Abstract：
OBJECTIVE: Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction (ACLR) to restore knee stability. However, ACLR substantially alters knee biomechanics (e.g., motion and tissue mechanics) placing the patient at elevated risk of early-onset knee osteoarthritis.
METHODS: This study employed a linked neuromusculoskeletal (NMSK)-finite element (FE) model to determine effects of four critical ACLR surgical parameters (graft type, size, location and pre-tension) on tibial articular cartilage stresses in three paediatric knees of different sizes during walking. Optimal surgical combinations were defined by minimal kinematic and tibial cartilage stress deviations in comparison to a corresponding intact healthy knee, with substantial deviations defined by normalized root mean square error (nRMSE) > 10%.
RESULTS: Results showed unique trends of principal stress deviations across knee sizes with small knee showing least deviation from intact knee, followed by large- and medium-sized knees. The nRMSE values for cartilage stresses displayed notable variability across different knees. Surgical combination yielding the highest nRMSE in comparison to the one with lowest nRMSE resulted in an increase of maximum principal stress on the medial tibial cartilage by 18.0%, 6.0% and 1.2% for small, medium and large knees, respectively. Similarly, there was an increase of maximum principal stress on lateral tibial cartilage by 11.2%, 4.1% and 12.7% for small, medium and large knees, respectively. Knee phenotype and NMSK factors contributed to deviations in knee kinematics and tibial cartilage stresses. Although optimal surgical configurations were found for each knee size, no generalizable trends emerged emphasizing the subject-specific nature of the knee and neuromuscular system.
CONCLUSIONS: Study findings underscore subject-specific complexities in ACLR biomechanics, necessitating personalized surgical planning for effective restoration of native motion and tissue mechanics. Future research should expand investigations to include a broader spectrum of subject-specific factors to advance personalized surgical planning.
METHODS: Level III.
METHODS: This study employed a linked neuromusculoskeletal (NMSK)-finite element (FE) model to determine effects of four critical ACLR surgical parameters (graft type, size, location and pre-tension) on tibial articular cartilage stresses in three paediatric knees of different sizes during walking. Optimal surgical combinations were defined by minimal kinematic and tibial cartilage stress deviations in comparison to a corresponding intact healthy knee, with substantial deviations defined by normalized root mean square error (nRMSE) > 10%.
RESULTS: Results showed unique trends of principal stress deviations across knee sizes with small knee showing least deviation from intact knee, followed by large- and medium-sized knees. The nRMSE values for cartilage stresses displayed notable variability across different knees. Surgical combination yielding the highest nRMSE in comparison to the one with lowest nRMSE resulted in an increase of maximum principal stress on the medial tibial cartilage by 18.0%, 6.0% and 1.2% for small, medium and large knees, respectively. Similarly, there was an increase of maximum principal stress on lateral tibial cartilage by 11.2%, 4.1% and 12.7% for small, medium and large knees, respectively. Knee phenotype and NMSK factors contributed to deviations in knee kinematics and tibial cartilage stresses. Although optimal surgical configurations were found for each knee size, no generalizable trends emerged emphasizing the subject-specific nature of the knee and neuromuscular system.
CONCLUSIONS: Study findings underscore subject-specific complexities in ACLR biomechanics, necessitating personalized surgical planning for effective restoration of native motion and tissue mechanics. Future research should expand investigations to include a broader spectrum of subject-specific factors to advance personalized surgical planning.
METHODS: Level III.
摘要：
目的：前交叉韧带（ACL）断裂在儿科和青少年人群中越来越常见，通常需要外科ACL重建（ACLR）以恢复膝关节稳定性。然而,ACLR显著改变了膝关节生物力学(例如，运动和组织力学）使患者处于早发性膝骨关节炎的高风险中。
方法：本研究采用了神经肌肉骨骼（NMSK）-有限元（FE）模型来确定四个关键ACLR手术参数（移植物类型，尺寸,位置和预张紧）在步行过程中三个不同大小的小儿膝盖的胫骨关节软骨应力。与相应的完整健康膝关节相比，通过最小的运动学和胫骨软骨应力偏差来定义最佳的手术组合。由归一化均方根误差(nRMSE)>10%定义的实质性偏差。
结果：结果显示不同尺寸的膝关节主应力偏差的独特趋势，小膝关节与完整膝关节的偏差最小，其次是大中型膝盖。软骨应力的nRMSE值显示出不同膝盖之间的显着变异性。与nRMSE最低的手术组合相比，nRMSE最高的手术组合导致内侧胫骨软骨的最大主应力增加18.0％。小的6.0%和1.2%，中等和大膝盖，分别。同样，胫骨外侧软骨的最大主应力增加了11.2%，小的4.1%和12.7%，中等和大膝盖，分别。膝关节表型和NMSK因素导致膝关节运动学和胫骨软骨应力的偏差。尽管每个膝盖尺寸都找到了最佳的手术配置，没有出现强调膝关节和神经肌肉系统的受试者特异性的可推广趋势.
结论：研究结果强调了ACLR生物力学中特定受试者的复杂性，需要个性化的手术计划，以有效恢复自然运动和组织力学。未来的研究应扩大调查范围，以包括更广泛的受试者特定因素，以推进个性化的手术计划。
方法：三级。
方法：本研究采用了神经肌肉骨骼（NMSK）-有限元（FE）模型来确定四个关键ACLR手术参数（移植物类型，尺寸,位置和预张紧）在步行过程中三个不同大小的小儿膝盖的胫骨关节软骨应力。与相应的完整健康膝关节相比，通过最小的运动学和胫骨软骨应力偏差来定义最佳的手术组合。由归一化均方根误差(nRMSE)>10%定义的实质性偏差。
结果：结果显示不同尺寸的膝关节主应力偏差的独特趋势，小膝关节与完整膝关节的偏差最小，其次是大中型膝盖。软骨应力的nRMSE值显示出不同膝盖之间的显着变异性。与nRMSE最低的手术组合相比，nRMSE最高的手术组合导致内侧胫骨软骨的最大主应力增加18.0％。小的6.0%和1.2%，中等和大膝盖，分别。同样，胫骨外侧软骨的最大主应力增加了11.2%，小的4.1%和12.7%，中等和大膝盖，分别。膝关节表型和NMSK因素导致膝关节运动学和胫骨软骨应力的偏差。尽管每个膝盖尺寸都找到了最佳的手术配置，没有出现强调膝关节和神经肌肉系统的受试者特异性的可推广趋势.
结论：研究结果强调了ACLR生物力学中特定受试者的复杂性，需要个性化的手术计划，以有效恢复自然运动和组织力学。未来的研究应扩大调查范围，以包括更广泛的受试者特定因素，以推进个性化的手术计划。
方法：三级。
