Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France.
Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France; Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France; TwInsight, 38000 Grenoble, France.
J Biomech. 2022 May;136:111062. doi: 10.1016/j.jbiomech.2022.111062. Epub 2022 Mar 26.
Medial open-wedge high tibial osteotomy is a surgical treatment for patients with a varus deformity and early-stage medial knee osteoarthritis. Observations suggest that this surgery can negatively affect the patellofemoral joint and change the patellofemoral kinematics. However, what causes these effects and how the correction angle can change the surgery's impact on the patellofemoral joint has not been investigated before. The objective of this study was to develop a biomechanical model that can predict the surgery's impact on the patellar position and find the correlation between the opening angles and the patellar position after the surgery. A combined finite element and multibody model of the lower limb was developed. The model's capabilities for predicting the patellofemoral kinematics were evaluated by performing a passive deep flexion simulation of the native knee and comparing the outcomes with magnetic resonance images of the study subject at various flexion angles. The model at a fixed knee flexion angle was then used to simulate the high tibial osteotomy surgery virtually. The results showed a correlation between the wedge opening angles and the patellar position in various degrees of freedom. These results indicate that larger wedge openings result in increased values of patellar distalization, lateral patellar shift, patellar rotation, and patellar internal tilt. The developed model in this study can be used in future studies to monitor the stress distribution on the patellar cartilage and connecting tissues to investigate their relationship with observations of pain and cartilage injury due to post-operative altered patellar kinematics.
内侧开放楔形胫骨高位截骨术是一种治疗内翻畸形和早期内侧膝关节骨关节炎患者的手术方法。观察表明，这种手术会对髌股关节产生负面影响，并改变髌股运动学。然而，导致这些影响的原因以及矫正角度如何改变手术对髌股关节的影响尚未得到研究。本研究的目的是开发一种生物力学模型，可以预测手术对髌骨位置的影响，并找到手术开口角度与术后髌骨位置之间的相关性。建立了下肢的组合有限元和多体模型。通过对自然膝关节进行被动深度屈曲模拟来评估模型预测髌股运动学的能力，并将结果与研究对象在不同屈曲角度的磁共振图像进行比较。然后，在固定的膝关节屈曲角度下，使用模型对胫骨高位截骨术进行虚拟模拟。结果表明，在不同自由度下，楔形开口角度与髌骨位置之间存在相关性。这些结果表明，较大的楔形开口导致髌骨远端化、髌骨外侧移位、髌骨旋转和髌骨内倾增加。本研究中开发的模型可用于未来的研究中，以监测髌骨软骨和连接组织的应力分布，研究它们与术后髌股运动学改变导致的疼痛和软骨损伤观察结果之间的关系。
