根据冠状面膝关节对线分类评估外翻对线亚型中外侧滑车沟磨损患病率的增加：一项回顾性单中心研究
Increased prevalence of lateral trochlear groove wear among valgus alignment subtypes by coronal knee alignment classification: A retrospective single-center study.
作者信息
DeMoes Danielle, Borazjani Roham, Orsi Alexander D, Plaskos Christopher, Kreuzer Stefan
机构信息
INOV8 Research, Houston, TX, USA.
Corin Group, Boston, MA, USA.
出版信息
J Orthop. 2025 Mar 26;63:141-147. doi: 10.1016/j.jor.2025.03.050. eCollection 2025 May.
INTRODUCTION
The Coronal Plane Alignment of The Knee (CPAK) classification aims to restore the constitutional knee alignment, although it neglects the patellofemoral joint. Therefore, this study aims to examine the correlation between trochlear groove wear (TGW) patterns and CPAK classifications.
METHODS
Our institutional database was queried to include unilateral primary total knee arthroplasties (TKA) between 2021 and 2025. TGW was categorized into central, medial, lateral, and no TGW based on the most prominent wear observed intraoperatively. Using OMNIBotics® surgical navigation system (Corin Ltd.), nine CPAK phenotypes were determined by intraoperative registration of the arithmetic hip-knee-ankle angles (aHKA), joint line obliquity (JLO), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA).
RESULTS
Among 559 cases, central TGW (53.7 %), followed by lateral (21.8 %) and medial (15.2 %), were the most frequent TGW. Lateral TGW had a higher mean of MPTA (88.5 ± 2.3), while medial TGW had a significantly higher mean of LDFA (87.3 ± 2.2) than the other groups. Central TGW was the most prevalent wear in all aHKA groups, with the lateral TGW being more frequent (33 %) in the valgus knees than the medial TGW (8.4 %). Forty-two percent of cases with lateral TGW had CPAK type Ⅲ, followed by CPAK type Ⅱ (30 %) and CPAK type Ⅵ (13.0 %). The most frequently observed CPAK phenotypes with the central TGW were type Ⅱ (40 %), type Ⅲ (25 %), and typeⅠ (17 %). The same trend was detected for medial TGW and those without wear.
CONCLUSION
The interplay between joint health and structural alignment can impact surgical planning, as we observed a significant association between the TGW and CPAK parameters. Surgeons may adjust femoral component rotation in CPAK Ⅲ with lateral TGW to address patellar maltracking, though further research is needed.
引言
膝关节冠状面排列（CPAK）分类旨在恢复膝关节的固有排列，尽管它忽略了髌股关节。因此，本研究旨在探讨滑车沟磨损（TGW）模式与CPAK分类之间的相关性。
方法
查询我们机构的数据库，纳入2021年至2025年期间的单侧初次全膝关节置换术（TKA）。根据术中观察到的最明显磨损情况，将TGW分为中央型、内侧型、外侧型和无TGW。使用OMNIBotics®手术导航系统（Corin有限公司），通过术中记录算术髋-膝-踝角（aHKA）、关节线倾斜度（JLO）、股骨外侧远端角（LDFA）和胫骨内侧近端角（MPTA）来确定9种CPAK表型。
结果
在559例病例中，中央型TGW最为常见（53.7%），其次是外侧型（21.8%）和内侧型（15.2%）。外侧型TGW的MPTA平均值较高（88.5±2.3），而内侧型TGW的LDFA平均值显著高于其他组（87.3±2.2）。中央型TGW在所有aHKA组中都是最普遍的磨损类型，外侧型TGW在膝外翻病例中比内侧型TGW更常见（33%对8.4%）。42%的外侧型TGW病例为CPAKⅢ型，其次是CPAKⅡ型（30%）和CPAKⅥ型（13.0%）。中央型TGW最常观察到的CPAK表型是Ⅱ型（40%）、Ⅲ型（25%）和Ⅰ型（17%）。内侧型TGW和无磨损病例也检测到相同趋势。
结论
关节健康与结构排列之间的相互作用会影响手术规划，因为我们观察到TGW与CPAK参数之间存在显著关联。对于外侧型TGW的CPAKⅢ型患者，外科医生可能需要调整股骨组件的旋转以解决髌骨轨迹不良问题，不过还需要进一步研究。
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