Walker Peter S, Borukhov Ilya, LiArno Sally
NYU Langone Orthopedic Hospital, New York, NY, United States.
Knee. 2022 Mar;35:133-141. doi: 10.1016/j.knee.2022.02.013. Epub 2022 Mar 18.
Since the introduction of the first total knee designs, a frequent design goal has been to reproduce normal knee motion. However, studies of many currently used total knee designs, have shown that this goal has not been achieved. We proposed that Guided Motion total knee designs, could achieve more anatomic motion than present standard designs.
Several Guided Motion knees for application without cruciate ligaments were designed using a computer method where the bearing surfaces were generated by the motion required. A knee testing machine was constructed where physiological forces including compressive, shear and torque were applied during knee flexion. The neutral path of motion and the laxity about the neutral path were measured. This evaluation method was a modification of the ASTM standard Constraint Test.
The motions of the Guided Motion knees and a standard PS knee were compared with the anatomic motion of knee specimens determined in an earlier study The Guided Motion knees showed motion patterns which were closer to anatomic than the PS knee.
The results provided justification for carrying out further evaluations of functional conditions, using either knee simulators or computer modelling. If anatomic motions could be reproduced in vivo, it is possible that clinical outcomes could be improved.
自首款全膝关节设计问世以来，一个常见的设计目标是重现正常膝关节运动。然而，对许多当前使用的全膝关节设计的研究表明，这一目标尚未实现。我们提出，导向运动全膝关节设计比目前的标准设计能够实现更接近解剖学的运动。
使用计算机方法设计了几种用于无交叉韧带情况的导向运动膝关节，其承重面由所需运动生成。构建了一台膝关节测试机，在膝关节屈曲过程中施加包括压缩力、剪切力和扭矩在内的生理力。测量了运动的中性路径以及围绕中性路径的松弛度。这种评估方法是对ASTM标准约束测试的一种改进。
将导向运动膝关节和标准后稳定型（PS）膝关节的运动与早期研究中确定的膝关节标本的解剖学运动进行了比较。导向运动膝关节显示出比PS膝关节更接近解剖学的运动模式。
这些结果为使用膝关节模拟器或计算机建模对功能状况进行进一步评估提供了依据。如果能够在体内重现解剖学运动，那么临床结果有可能得到改善。
