Haruo Kawatake Ednei, de Castro Pochini Alberto, Cohen Moisés, Vinicius Malheiros Luzo Marcus, Augusto Real Martinez Carlos, Aires Pereira José
Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), Sao Paulo, Brazil.
Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), Sao Paulo, Brazil.
Knee. 2023 Jan;40:42-51. doi: 10.1016/j.knee.2022.10.010. Epub 2022 Nov 17.
The number of total knee arthroplasties (TKA) has increased steadily with the aging of the population. This surgical procedure is recognized for its success in pain relief and restoration of knee function. However, decreased quadriceps femoris (QF) muscle strength after TKA is frequently observed but with unknown etiology. Evidence suggests that the location of the operative incision (i.e., surgical access) can influence QF muscle structure and function. The present study aimed to assess the fiber type composition, structure and assembly of the QF's vastus medialis (VM) and vastus lateralis (VL) muscles before and after TKA.
Muscle biopsies (VM and VL muscles) were collected from patients previously submitted to TKA via the medial parapatellar route and undergoing TKA revision (main group, n = 9) and patients with osteoarthrosis (OA) who were due to undergo TKA (control group: n = 18). The biopsied muscle tissue was prepared, stored, and then sectioned in a cryostat at -25 °C. The tissue sections were evaluated using routine staining techniques in pathological anatomy and histochemistry.
The normal mosaic pattern of the medial and lateral knee muscles was observed in the main and control groups, with no evidence of peripheral nerve damage. Notably, 88.9 % of the patients exhibited mild to severe VL atrophy, while only 11.1 % of patients in the control group presented this feature (P < 0.001).
The medial parapatellar incision for TKA surgical access does not generate definitive morphological changes in the VM and VL muscle fibers but may contribute to VL atrophy.
随着人口老龄化，全膝关节置换术（TKA）的数量稳步增加。这种外科手术因其在缓解疼痛和恢复膝关节功能方面的成功而得到认可。然而，TKA后股四头肌（QF）肌力下降经常被观察到，但其病因尚不清楚。有证据表明，手术切口的位置（即手术入路）会影响QF肌肉的结构和功能。本研究旨在评估TKA前后QF的股内侧肌（VM）和股外侧肌（VL）的纤维类型组成、结构和装配情况。
从先前通过髌旁内侧入路接受TKA并进行TKA翻修的患者（主要组，n = 9）和因骨关节炎（OA）即将接受TKA的患者（对照组：n = 18）中采集肌肉活检样本（VM和VL肌肉）。将活检的肌肉组织进行制备、储存，然后在-25°C的低温恒温器中切片。使用病理解剖学和组织化学中的常规染色技术对组织切片进行评估。
在主要组和对照组中均观察到膝关节内外侧肌肉的正常镶嵌模式，没有周围神经损伤的证据。值得注意的是，88.9%的患者表现出轻度至重度的VL萎缩，而对照组中只有11.1%的患者有此特征（P < 0.001）。
TKA手术入路的髌旁内侧切口不会在VM和VL肌纤维中产生明确的形态学变化，但可能导致VL萎缩。
