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Liu D, Lu W, Vithran DTA, Bi Q, Hong Z, Liu X, Yuan D, Chen C, Xiao W, Li Y. Gradual stabilization and narrowing of bone tunnels following primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39091244 DOI: 10.1002/ksa.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/27/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The purpose of this study is to dynamically assess variations in tunnel diameters following anterior cruciate ligament reconstruction (ACLR) and investigate correlations with patient-reported outcomes (PROs) and graft maturity based on signal-to-noise quotient (SNQ). METHODS Tunnel diameter and tunnel position were measured using three-dimensional models derived from computed tomography (CT) data. Postoperative graft maturity and integration were evaluated using magnetic resonance imaging (MRI). Clinical outcomes were assessed through PROs, which included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Scores and Lysholm scores. The correlation between tunnel enlargement extent, PROs and SNQ values, as well as correlations between confounding factors, tunnel diameter differences and SNQ were analyzed. RESULTS A total of 73 participants underwent primary ACLR and scheduled follow-ups. At the segment of the articular aperture, the femoral tunnel was enlarged by 32.3% to 10.4 ± 1.6 mm (p < 0.05), and the tibial tunnel was widened by 17.2% to 9.6 ± 1.2 mm (p < 0.05) at the 6-month follow-up. At 1 year postoperatively, diameters at the articular aperture were not further increased on the femoral (n.s.) and tibial (n.s.) sides. In early postoperative follow-up, the femoral tunnel was anteriorly and distally shifted, coupled with posterior and lateral deviation involving the tibial side, exhibiting minimal migration at 1-year follow-up. The degree of tunnel widening was not correlated with PROs and SNQ values. Age, gender, body mass index (BMI), time from surgery to follow-up, concomitant injuries and autograft type were not correlated with tunnel diameter differences and SNQ. CONCLUSIONS The femoral and tibial bone tunnels exhibited eccentrical widening and gradually stabilized at 1 year following ACLR. Furthermore, the enlarged bone tunnels were not correlated with unsatisfied PROs and inferior graft maturity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Di Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenhao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Djandan Tadum Arthur Vithran
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Bi
- Department of Sports Medicine, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zheping Hong
- Department of Sports Medicine, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xu Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Dongliang Yuan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Kwak YH, Ko YJ, Kwon H, Koh YG, Aldosari AM, Nam JH, Kang KT. Application of a machine learning and optimization method to predict patellofemoral instability risk factors in children and adolescents. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39033342 DOI: 10.1002/ksa.12372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Conservative treatment remains the standard approach for first-time patellar dislocations. While risk factors for patellofemoral instability, a common paediatric injury, are well-established in adults, data concerning the progression of paediatric recurrent patellar dislocation remain scarce. A reproducible method was developed to quantitatively assess the patellofemoral morphology and anatomic risk factors in paediatric patients using magnetic resonance imaging (MRI) and machine learning analysis. METHODS Data were analyzed from a retrospective review (2005-2022) of paediatric patients diagnosed with acute lateral patellar dislocation (54 patients) who underwent MRI and were compared with an age-based control group (54 patients). Patellofemoral, tibial, tibiofemoral and patellar height parameters were measured. Differences between groups were analyzed with respect to MRI parameters. The potential diagnostic utility of the parameters was assessed via machine learning and genetic algorithm analyses. RESULTS Significant differences were observed between the two groups in six patellofemoral morphological parameters. Regarding patellar height morphological parameters, all methods exhibited significant between-group differences. Among the tibia and tibiofemoral morphological parameters, only the tibial tubercle-trochlear groove distance exhibited significant differences between the two groups. No sex-related differences were present. Significant variations were observed in patellar height parameters, particularly in the Koshino-Sugimoto (KS) index, which had the highest area under the curve (AUC: 0.87). Using genetic algorithms and logistic regression, our model excelled with seven key independent variables. CONCLUSION KS index and Wiberg index had the strongest association with lateral patellar dislocation. An optimized logistic regression model achieved an AUC of 0.934. Such performance is considered clinically relevant, indicating the model's effectiveness for the intended application. LEVEL OF EVIDENCE Level Ⅲ.
