Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia.
Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
Comput Methods Programs Biomed. 2024 May;248:108132. doi: 10.1016/j.cmpb.2024.108132. Epub 2024 Mar 11.
Incidence of paediatric anterior cruciate ligament (ACL) rupture has increased substantially over recent decades. Following ACL rupture, ACL reconstruction (ACLR) surgery is typically performed to restore passive knee stability. This surgery involves replacing the failed ACL with a graft, however, surgeons must select from range of surgical parameters (e.g., type, size, insertion, and pre-tension) with no robust evidence guiding these decisions. This study presents a systemmatic computational approach to study effects of surgical parameter variation on kinematics of paediatric knees.
This study used sequentially-linked neuromusculoskeletal (NMSK) finite element (FE) models of three paediatric knees to estimate the: (i) sensitivity of post-operative knee kinematics to four surgical parameters (type, size, insertion, and pre-tension) through multi-input multi-output sensitivity analysis; (ii) influence of motion and loading conditions throughout stance phase of walking gait on sensitivity indices; and (iii) influence of subject-specific anatomy (i.e., knee size) on sensitivivty indices. A previously validated FE model of the intact knee for each subject served as a reference against which ACLR knee kinematics were compared.
Sensitivity analyses revealed significant influences of surgical parameters on ACLR knee kinematics, albeit without discernible trend favouring any one parameter. Graft size and pre-tension were primary drivers of variation in knee translations and rotations, however, their effects fluctuated across stance indicating motion and loading conditions affect system sensitivity to surgical parameters. Importantly, the sensitivity of knee kinematics to surgical parameter varied across subjects, indicating geometry (i.e., knee size) influenced system sensitivity. Notably, alterations in graft parameters yielded substantial effects on kinematics (normalized root-mean-square-error > 10 %) compared to intact knee models, indicating surgical parameters vary post-operative knee kinematics.
Overall, this initial study highlights the importance of surgical parameter selection on post-operative kinematics in the paediatric ACLR knee, and provides evidence of the need for personalized surgical planning to ultimately enhance patient outcomes.
近几十年来，儿童前交叉韧带（ACL）撕裂的发病率显著增加。ACL 撕裂后，通常会进行 ACL 重建（ACLR）手术以恢复被动膝关节稳定性。该手术涉及用移植物替换失效的 ACL，但外科医生必须从一系列手术参数（例如类型、大小、插入位置和预张力）中进行选择，而这些决策没有可靠的证据指导。本研究提出了一种系统的计算方法来研究手术参数变化对儿童膝关节运动学的影响。
本研究使用三个儿童膝关节的顺序连接神经肌肉骨骼（NMSK）有限元（FE）模型，通过多输入多输出灵敏度分析来估计：（i）手术后膝关节运动学对四个手术参数（类型、大小、插入位置和预张力）的敏感性；（ii）步行步态站立阶段的运动和加载条件对灵敏度指标的影响；（iii）个体解剖结构（即膝关节大小）对灵敏度指标的影响。每个受试者的完整膝关节的先前验证的 FE 模型用作参考，与 ACLR 膝关节运动学进行比较。
灵敏度分析表明，手术参数对 ACLR 膝关节运动学有显著影响，尽管没有明显的趋势支持任何一个参数。移植物大小和预张力是膝关节平移和旋转变化的主要驱动因素，但它们的影响在整个站立期波动，表明运动和加载条件会影响系统对手术参数的敏感性。重要的是，膝关节运动学对手术参数的敏感性在受试者之间存在差异，表明几何形状（即膝关节大小）会影响系统的敏感性。值得注意的是，与完整膝关节模型相比，移植物参数的改变对运动学产生了很大的影响（归一化均方根误差>10%），表明手术参数会改变术后膝关节运动学。
总的来说，这项初步研究强调了手术参数选择对儿童 ACLR 膝关节术后运动学的重要性，并为个性化手术计划提供了证据，以最终提高患者的治疗效果。
