Antonio Klasan, Victoria Anelli-Monti, Alexander Johannes Nedopil
{"title":"全膝关节置换术中未磨损软骨严重偏离2毫米：MRI，机器人辅助和尺子评估。","authors":"Antonio Klasan, Victoria Anelli-Monti, Alexander Johannes Nedopil","doi":"10.1002/ksa.12671","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Kinematic alignment (KA) in total knee arthroplasty (TKA) aims to resurface the articular surface of the pre-arthritic knee. One cornerstone of KA TKA and the basis for conventional instrumentation (CI) is a 2 mm cartilage thickness of the healthy distal femur. This study of image-based (CT) robotic-assisted surgery (RAS) TKA determined (1) the difference in measuring cartilage thickness using preoperative MRI, the RAS registration probe and MRI and (2) the percentage of knees with a <1.5 or >2.5 mm thickness of the unworn cartilage.</p><p><strong>Methods: </strong>Forty-two patients undergoing a TKA using an image-based RAS were included. Preoperative long-leg radiographs provided the limb phenotype. The two zones of interest for cartilage thickness were the distal unworn (DU) and posterior unworn (PU) condyle. The preoperative MRI provided cartilage thickness values for both zones. Intraoperatively, the surgeon identified the zones without cartilage wear (healthy cartilage) and measured the distance between the cartilage and bone with the RAS registration probe. After resecting the condyles, a ruler was provided to measure the cartilage thickness reference.</p><p><strong>Results: </strong>Mean patient age was 68.2 ± 4.1 years, and gender was evenly distributed. According to the phenotype classification, there were 8 NEU<sub>HKA</sub>0°, 13 VAR<sub>HKA</sub>3°, 9 VAR<sub>HKA</sub>6°, 5 VAR<sub>HKA</sub>9°, 4 VAL<sub>HKA</sub>3°, 2 VAL<sub>HKA</sub>6° and 1 VAL<sub>HKA</sub>9° patient. The difference between measurement techniques was not statistically significant for both zones (DU p = 0.960, PU p = 0.267). In seven patients (16.7%), the DU cartilage thickness was >2.5 mm measured with any of the three techniques, and up to 50% of patients had unworn cartilage thickness <1.5 mm, depending on the zone and measurement technique.</p><p><strong>Conclusion: </strong>There is a significant variation of unworn cartilage thickness from the assumed 2 mm, with a significant proportion (up to 67.7%) having >2.5 or <1.5 mm. If KA is applied, additional preoperative or intraoperative measurements might provide valuable information to avoid the risk of femoral component malposition.</p><p><strong>Level of evidence: </strong>Level II, diagnostic study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Unworn cartilage in total knee arthroplasty strongly deviates from 2 mm: MRI, robotic-assisted and ruler assessment.\",\"authors\":\"Antonio Klasan, Victoria Anelli-Monti, Alexander Johannes Nedopil\",\"doi\":\"10.1002/ksa.12671\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Kinematic alignment (KA) in total knee arthroplasty (TKA) aims to resurface the articular surface of the pre-arthritic knee. One cornerstone of KA TKA and the basis for conventional instrumentation (CI) is a 2 mm cartilage thickness of the healthy distal femur. This study of image-based (CT) robotic-assisted surgery (RAS) TKA determined (1) the difference in measuring cartilage thickness using preoperative MRI, the RAS registration probe and MRI and (2) the percentage of knees with a <1.5 or >2.5 mm thickness of the unworn cartilage.</p><p><strong>Methods: </strong>Forty-two patients undergoing a TKA using an image-based RAS were included. Preoperative long-leg radiographs provided the limb phenotype. The two zones of interest for cartilage thickness were the distal unworn (DU) and posterior unworn (PU) condyle. The preoperative MRI provided cartilage thickness values for both zones. Intraoperatively, the surgeon identified the zones without cartilage wear (healthy cartilage) and measured the distance between the cartilage and bone with the RAS registration probe. After resecting the condyles, a ruler was provided to measure the cartilage thickness reference.