Romano Francesco, Rossi Roberto, Cottino Umberto, Bruzzone Matteo, Pirato Francesco, Rosso Federica
Department of surgery, Università degli Studi di Torino, Via Po 8, 10100 Torino, Italy.
AO Ordine Mauriziano, Department of Orthopaedics and Traumatology, University of Torino, Largo Turati 62, 10128 Torino, Italy.
Medicina (Kaunas). 2025 May 3;61(5):844. doi: 10.3390/medicina61050844.
: Total knee arthroplasty (TKA) is one of the most common medical procedures worldwide. However, 10 to 20% of patients are still dissatisfied despite implants and surgical technique advancements. Recently, several medial-stabilized TKAs have been developed in attempts to replicate the native kinematics of the knee. The aim of this scoping review on medial-stabilized TKA inserts-medial congruent (MC) and medial pivot (MP)-is to focus on their clinical outcomes and the role of the posterior cruciate ligament (PCL), aiming to systematically map the existing research and highlight current knowledge gaps. : A search of the PubMed, Embase and Cochrane databases was performed to identify relevant studies on the kinematics and outcomes of medial pivot (MP) or medial congruent (MC) inserts. The following Mesh terms were used in combination with the Boolean operators "AND" and "OR": "total knee arthroplasty", "total knee replacement", "medial pivot", "medial congruence", "outcomes" and "kinematic". Original studies reporting on clinical outcomes assessed with validated patient-reported scales, surgical techniques and reoperation rates for any reason with a minimum follow-up of 18 months were included. : A total of 39 articles met the inclusion criteria, accounting for 6143 total knee replacements. The overall reoperation-free survivorship rate was 98.4% (6047 out of 6143 knees) at a weighted average follow-up of 6.3 years (range 1.5-15.2 years, SD 0.7). Both MP and MC inserts demonstrated good outcomes, with no differences between groups. Few studies evaluated the role of the PCL in MP and MC inserts, with no differences in terms of clinical outcomes between retaining and sacrificing the PCL. : MS-TKA demonstrated good outcomes in the literature independently of the specific design (medial pivot or medial congruent). Different possible biases may be present when evaluating the outcomes of these inserts, including different types of alignment and soft tissue balancing philosophies.
全膝关节置换术（TKA）是全球最常见的医疗手术之一。然而，尽管植入物和手术技术不断进步，仍有10%至20%的患者不满意。最近，为了复制膝关节的自然运动学，人们开发了几种内侧稳定型全膝关节置换术。本综述旨在探讨内侧稳定型全膝关节置换术的两种类型：内侧贴合型（MC）和内侧旋转铰链型（MP），关注其临床结果以及后交叉韧带（PCL）的作用，旨在系统梳理现有研究并突出当前的知识空白。
检索了PubMed、Embase和Cochrane数据库，以识别关于内侧旋转铰链型（MP）或内侧贴合型（MC）假体的运动学和结果的相关研究。以下医学主题词与布尔运算符“AND”和“OR”结合使用：“全膝关节置换术”、“全膝关节置换”、“内侧旋转铰链”、“内侧贴合”、“结果”和“运动学”。纳入的原始研究需报告使用经过验证的患者报告量表评估的临床结果、手术技术以及任何原因导致的再手术率，且最短随访时间为18个月。
共有39篇文章符合纳入标准，涉及6143例全膝关节置换术。在加权平均随访6.3年（范围1.5 - 15.2年，标准差0.7）时，总体无再手术生存率为98.4%（6143例膝关节中的6047例）。MP和MC假体均显示出良好的结果，两组之间无差异。很少有研究评估PCL在MP和MC假体中的作用，保留和牺牲PCL在临床结果方面没有差异。
在文献中，内侧稳定型全膝关节置换术（MS-TKA）无论具体设计（内侧旋转铰链或内侧贴合）均显示出良好的结果。在评估这些假体的结果时可能存在不同的潜在偏倚，包括不同类型的对线和软组织平衡理念。
