Adouni Malek, Faisal Tanvir, Dhaher Yasin
Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois.
Department of Mechanical Engineering, Australian College of Kuwait, Kuwait City, Kuwait.
J Knee Surg. 2023 Feb;36(3):310-321. doi: 10.1055/s-0041-1733879. Epub 2021 Aug 10.
In this study, we aimed to develop an in-silico synthesis of the effect of critical surgical design parameters on articular contact behavior for a bone-patellar-tendon-bone anterior cruciate ligament reconstruction (ACL-R) surgery. A previously developed finite element model of the knee joint consisting of all relevant soft tissues was employed. The knee model was further updated with additional features to develop the parametric FE model of the biomechanical experiments that depicted the ACL-R surgery. The parametricity was created involving femoral tunnel architecture (orientations and locations) and graft fixation characteristics (pretension and angle of fixation). A global sensitivity analysis based on variance decomposition was used to investigate the contribution of the surgical parameters to the uncertainty in response to the ACL-R joint. Our examinations indicated that the total contact force was primarily influenced by either combined or individual action of the graft pretension and fixation angle, with a modest contribution of the graft insertion sites. The joint contact center and area were affected mainly by the angle of fixation and the tunnel placements. Graft pretension played the dominant role in the maximum contact pressure variability, an observation that has been well-documented in the literature. Interestingly, the joint contact behavior was almost insensitive to the tunnel's coronal and sagittal orientations. Our data provide an evaluation of how the surgical parameters affect the knee joint's contact behavior after ACL-R and may provide additional information to better explain the occurrence of osteoarthritis as an aftermath of such surgery.
在本研究中，我们旨在通过计算机模拟，分析关键手术设计参数对髌腱骨前交叉韧带重建（ACL-R）手术中关节接触行为的影响。我们采用了一个先前开发的包含所有相关软组织的膝关节有限元模型。通过增加额外特征对膝关节模型进行进一步更新，以建立描述ACL-R手术的生物力学实验参数化有限元模型。参数化涉及股骨隧道结构（方向和位置）以及移植物固定特征（预张力和固定角度）。基于方差分解的全局敏感性分析用于研究手术参数对ACL-R关节响应不确定性的贡献。我们的研究表明，总接触力主要受移植物预张力和固定角度的联合或单独作用影响，移植物插入部位的影响较小。关节接触中心和面积主要受固定角度和隧道位置的影响。移植物预张力在最大接触压力变异性中起主导作用这一观察结果在文献中已有充分记载。有趣的是，关节接触行为对隧道的冠状面和矢状面方向几乎不敏感。我们的数据评估了手术参数如何影响ACL-R术后膝关节的接触行为，并可能提供更多信息，以更好地解释此类手术后骨关节炎的发生情况。
