Department of Orthopaedic Surgery, Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, 159 Wells Avenue, Newton, MA, 02459, USA.
Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Arch Orthop Trauma Surg. 2022 Sep;142(9):2313-2322. doi: 10.1007/s00402-021-04116-3. Epub 2021 Aug 18.
There has been no consensus on the benefit of retaining the anterior cruciate ligament (ACL) in TKAs. This study aims to review recent evidences around the kinematics of bicruciate retaining (BCR) total knee arthroplasty (TKA).
A search of the literature was conducted on PubMed and Web of Science. Reports that assessed the BCR TKA kinematics, including both in vitro cadaveric studies and in vivo clinical studies, were reviewed.
A total number of 169 entries were obtained. By exclusion criteria, five in vitro studies using cadaveric knee specimens and six in vivo studies using patient cohorts were retained. In vitro studies showed a low internal rotation (< 10°) throughout the flexion path in all BCR TKAs. Compared to native knees, the difference in the internal rotation was maximal during early and late flexion; the femur in the BCR TKA was significantly more anteriorly positioned (1.7-3.6 mm from 0° to 110°) and more externally rotated (3.6°-4.2° at 110° and 120°). In vivo studies revealed that the native knee kinematics, in general, were not fully restored after BCR TKA during various knee activates (squatting, level-walking, and downhill-walking). There are asymmetric kinematics during the stance phase of gait cycle and a smaller range of axial rotation (23% patients exhibiting external tibial rotation) throughout the gait cycle in BCR TKAs.
Critical insights in the complex BCR TKA biomechanics have been reported from recent laboratory kinematics studies. However, whether contemporary BCR TKAs can fully restore native knee kinematics remains debatable, warranting further investigations.
在 TKA 中保留前交叉韧带（ACL）的益处尚未达成共识。本研究旨在回顾有关保留双交叉韧带（BCR）全膝关节置换术（TKA）运动学的最新证据。
在 PubMed 和 Web of Science 上进行了文献检索。回顾了评估 BCR TKA 运动学的报告，包括尸体的体外研究和体内临床研究。
共获得 169 项研究。根据排除标准，保留了 5 项使用尸体膝关节标本的体外研究和 6 项使用患者队列的体内研究。体外研究显示，所有 BCR TKA 在整个屈曲过程中都有较低的内旋（<10°）。与正常膝关节相比，在早期和晚期屈曲时，内旋的差异最大；BCR TKA 中的股骨明显更靠前（0°到 110°时为 1.7-3.6mm，110°和 120°时为 3.6°-4.2°）和外旋（3.6°-4.2°在 110°和 120°）。体内研究表明，在各种膝关节活动（深蹲、平路行走和下坡行走）中，BCR TKA 后一般无法完全恢复正常膝关节的运动学。在步态周期的支撑相存在不对称的运动学，并且在整个步态周期中轴向旋转的范围较小（23%的患者表现出外胫骨旋转）。
最近的实验室运动学研究报告了对复杂 BCR TKA 生物力学的深入了解。然而，现代 BCR TKA 是否能完全恢复正常膝关节的运动学仍存在争议，需要进一步研究。