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Affiliation(s)
- Yoon Hae Kwak
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yu Jin Ko
- Cell & Developmental Biology, University of Rochester, Rochester, New York, USA
| | - Hyunjae Kwon
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seoul, Korea
| | - Amaal M Aldosari
- Department of Orthopedic Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
- Skyve R&D LAB, Seoul, Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
- Skyve R&D LAB, Seoul, Korea
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Zhu J, Zhu W, Zhao Q. Computational modelling of the graft-tunnel interaction in single-bundle ACL reconstructed knee. BIOMED ENG-BIOMED TE 2023; 68:573-582. [PMID: 37462669 DOI: 10.1515/bmt-2022-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/06/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Tunnel enlargement and graft failure are common complications associated with ACL reconstruction. The mechanical interaction between the graft and the tunnel aperture may play a more important role. This study aims to evaluate graft position within femoral tunnel and the graft force under external loads. METHODS An FE model of the femur-graft-tibia complex was constructed from CT images of an anatomically reconstructed knee specimen. The model was subjected to kinematics of passive flexion extension, anterior/posterior translation, internal/external rotation and valgus kinematics, which were collected from experimental testing. Graft shift and rotation of graft-tunnel contact region during flexion/extension and external loadings were recorded and compared to experimental measurements. RESULTS Model showed that the graft shifted in the femoral tunnel during flexion and under external loads. The graft-tunnel contact area rotated by up to 55° during flexion from full extension to 90° of extension implying that the so-called "wiper effect" occurs during most of flexion angles. CONCLUSIONS Different regions of the femoral tunnel aperture, particularly the anterior region, were under significantly more contact force from the graft than other areas of the aperture during the anterior translation test, potentially leading to femoral tunnel enlargement to the anterior side of the aperture.
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Affiliation(s)
- Junjun Zhu
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Weimin Zhu
- Shenzhen 2nd People's Hospital (The First Affiliated Hospital of Shenzhen University), Shenzhen, Guangdong, China
| | - Qijie Zhao
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
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Moon HS, Song SY, Oh JU, Seo YJ. Effects of modified trans-tibial versus trans-portal technique on stress patterns around the femoral tunnel in anatomical single-bundle ACL reconstruction with different knee flexion angles using finite element analysis. BMC Musculoskelet Disord 2022; 23:759. [PMID: 35941643 PMCID: PMC9361554 DOI: 10.1186/s12891-022-05713-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/27/2022] [Indexed: 12/20/2022] Open
Abstract
Background It is unclear whether different anterior cruciate ligament (ACL) graft trajectories in the distal femur would have different effects on stress generated within the distal femur around the femoral tunnel during knee motion. Thus, the purpose of this study was to determine differences in stress patterns around the femoral tunnel created by trans-portal (TP) vs. modified trans-tibial (TT) technique in anatomical ACL reconstruction at different knee flexion angles. Methods Twelve male subjects’ right knees were scanned with a high-resolution computed tomography (CT) scanner (slice thickness: 1 mm) at four different knee flexion angles (0°, 45°, 90°, and 135°). Three-dimensional (3D) models of these four different flexion angles were created and manipulated with several modelling programs. For the TP group, the virtual femoral tunnelling procedure was performed in a 135° flexion model from the low far anteromedial (AM) portal. For the modified TT group, the same knee models were drilled through the modified TT technique at 90° of flexion separately. Virtual grafts under tension of 40 N were put into corresponding bone tunnel and fixed at the outer aperture of femoral tunnels to simulate the suspensory fixation, followed by fixation of the grafts at the middle of tibial tunnels in the 0° knee flexion models. Finally, the models were exported to a finite element analysis package and analysed using ABAQUS/Explicit code (ABAQUS, USA) to monitor the stress occurring at the node where stress distribution occurred most significantly in the femoral bone around the bone tunnel. Results In general, both groups showed a high stress distribution in bony structures around inner and outer orifices of the femoral tunnel. Mean maximal stresses occurring at the lateral femoral condyle around the inner orifice of the femoral tunnel in the TP group were found to be significantly greater than those in the modified TT group at all flexion angles except 90° of flexion. Mean maximal stresses monitored around the outer orifice of the femoral tunnel in the TP group were also significantly greater than those in the modified TT group at all flexion angles. Conclusions Different tunnelling technologies could yield different stress patterns in the lateral femoral condyle around the femoral tunnel. During knee motion, higher stresses were noticed in the TP group than in the modified TT group, especially around inner and outer orifices of the tunnel. Position of the tunnel after reconstruction with the TP technique can have a greater effect on the stress increase in the femur compared to that with the modified TT technique.
