The effects of a posterior-stabilized prosthesis on knee ligament loads during walking: A musculoskeletal modelling study

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-04-12 DOI:10.1016/j.clinbiomech.2025.106526

Lucia Donno, Christian Dubbini, Carlo Albino Frigo

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Abstract

Background

The correct balancing of the knee joint ligaments in case of total knee arthroplasty is fundamental for the functional outcome. Hence, it could be of interest for surgeons to understand how the ligaments' tension and intraarticular forces change after the implantation of a knee prosthesis, not only in clinical tests but particularly during functional activities. Many studies have compared the effects of different implant designs but without any reference to changes compared to the natural knee.

Methods

In this study, a posterior-stabilized prosthesis was virtually implanted in a three-dimensional musculoskeletal model of the knee joint. Through a dynamic simulation of the gait cycle, the knee kinematics, ligaments' tension and tibial-femoral contact force were quantified and compared with those obtained by the intact knee model.

Findings

In the presence of the prosthesis, the tibia preserved the two peaks of anterior displacement in correspondence with the peaks of knee flexion, even if reduced in relation to the intact knee. The superficial and deep Medial Collateral Ligaments supported the highest load, compensating for the absence of the cruciate ligaments. After the introduction of the prosthesis, the tibial-femoral contact force showed the same trend obtained in the natural knee model, however it appeared reduced compared to the intact knee condition and approached the experimental data recorded by an instrumented prosthesis.

Interpretation

This study quantified the changes induced by the posterior-stabilized implant in terms of kinematics, ligament tensions and intraarticular forces during walking, demonstrating how musculoskeletal models can support gaining insight into complex biomechanical systems.

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步行时后稳定假体对膝关节韧带负荷的影响：一项肌肉骨骼模型研究

背景：在全膝关节置换术中，膝关节韧带的正确平衡是功能结果的基础。因此，对于外科医生来说，了解膝关节假体植入后韧带张力和关节内力是如何变化的，不仅在临床试验中，而且在功能活动中也是如此。许多研究比较了不同植入物设计的效果，但没有提及与自然膝关节相比的变化。方法在本研究中，将一个后稳定假体虚拟植入三维膝关节肌肉骨骼模型中。通过对步态周期的动态模拟，量化了膝关节运动学、韧带张力和胫股接触力，并与完整膝关节模型进行了比较。发现在假体存在的情况下，胫骨保留了与膝关节屈曲峰对应的两个前移位峰，即使与完整的膝关节相比有所减少。浅层和深层内侧副韧带支持最高负荷，弥补了交叉韧带的缺失。植入假体后，胫骨-股骨接触力的变化趋势与自然膝关节模型相同，但与完整膝关节相比有所减小，接近假体置入后的实验数据。本研究量化了后稳定植入物在行走过程中运动学、韧带张力和关节内力方面引起的变化，展示了肌肉骨骼模型如何支持深入了解复杂的生物力学系统。

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.