Jiang Zheng, He Axiang, Zheng Nan, Mao Yanjie, Lin Weiming, Zhang Xiaoyin, Guo Han, Liu Yuyan, Tsai Tsung-Yuan, Liu Wanjun
Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
Orthop Surg. 2025 May;17(5):1478-1485. doi: 10.1111/os.70023. Epub 2025 Mar 18.
With the advancement of digital orthopedics, the growing prevalence of medial compartment knee osteoarthritis (MCKOA) and the widespread adoption of knee-preserving surgical techniques have heightened new interest in predicting the onset of MCKOA and promoting surgical outcomes. This study was to clarify the differences in kinematics and contact patterns between the MCKOA knee and its native sides during knee extension.
From March 2023 to June 2024, thirty-two patients who suffered from unilateral MCKOA, with their contralateral extremities asymptomatic and intact, were enrolled in this descriptive research. Three-dimensional models were created from computed tomography scans, and all patients performed continuous stair climbing under the surveillance of a dual fluoroscopic imaging system (DFIS) to determine the accurate 6-degrees-of-freedom (6-DOF) of their medial OA knees and the contralateral knees. The volume penetration centers between tibial and femoral cartilage models were defined as contact centers. All measured parameters were tested for significant differences using the Wilcoxon Rank-Sum test.
Compared to native knees, the MCKOA tibia showed increased flexion (mean 3.6°) and varus rotation (mean 1.6°), with more posterior (mean 1.4 mm), lateral (mean 1.2 mm) and proximal translations (mean 0.5 mm) relative to the femur during extension (p < 0.05). The tibiofemoral contact patterns on the medial and lateral tibial plateau of the MCKOA knee both shifted more medially (mean 1.4 mm and 1.3 mm, respectively, p < 0.05) than the native side, which was consistent with the lateral translations observed in 6-DOF.
Our findings offer valuable insights into the in vivo kinematics of MCKOA knee, its tibiofemoral joint (TFJ) and contact pattern. In MCKOA knees, the tibia exhibited increased flexion and varus rotation, along with more posterior, lateral, and proximal translation relative to the femur compared to the native side during extension. These changes aligned with the more medial shifts in contact patterns of the tibial plateau on the MCKOA side. These findings provide data support for the digital diagnosis and treatment of MCKOA.
随着数字骨科技术的进步，内侧间室膝关节骨关节炎（MCKOA）的患病率不断上升，以及保膝手术技术的广泛应用，人们对预测MCKOA的发病和改善手术效果产生了新的兴趣。本研究旨在阐明MCKOA膝关节与其健侧在膝关节伸展过程中的运动学和接触模式差异。
2023年3月至2024年6月，32例单侧MCKOA患者被纳入本描述性研究，其对侧肢体无症状且完好。通过计算机断层扫描创建三维模型，所有患者在双荧光透视成像系统（DFIS）监测下进行连续爬楼梯，以确定其内侧OA膝关节和对侧膝关节准确的六自由度（6-DOF）。胫骨和股骨软骨模型之间的体积穿透中心被定义为接触中心。使用Wilcoxon秩和检验对所有测量参数进行显著性差异检验。
与健侧膝关节相比，MCKOA膝关节的胫骨在伸展过程中屈曲增加（平均3.6°）、内翻旋转增加（平均1.6°），相对于股骨有更多的向后（平均1.4毫米）、向外（平均1.2毫米）和近端移位（平均0.5毫米）（p<0.05）。MCKOA膝关节内侧和外侧胫骨平台的胫股接触模式均比健侧更向内侧移位（分别平均为1.4毫米和1.3毫米，p<0.05），这与6-DOF中观察到的向外移位一致。
我们的研究结果为MCKOA膝关节、其胫股关节（TFJ）的体内运动学和接触模式提供了有价值的见解。在MCKOA膝关节中，与健侧相比，胫骨在伸展过程中表现出屈曲增加、内翻旋转增加，以及相对于股骨更多的向后、向外和近端移位。这些变化与MCKOA侧胫骨平台接触模式更向内侧移位一致。这些发现为MCKOA的数字诊断和治疗提供了数据支持。
