, specimens were tested on a VIVO joint motion simulator to measure and compare anterior/posterior, internal/external, and varus/valgus kinematics and laxity.
There was no significant difference in joint kinematics or laxity between the SLA and MPA groups.
Both the SLA and MPA offer similar knee kinematics and laxity based on a cadaveric model. Although the surgical approach was different, inherently releasing different ligaments, both approaches resulted in a stable knee. This suggests that either approach will enable the surgeon to provide a stable knee, and that the implant itself may contribute a significant portion of the knee's kinematics.
全膝关节置换术（TKA）的标准治疗方法是内侧髌旁入路（MPA）。我们旨在研究一种新的外侧股外侧肌下入路（SLA），该方法具有保持伸肌机制和内侧软组织完整的优点。为了确保该方法在体内能够安全使用，进行了一项生物力学研究，以评估在进行 TKA 后关节运动学是否得到保留。
使用 14 个新鲜冷冻的尸体膝关节进行生物力学研究，其中 MPA 和 SLA 各有 7 个标本。在单个半径、骨水泥固定保留十字韧带的 TKA 后，在 VIVO 关节运动模拟器上对标本进行测试，以测量和比较前/后、内/外和内翻/外翻运动学和松弛度。
SLA 和 MPA 组之间的关节运动学或松弛度没有显著差异。
基于尸体模型，SLA 和 MPA 均提供相似的膝关节运动学和松弛度。尽管手术入路不同，固有地释放不同的韧带，但两种方法都导致了稳定的膝关节。这表明，两种方法都可以使外科医生提供一个稳定的膝关节，而植入物本身可能对膝关节的运动学有很大的贡献。