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Affiliation(s)
- Hyun-Soo Moon
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
| | - Si Young Song
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Ji Ung Oh
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Young-Jin Seo
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, Gyeonggi-do, Republic of Korea.
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Fan Z, Yan J, Zhou Z, Gao Y, Tang J, Li Y, Zhang Z, Yang M, Lv J. Delayed Versus Accelerated Weight-bearing Rehabilitation Protocol Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. J Rehabil Med 2022; 54:jrm00260. [PMID: 35037693 PMCID: PMC8892302 DOI: 10.2340/jrm.v53.1438] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To compare accelerated and delayed weight-bearing rehabilitation of anterior cruciate ligament reconstruction regarding clinical outcome measures of knee function (International Knee Documentation Committee Subjective Knee Form (IKDC), Lysholm Knee Scoring Scale, Tegner Activity Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS)), knee laxity, range of movement, quadriceps, and bone tunnel enlargement. Design Systematic review and meta-analysis. Methods Systematic searches of Embase, MEDLINE, CINAHL, and the Cochrane Library databases, from inception to February 2021, for studies comparing delayed or accelerated weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction in adult patients. Results Nine studies met the eligibility criteria. A meta-analysis revealed a higher risk of knee laxity in the accelerated weight-bearing group. Accelerated weight-bearing may be related to higher IKDC scores, while there was no statistical difference for Lysholm, Tegner, and KOOS scores at a follow-up within 2 years. Four of 5 studies reported no statistical difference for quadriceps strength and range of movement scores, while 2 studies reported bone tunnel enlargement in the accelerated weight-bearing group. Conclusion This systematic review confirmed that accelerated weight-bearing caused more serious knee laxity and bone tunnel widening than delayed weight-bearing after anterior cruciate ligament reconstruction. We therefore recommend that clinicians should select postoperative rehabilitation programmes with caution.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jiayin Lv
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, P. R. China.
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Cho BW, Nam JH, Koh YG, Min JH, Park KK, Kang KT. Gender-Based Quantitative Analysis of the Grand Piano Sign in Mechanically Aligned Total Knee Arthroplasty in Asians. J Clin Med 2021; 10:jcm10091969. [PMID: 34064317 PMCID: PMC8125574 DOI: 10.3390/jcm10091969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
In mechanically aligned (MA) total knee arthroplasty (TKA), the grand piano sign helps surgeons to further ensure the proper external rotation of the femoral component. The goal of this study was to determine the sex-related differences in the shape of the anterior resection surface using 3D magnetic resonance imaging (MRI) models. MRI scans were performed on 267 consecutive patients (202 women and 65 men) with osteoarthritis who underwent TKA in order to reconstruct a 3D model. Virtual anterior condylar resection was performed based on the surgical transepicondylar axis (sTEA), Whiteside's line (WSL), and flexion-extension axis (FEA). On the anterior resection surface, both lateral length (LatL) and medial length (MedL) were measured, and the ratio between the two (MedL/LatL) was calculated. The mediolateral width of the distal femur (ML) and anterior resection surface (M'L') were measured, and the ratio between the M'L' and ML (M'L'/ML) was calculated. Both the lateral deviation (LD) and the ratio between LD and ML (LD/ML) were also determined. Morphological classification of the anterior resection surface was conducted based on the presence of a definite medial peak. When based on the sTEA or WSL, the MedL/LatL of female subjects was significantly greater than that of male subjects (p < 0.001 and p < 0.05, respectively). The MedL/LatL of the FEA was consistently larger than that obtained using the sTEA or WSL. Among female subjects, the MedL/LatL of the sTEA was significantly greater than that of the WSL, although this was not the case in either the total study population or the male subjects alone. When based on the sTEA, the M'L'/ML was statistically greater in the female subjects (p < 0.01). The LD was greater in the male subjects (p < 0.01), but there was no difference between the male and female subjects when comparing the LD/ML (p = 0.93). The proportion of double- and single-peak types was not significantly different between the sexes (p = 0.196). Surgeons should be aware that the shape of the anterior resection surface may differ depending on the sex of the patient. The results of this study provide more consistent surgical outcomes as well as fundamental anatomical data for designing suitable prostheses applicable to the Korean population.
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Affiliation(s)
- Byung-Woo Cho
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.-H.M.)
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, Korea;
| | - Ji-Hwan Min
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.-H.M.)
| | - Kwan-Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.-H.M.)
- Correspondence: (K.-K.P.); (K.-T.K.)
