Biomechanical analysis of the effect of postero-latero-central tibial plateau fractures in the knee joint: Can posterior soft tissues prevent instability? A finite element study.

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2024-09-21 DOI:10.1016/j.clinbiomech.2024.106353

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引用次数: 0

Abstract

Background

Almost 86 % of all tibial plateau fractures involves the failure of the postero-latero-central region of the tibial plateau. Surgical treatment of this region is technically demanding and in case of limited depression, it's occasionally chosen to leave them untreated. The aim of the study is to numerically check to what extent this choice can be accepted avoiding inferior outcomes (i.e. joint instability), and to analyze posterior soft tissues role in presence of this fractures.

Methods

Starting from a previous validated finite element model with baseline structures, several configurations were developed by inserting posterior soft tissues and postero-latero-central fracture, with different articular depressions. Squat motion was numerically simulated and tibio-femoral kinematics were compared among configurations.

Findings

An increasing step-off led to a progressive joint instability, especially in the first 35°-40° of flexion. Posterior soft tissues showed to be beneficial in initial stabilization and early flexion. Tibial Axial Rotation didn't show any restorative effect of posterior soft tissues on knee kinematics. Tibial Antero-Posterior Translation is the most significant biomechanical parameter, showing posterior soft tissues restoring native antero-posterior translation, completely for 1-mm step-off fracture, only partially for 2-mm step-off fracture, and not sufficiently for 3-mm step-off fracture, at least in the first 30° of flexion.

Interpretation

The results suggest that postero-latero-central fractures with step-off ≥2 mm should be treated to restore articular kinematic, whereas fractures with step-off <2 mm need a broad evaluation to assess the effective need of surgery. These information can be valuable for surgeons, to aid their decision to surgically operate or not.

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膝关节胫骨平台后中央骨折影响的生物力学分析：后软组织能否防止失稳？有限元研究。

背景几乎 86% 的胫骨平台骨折都发生在胫骨平台的后中央区。该区域的手术治疗技术要求较高，在凹陷有限的情况下，有时会选择不进行治疗。本研究的目的是通过数值检查在多大程度上可以接受这种选择，避免出现不良后果（即关节不稳定），并分析后软组织在出现这种骨折时的作用。方法从以前经过验证的具有基线结构的有限元模型开始，通过插入后软组织和不同关节凹陷的后后中央骨折，开发了几种配置。对下蹲运动进行了数值模拟，并比较了不同结构的胫骨-股骨运动学特性。研究结果随着下蹲幅度的增大，关节不稳定性逐渐增加，尤其是在屈曲的前35°-40°。后部软组织对初始稳定和早期屈曲有好处。胫骨轴向旋转没有显示出后软组织对膝关节运动学有任何恢复作用。胫骨前-后平移是最重要的生物力学参数，结果表明后部软组织可完全恢复原生前-后平移，对于1毫米的台阶式骨折，后部软组织可完全恢复原生前-后平移，对于2毫米的台阶式骨折，后部软组织只能部分恢复原生前-后平移，而对于3毫米的台阶式骨折，后部软组织则不能完全恢复原生前-后平移，至少在屈膝的前30°时是如此。释义结果表明，阶差≥2 mm的后中央骨折应进行治疗以恢复关节运动学，而阶差<2 mm的骨折则需要进行广泛评估，以评估手术的有效需求。这些信息对外科医生很有价值，有助于他们决定是否进行手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.