</p><p><strong>Results: </strong>Mean patient age was 68.2 ± 4.1 years, and gender was evenly distributed. According to the phenotype classification, there were 8 NEU<sub>HKA</sub>0°, 13 VAR<sub>HKA</sub>3°, 9 VAR<sub>HKA</sub>6°, 5 VAR<sub>HKA</sub>9°, 4 VAL<sub>HKA</sub>3°, 2 VAL<sub>HKA</sub>6° and 1 VAL<sub>HKA</sub>9° patient. The difference between measurement techniques was not statistically significant for both zones (DU p = 0.960, PU p = 0.267). In seven patients (16.7%), the DU cartilage thickness was >2.5 mm measured with any of the three techniques, and up to 50% of patients had unworn cartilage thickness <1.5 mm, depending on the zone and measurement technique.</p><p><strong>Conclusion: </strong>There is a significant variation of unworn cartilage thickness from the assumed 2 mm, with a significant proportion (up to 67.7%) having >2.5 or <1.5 mm. 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引用次数: 0
摘要
背景：全膝关节置换术（TKA）中的运动对位（KA）旨在恢复关节炎前膝关节的关节面。KA TKA的基石和传统器械（CI）的基础是健康股骨远端2毫米的软骨厚度。这项基于图像（CT）的机器人辅助手术（RAS）TKA研究确定了：（1）使用术前核磁共振成像、RAS登记探针和核磁共振成像测量软骨厚度的差异；（2）未磨损软骨厚度达到2.5毫米的膝关节百分比：纳入了42名使用基于图像的RAS进行TKA手术的患者。术前长腿X光片提供了肢体表型。软骨厚度的两个关注区是远端未损坏（DU）和后方未损坏（PU）髁。术前核磁共振成像提供了这两个区域的软骨厚度值。术中，外科医生确定了没有软骨磨损的区域（健康软骨），并用RAS登记探针测量了软骨和骨之间的距离。切除髁突后，提供一把尺子测量软骨厚度参考值：患者平均年龄（68.2±4.1）岁，性别分布均匀。根据表型分类，NEUHKA0°患者8例，VARHKA3°患者13例，VARHKA6°患者9例，VARHKA9°患者5例，VALHKA3°患者4例，VALHKA6°患者2例，VALHKA9°患者1例。两种测量技术之间的差异在统计学上并不显著（DU p = 0.960，PU p = 0.267）。有七名患者（16.7%）用三种技术中的任何一种测量出的 DU 软骨厚度大于 2.5 毫米，多达 50%的患者有未磨损的软骨厚度 结论：未磨损的软骨厚度与假定的2毫米有很大差异，很大一部分患者（高达67.7%）的未磨损软骨厚度大于2.5毫米：二级，诊断性研究。
Unworn cartilage in total knee arthroplasty strongly deviates from 2 mm: MRI, robotic-assisted and ruler assessment.
Background: Kinematic alignment (KA) in total knee arthroplasty (TKA) aims to resurface the articular surface of the pre-arthritic knee. One cornerstone of KA TKA and the basis for conventional instrumentation (CI) is a 2 mm cartilage thickness of the healthy distal femur. This study of image-based (CT) robotic-assisted surgery (RAS) TKA determined (1) the difference in measuring cartilage thickness using preoperative MRI, the RAS registration probe and MRI and (2) the percentage of knees with a <1.5 or >2.5 mm thickness of the unworn cartilage.
Methods: Forty-two patients undergoing a TKA using an image-based RAS were included. Preoperative long-leg radiographs provided the limb phenotype. The two zones of interest for cartilage thickness were the distal unworn (DU) and posterior unworn (PU) condyle. The preoperative MRI provided cartilage thickness values for both zones. Intraoperatively, the surgeon identified the zones without cartilage wear (healthy cartilage) and measured the distance between the cartilage and bone with the RAS registration probe. After resecting the condyles, a ruler was provided to measure the cartilage thickness reference.
Results: Mean patient age was 68.2 ± 4.1 years, and gender was evenly distributed. According to the phenotype classification, there were 8 NEUHKA0°, 13 VARHKA3°, 9 VARHKA6°, 5 VARHKA9°, 4 VALHKA3°, 2 VALHKA6° and 1 VALHKA9° patient. The difference between measurement techniques was not statistically significant for both zones (DU p = 0.960, PU p = 0.267). In seven patients (16.7%), the DU cartilage thickness was >2.5 mm measured with any of the three techniques, and up to 50% of patients had unworn cartilage thickness <1.5 mm, depending on the zone and measurement technique.
Conclusion: There is a significant variation of unworn cartilage thickness from the assumed 2 mm, with a significant proportion (up to 67.7%) having >2.5 or <1.5 mm. If KA is applied, additional preoperative or intraoperative measurements might provide valuable information to avoid the risk of femoral component malposition.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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