Dobrich Jordan, Bauer Sawyer, Elicegui Steven, LaCour Michael, Ries Michael
School of Medicine, University of Nevada, Reno, NV, USA.
University of Tennessee, Knoxville, TN, USA.
Arthroplast Today. 2024 Jun 3;27:101417. doi: 10.1016/j.artd.2024.101417. eCollection 2024 Jun.
Following total knee arthroplasty (TKA), normal knee kinematics are rarely replicated. Retention of both cruciate ligaments (bicruciate retaining TKA) has helped this. Postoperative posterior tibial slope (PPTS) may further affect ligament tension and kinematics. The objective of this study is to determine how changes between the preoperative posterior tibial slope (PTS) and PPTS affect knee kinematics.
Twenty bicruciate retaining TKAs were performed using standard instrumentation. Fluoroscopic kinematic data were obtained during gait and a single knee bend. Differences (Δ) between radiographic measurements of preoperative and PPTS were correlated with in-vivo knee kinematics. Patients were separated into 2 groups based on their Δ values. Group I consisted of Δ values less than 0.7, indicating either a similar PPTS compared to preoperative PTS or a slightly flatter PPTS. Group II consisted of Δ values above 0.7, indicating a steepened PPTS.
Preoperative PTS values ranged from -0.5° to 11.2°, with an average of 5.0° ± 3.4°. PPTS values ranged from 3.0° to 12.1°, with an average of 7.1° ± 3.1°. Weight-bearing range of motion (WBROM) measured from 94° to 139°, and femorotibial axial rotation ranged from -2.9° to 17.3°. A -test revealed average values for WBROM in Group I (Δ < 0.7) to be significantly greater than those for Group II (Δ > 0.7) ( = .01).
These findings indicate that either a PPTS approximating the preoperative PTS or a slightly flattened PPTS in comparison (Δ < 0.7) is associated with WBROM greater than 130°. Values for axial rotation and anterior sliding were not significantly associated with changes to the PTS.
全膝关节置换术（TKA）后，很少能重现正常的膝关节运动学。保留两条交叉韧带（双交叉韧带保留型TKA）对此有帮助。术后胫骨后倾坡度（PPTS）可能会进一步影响韧带张力和运动学。本研究的目的是确定术前胫骨后倾坡度（PTS）与PPTS之间的变化如何影响膝关节运动学。
使用标准器械进行了20例双交叉韧带保留型TKA。在步态和单次膝关节弯曲过程中获取了荧光透视运动学数据。术前和PPTS的影像学测量差异（Δ）与体内膝关节运动学相关。根据Δ值将患者分为两组。第一组的Δ值小于0.7，表明与术前PTS相比PPTS相似或略平坦。第二组的Δ值大于0.7，表明PPTS变陡。
术前PTS值范围为-0.5°至11.2°，平均为5.0°±3.4°。PPTS值范围为3.0°至12.1°，平均为7.1°±3.1°。负重活动范围（WBROM）测量值为94°至139°，股胫轴向旋转范围为-2.9°至17.3°。t检验显示，第一组（Δ<0.7）的WBROM平均值显著大于第二组（Δ>0.7）（P = .01）。
这些发现表明，PPTS接近术前PTS或相比之下略平坦（Δ<0.7）与大于130°的WBROM相关。轴向旋转和前向滑动值与PTS的变化无显著关联。
