Giurazza Giancarlo, Caria Clemente, Campi Stefano, Franceschetti Edoardo, Papalia Giuseppe Francesco, Basciani Susanna, Zampoli Andrea, Gregori Pietro, Papalia Rocco, Marinozzi Andrea
Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Roma, Italy.
Knee Surg Sports Traumatol Arthrosc. 2025 Feb;33(2):634-645. doi: 10.1002/ksa.12408. Epub 2024 Aug 13.
Kinematically aligned total knee arthroplasty (KA TKA), as a pure resurfacing procedure, is based on matching implant thickness with bone cut and kerf thickness, plus cartilage wear. However, the assumption of a consistent 2 mm femoral cartilage thickness remains unproven. This study aimed to systematically review the available literature concerning magnetic resonance imaging (MRI) assessment of femoral cartilage thickness in non-arthritic patients. Our hypothesis was that cartilage thickness values would vary significantly among individuals, thereby challenging the established KA paradigm of 'one-cartilage-fits-all'.
Systematic literature searches (Pubmed, Scopus and Cochrane Library) followed PRISMA guidelines. English-language studies assessing distal and posterior femoral cartilage thickness using MRI in non-arthritic adults were included. Studies lacking numerical cartilage thickness data, involving post-operative MRI, considering total femoro-tibial cartilage thickness, or failing to specify the compartment of the knee being studied were excluded.
Overall, 27 studies comprising 8170 MRIs were analysed. Weighted mean femoral cartilage thicknesses were: 2.05 ± 0.62 mm (mean range 1.06-2.6) for the distal medial condyle, 1.95 ± 0.4 mm (mean range 1.15-2.5) for the distal lateral condyle, 2.44 ± 0.5 mm (mean range 1.37-2.6) for the posterior medial condyle and 2.27 ± 0.38 mm (mean range 1.48-2.5) for the posterior lateral condyle.
Femoral cartilage thickness varies significantly across patients. In KA TKA, relying on a fixed thickness of 2 mm may jeopardize the accurate restoration of individual anatomy, leading to errors in implant coronal and rotational alignment. An intraoperative assessment of cartilage thickness may be advisable to express the KA philosophy at its full potential.
Level IV.
运动学对齐全膝关节置换术（KA TKA）作为一种单纯的表面置换手术，基于将植入物厚度与截骨厚度、锯缝厚度以及软骨磨损相匹配。然而，股骨软骨厚度一致为2毫米这一假设仍未得到证实。本研究旨在系统回顾关于非关节炎患者股骨软骨厚度磁共振成像（MRI）评估的现有文献。我们的假设是，软骨厚度值在个体之间会有显著差异，从而对既定的“一刀切”的KA范式提出挑战。
按照PRISMA指南进行系统的文献检索（PubMed、Scopus和Cochrane图书馆）。纳入使用MRI评估非关节炎成年人股骨远端和后侧软骨厚度的英文研究。排除缺乏软骨厚度数值数据、涉及术后MRI、考虑全股骨 - 胫骨软骨厚度或未明确所研究膝关节腔室的研究。
总体而言，分析了包含8170例MRI的27项研究。股骨软骨厚度的加权平均值为：内侧髁远端2.05±0.62毫米（平均范围1.06 - 2.6毫米），外侧髁远端1.95±0.4毫米（平均范围1.15 - 2.5毫米），内侧髁后侧2.44±0.5毫米（平均范围1.37 - 2.6毫米），外侧髁后侧2.27±0.38毫米（平均范围1.48 - 2.5毫米）。
患者之间股骨软骨厚度差异显著。在KA TKA中，依赖固定的2毫米厚度可能会危及个体解剖结构的准确恢复，导致植入物冠状面和旋转对齐出现误差。术中评估软骨厚度可能有助于充分发挥KA理念的潜力。
四级。