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
- Correspondence: (K.-K.P.); (K.-T.K.)
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Kim SJ, Song SY, Kim TS, Kim YS, Jang SW, Seo YJ. Creating a Femoral Tunnel Aperture at the Anteromedial Footprint Versus the Central Footprint in ACL Reconstruction: Comparison of Contact Stress Patterns. Orthop J Sports Med 2021; 9:23259671211001802. [PMID: 33997070 PMCID: PMC8111278 DOI: 10.1177/23259671211001802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Background: It remains unclear whether an anteromedial (AM) footprint or a central footprint anterior cruciate ligament (ACL) graft exhibits less contact stress with the femoral tunnel aperture. This contact stress can generate graft attrition forces, which can lead to potential graft failure. Purpose/Hypothesis: The purpose of this study was to compare the difference in contact stress patterns of the graft around a femoral tunnel that is created at the anatomic AM footprint versus the central footprint. It was hypothesized that the difference in femoral tunnel positions would influence the contact stress at the interface between the reconstructed graft and the femoral tunnel orifice. Study Design: Controlled laboratory study. Methods: A total of 24 patients who underwent anatomic single-bundle ACL reconstruction were included in this study. In 12 patients, the femoral tunnels were created at the center of the native AM footprint (AM group), and in the remaining 12 patients the center of the femoral tunnel was placed in the anatomic central footprint (central group). Three-dimensional knee models were created and manipulated using several modeling programs, and the graft-tunnel angle (GTA) was determined using a special software program. The peak contact stresses generated on the virtual ACL graft around the femoral tunnel orifice were calculated using a finite element method. Results: The mean GTA was significantly more obtuse in the AM group than in the central group (124.2° ± 5.9° vs 112.6° ± 7.9°; P = .001). In general, both groups showed high stress distribution on the anterior surface of the graft, which came in contact with the anterior aspect of the femoral tunnel aperture. The degree of stress in the central group (5.3 ± 2.6 MPa) was significantly higher than that in the AM group (1.2 ± 1.1 MPa) (P < .001). Conclusion: Compared with the AM footprint ACL graft, the central footprint ACL graft developed significantly higher contact stress in the extended position, especially around the anterior aspect of the femoral tunnel orifice. Clinical Relevance: The contact stress of the ACL graft at the extended position of the knee may be minimized by creating the femoral tunnel at the AM-oriented footprint.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopaedic Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Si Young Song
- Department of Orthopaedic Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Tae Soung Kim
- Department of Orthopaedic Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Yoon Sang Kim
- BioComputing Lab, School of Computer Science and Engineering, Korea University of Technology and Education (KOREATECH), Cheonan, Republic of Korea
| | - Seong-Wook Jang
- BioComputing Lab, School of Computer Science and Engineering, Korea University of Technology and Education (KOREATECH), Cheonan, Republic of Korea
| | - Young-Jin Seo
- Department of Orthopaedic Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
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Kwak YH, Nam JH, Koh YG, Park BK, Kang KT. Anatomic Differences in the Sagittal Knee Joint Are Associated With ACL Injury: Results From a Skeletally Immature Korean Population. Orthop J Sports Med 2021; 9:2325967121994795. [PMID: 33869647 PMCID: PMC8024458 DOI: 10.1177/2325967121994795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Differences in tibiofemoral articular morphology are associated with risks of anterior cruciate ligament (ACL) injury. Purpose: To determine whether bony and cartilaginous morphological characteristics are related to ACL injury in pediatric patients and to investigate any differences according to sex. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 200 skeletally immature Korean patients from a single institution were included in this study; 100 patients had an ACL injury, and 100 had an intact ACL. Condylar morphology and tibial slopes were evaluated and compared between the groups, and differences between sexes were evaluated in the ACL-injured group. Results: The lateral femoral curvature was significantly greater and the lateral and medial tibial curvatures were significantly smaller in the ACL-injured group than in the intact group (P < .01 for all). In addition, the lateral and medial femoral curvatures as well as the lateral tibial curvature were significantly smaller in female than in male patients (P < .01 for all). Both the medial and lateral tibial slopes were greater in the ACL-injured versus intact group (medial slope, 5.5° vs 5.0°; lateral slope, 3.0° vs 1.3°, respectively); this difference was statistically significant for lateral tibial slope (P = .026). No sex-based differences were found for medial or lateral tibial slope. Conclusion: Femoral and tibial curvatures as well as lateral tibial slope were significantly different between the ACL-injured and ACL-intact patients, and the lateral tibial curvature was significantly smaller in female than in male patients. Medial and lateral tibial slopes were not associated with a significant difference in ACL injury between male and female patients.
