Kinematics evaluation of anterior cruciate ligament reconstructed total knee arthroplasty

• Main Authors: Chia-Ming Chang, 張家銘
• Other Authors: Cheng-Kung Cheng
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/y77pck

博士 === 國立陽明大學 === 生物醫學工程學系 === 106 === Total knee arthroplasty (TKA) is a common surgery in knee joint, and the anatomical like TKA has close kinematic performance to the intact knee. With the patients need to do the TKA become younger, retaining anterior cruciate ligament (ACL) in TKA may improve their quality of life and kinematic performance. Although there are some design to retain ACL in TKA, these designs have complicated surgical procedures. In addition, most of ACL are not intact during TKA. In clinical, the ACL reconstruction is commonly performed to fix the non-intact ACL, and it demonstrates well clinical outcome. Therefore, the ACL may need to be reconstructed in TKA (anterior cruciate ligament reconstructed anatomical like TKA, ARA-TKA). For development of the ARA-TKA, the attachment sites of ACL are very important information for the reconstruction surgery. But the attachment site of ACL in femur is limited by the design of femoral component when doing ACL reconstruction. So only the tibial attachment site of ACL is considered in this study, and there are no information about the location of tibial attachment site in Taiwanese. Besides, the variables of ACL reconstruction may also affect the kinematic performance. The purposes of this study are then (1) measuring the tibial attachment site of ACL in Taiwanese, and (2) investigating the effect on kinematics by the tibial attachment site and pre-tension of ARA-TKA. The hypotheses of this study are the ARA-TKA has better kinematic performance to the intact knee and the variables of ACL reconstruction will influence the kinematic performance. In the method, the tibial attachment site of ACL in Taiwanese was measured, and the result was used to adjust the tibial attachment site in ARA-TKA model. A computational kinematic model, which developed by our lab, was used to evaluate the following variables of ACL reconstruction. Three tibial attachment sites, 35%, 45% and 55% of anterioposterior (AP) ratio was evaluated. The pre-tension also had three loads, 30, 40 and 60 N. For kinematic analysis, the AP translation of medial and lateral condyle, and tibial internal rotation were analyzed. The in situ force of ACL were also analyzed. In the results, the AP ratio of ACL tibial attachment site is 35.3 ± 4.2% in average. According to the computational model estimation, the ARA-TKA can make the kinematic performance of medial condyle close to the intact knee, but not in lateral condyle and tibial internal rotation. For the tibial attachment site and pre-tension of ACL reconstruction, more anterior translation and less tibial internal rotation are demonstrated with more posterior tibial attachment site and less pre-tension for ACL reconstruction. In conclusion, the ARA-TKA demonstrates closed kinematic performance to the intact knee in medial condyle and the variables of ACL reconstruction do not influence the kinematic performance in our computational model.