Ou Deyan, Ye Yongqing, Pan Jingwei, Huang Yu, Kuang Haisheng, Tang Shilin, Huang Richao, Mo Yongxin, Pan Shixin
Department of Limb and Joint Ward, Wuzhou Red Cross Hospital, Wuzhou, Guangxi Province, China.
Department of Medical Imaging Department, Wuzhou Red Cross Hospital, Wuzhou, Guangxi Province, China.
PLoS One. 2024 Mar 12;19(3):e0299649. doi: 10.1371/journal.pone.0299649. eCollection 2024.
The research objective of this study is to use finite element analysis to investigate the impact of anterior cruciate ligament (ACL) injury on medial unicompartmental knee arthroplasty (UKA) and explore whether patients with ACL injuries can undergo UKA.
Based on the morphology of the ACL, models of ACL with diameters ranging from 1 to 10mm are created. Finite element models of UKA include ACL absence and ACLs with different diameters. After creating a complete finite element model and validating it, four different types of loads are applied to the knee joint. Statistical analysis is conducted to assess the stress variations in the knee joint structure.
A total of 11 finite element models of UKA were established. Regarding the stress on the ACL, as the diameter of the ACL increased, when a vertical load of 750N was applied to the femur, combined with an anterior tibial load of 105N, the stress on the ACL increased from 2.61 MPa to 4.62 MPa, representing a 77.05% increase. Regarding the equivalent stress on the polyethylene gasket, a notable high stress change was observed. The stress on the gasket remained between 12.68 MPa and 14.33 MPa in all models. the stress on the gasket demonstrated a decreasing trend. The equivalent stress in the lateral meniscus and lateral femoral cartilage decreases, reducing from the maximum stress of 4.71 MPa to 2.61 MPa, with a mean value of 3.73 MPa. This represents a reduction of 44.72%, and the statistical significance is (P < 0.05). However, under the other three loads, there was no significant statistical significance (P > 0.05).
This study suggests that the integrity of the ACL plays a protective role in performing medial UKA. However, this protective effect is limited when performing medial UKA. When the knee joint only has varying degrees of ACL injury, even ACL rupture, and the remaining structures of the knee joint are intact with anterior-posterior stability in the knee joint, it should not be considered a contraindication for medial UKA.
本研究的研究目的是使用有限元分析来研究前交叉韧带（ACL）损伤对内侧单髁膝关节置换术（UKA）的影响，并探讨ACL损伤患者是否可以接受UKA。
基于ACL的形态，创建直径范围为1至10mm的ACL模型。UKA的有限元模型包括ACL缺失和不同直径的ACL。创建完整的有限元模型并进行验证后，对膝关节施加四种不同类型的载荷。进行统计分析以评估膝关节结构中的应力变化。
共建立了11个UKA有限元模型。关于ACL上的应力，随着ACL直径的增加，当对股骨施加750N的垂直载荷并结合105N的胫骨前载荷时，ACL上的应力从2.61MPa增加到4.62MPa，增加了77.05%。关于聚乙烯垫片上的等效应力，观察到明显的高应力变化。在所有模型中，垫片上的应力保持在12.68MPa至14.33MPa之间。垫片上的应力呈下降趋势。外侧半月板和外侧股骨软骨中的等效应力降低，从最大应力4.71MPa降低到2.61MPa，平均值为3.73MPa。这代表降低了44.72%，统计学意义为（P<0.05）。然而，在其他三种载荷下，没有显著的统计学意义（P>0.05）。
本研究表明，ACL的完整性在进行内侧UKA时起保护作用。然而，在进行内侧UKA时，这种保护作用是有限的。当膝关节仅存在不同程度的ACL损伤，甚至ACL断裂，且膝关节其余结构完整且膝关节具有前后稳定性时，不应将其视为内侧UKA的禁忌证。