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Affiliation(s)
- Yoon Hae Kwak
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Byoung-Kyu Park
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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Medio-Lateral and Flexion-Extension Gap Imbalances in Mechanically Aligned Total Knee Arthroplasty Using Measured Resection Technique in Korean Patients: 3D Simulation. J Clin Med 2021; 10:jcm10040845. [PMID: 33670763 PMCID: PMC7922268 DOI: 10.3390/jcm10040845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background: It is well known that the measured resection (MR) technique in mechanically aligned (MA) total knee arthroplasty (TKA) generates significant gap imbalances, but little is known about whether this applies to the knees of Asian patients. The aim of this study was to evaluate the medio-lateral and flexion-extension gap imbalances and to find the most optimal posterior femoral condyle resection method for operating on the knees of Asian patients. Methods: In total, 738 magnetic resonance imaging (MRI) scans of consecutive patients who underwent TKA were obtained. Four posterior femoral condylar resection methods were used: alignment by the surgical transepicondylar axis (TEA), Whiteside’s line (WSL), 3° external rotation to the posterior condylar axis (PCA), and flexion-extension axis (FEA). Results: For the medial compartments, there were significant differences between the flexion and extension gaps in the varus knee group in all four methods, but there were no differences between the flexion and extension gaps in the valgus knee group. For the lateral compartment, all the methods showed significant differences except for WSL of the valgus knee group and FEA of the varus knee group. Conclusions: In Asian patients, the use of the MA MR technique inevitably leads to medio-lateral or flexion-extension imbalances. Therefore, surgeons should consider which methods can minimize imbalances and choose the best method within the technically possible range.
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Nam JH, Koh YG, Kim PS, Park JH, Kang KT. Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees. J Orthop Surg Res 2020; 15:499. [PMID: 33121532 PMCID: PMC7597046 DOI: 10.1186/s13018-020-02030-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Surgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component. Methods Three-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition. Results In all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness. Conclusion Surgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.
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Affiliation(s)
- Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Paul Shinil Kim
- Department of Orthopaedic Surgery, The Bone Hospital, 67, Dongjak-daero, Dongjak-gu, Seoul, Republic of Korea
| | - Joon-Hee Park
- Department of Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, Republic of Korea.
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Wang H, Zhang B, Cheng CK. Stiffness and shape of the ACL graft affects tunnel enlargement and graft wear. Knee Surg Sports Traumatol Arthrosc 2020; 28:2184-2193. [PMID: 31690994 DOI: 10.1007/s00167-019-05772-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Tunnel enlargement and graft rupture are common complications associated with ACL reconstruction (ACLR). This study aims to explore how variations in graft stiffness and shape affect the strain energy density (SED) around bone tunnel entrances and stress on the graft and subsequently influencing the level of tunnel enlargement and graft wear. METHODS Finite element ACLR models were developed using different graft stiffnesses (323 N/mm, 545 N/mm and 776 N/mm) and shapes (circular and elliptical). The models were subjected to a combined loading of 103 N anterior tibial load, 7.5 Nm internal tibial moment, and 6.9 Nm valgus tibial moment at joint flexion of 30°. SED at tunnel entrances and stresses on the graft was recorded and compared among the different models. RESULTS Increasing the graft stiffness resulted in greater stress on the graft (17.2, 24.4 and 31.7 MPa for graft stiffnesses of 323 N/mm, 545 N/mm and 776 N/mm), but had little effect on the SED reduction around the tunnel entrances. Changing the cross section of the graft from circular to elliptical caused an additional reduction in SED (56.8 vs 2.8 kJ/m3) at the posterior zone of the femoral tunnel entrance and increased the stress on the graft (31.7 MPa vs 38.9 MPa). CONCLUSIONS This study recommends using ACL grafts with lower stiffness and a circular cross section to reduce tunnel enlargement and graft wear following ACLR.
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Affiliation(s)
- Huizhi Wang
- School of Biological Science and Medical Engineering, Beihang University, 37 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Bo Zhang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Cheng-Kung Cheng
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China.
- School of Biological Science and Medical Engineering, Beihang University, 37 Xueyuan Road, Haidian District, Beijing, 100083, China.
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