Ollivier Britt, Luyckx Thomas, Stragier Bruno, Vandenneucker Hilde
Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium.
Knee Surg Sports Traumatol Arthrosc. 2025 Feb;33(2):606-620. doi: 10.1002/ksa.12401. Epub 2024 Aug 5.
Patellofemoral pain, maltracking and instability remain common and challenging complications after total knee arthroplasty. Controversy exists regarding the effect of kinematic alignment on the patellofemoral joint, as it generally leads to more femoral component valgus and internal rotation compared to mechanical alignment. The aim of this systematic review is to thoroughly examine the influence of kinematic alignment on the third space.
A systematic search of the Pubmed, Cochrane and Web of Science databases was performed to screen for relevant articles published before 7 April 2024. This led to the final inclusion of 42 articles: 2 cadaveric, 9 radiographic, 12 computer simulation and 19 clinical studies. The risk of bias was evaluated with the risk of bias in non-randomised studies - of interventions tool as the lowest level of evidence of the included clinical studies was IV. The effects of kinematic alignment on patellar kinematics and kinetics, trochlear anatomy reconstruction and patellofemoral complication rate were investigated.
Kinematic alignment closely restores native patellar kinematics and kinetics, better reproduces native trochlear anatomy than mechanical alignment and leads to a 0%-11.4% incidence of patellofemoral complications. A more valgus joint line of the distal femur can cause lateral trochlear undercoverage and a trochlear angle orientation medial to the quadriceps vector when applying kinematic alignment, both of which can be solved by using an adjusted design with a 20.5° valgus trochlea.
Kinematic alignment appears to be a safe strategy for the patellofemoral joint in most knees, provided that certain precautions are taken to minimize the risk of complications.
Level IV clinical studies, in vitro research.
髌股疼痛、轨迹不良和不稳定仍是全膝关节置换术后常见且具有挑战性的并发症。关于运动学对线对髌股关节的影响存在争议，因为与机械对线相比，运动学对线通常会导致股骨假体更多的外翻和内旋。本系统评价的目的是全面研究运动学对线对第三间隙的影响。
对PubMed、Cochrane和Web of Science数据库进行系统检索，以筛选2024年4月7日前发表的相关文章。最终纳入42篇文章：2篇尸体研究、9篇影像学研究、12篇计算机模拟研究和19篇临床研究。采用非随机研究的干预工具偏倚风险评估纳入临床研究的偏倚风险，因为这些研究的最低证据水平为IV级。研究了运动学对线对髌骨运动学和动力学、滑车解剖结构重建以及髌股并发症发生率的影响。
运动学对线能密切恢复髌骨的自然运动学和动力学，比机械对线更好地重现自然滑车解剖结构，并导致髌股并发症的发生率为0%-11.4%。应用运动学对线时，股骨远端关节线更外翻会导致滑车外侧覆盖不足以及滑车角方向位于股四头肌向量内侧，这两个问题都可以通过使用20.5°外翻滑车的调整设计来解决。
在大多数膝关节中，运动学对线似乎是一种安全的髌股关节策略，前提是采取某些预防措施以尽量降低并发症风险。
IV级临床研究、体外研究。
