5.1 – Conclusões
Analisando o movimento das estruturas ósseas do modelo Intacto, podemos admitir que este foi capaz de reproduzir o comportamento de um joelho saudável. Os valores relativos a solicitações nas superfícies articulares e nas estruturas ligamentares estão próximos dos valores obtidos em estudos computacionais e experimentais consultados. O modelo Intacto apresenta-se como válido, podendo assim ser considerado uma referência para comparação com os restantes modelos. Os modelos FA-TC e FPS-TAI foram os que mais se afastaram do modelo Intacto. O enxerto ligamentar usado no modelo FA-TC é o mais curto e menos inclinado, constringindo os movimentos das estruturas ósseas durante a flexão da articulação e provocando tensões e deformações excessivas na sua zona superior, perto da inserção femoral. O Neo-ligamento do modelo FPS-TAI é o que sofre menos tensões e deformações mas os restantes ligamentos são os mais solicitados entre todos os modelos, este modelo apresenta também pouco controlo nas movimentações das estruturas ósseas. O modelo FPS-TAI aparenta ser o modelo que melhor caracteriza um joelho com rutura de ligamento cruzado anterior. Os modelos FC-TC e FC-TA apresentaram resultados relativamente idênticos entre si e foram os modelos que mais se aproximaram do modelo Intacto, constituindo as melhores opções para reconstrução do ligamento cruzado anterior por restituírem com maior eficácia a cinemática natural de um joelho saudável. Apesar de ambos os modelos apresentaram resultados positivos, a isometria que a posição FC-TA oferece torna-a a opção mais viável, já usada e defendida em reconstruções ligamentares do ligamento cruzado anterior. Ambas as posições na tíbia e no fémur do enxerto ligamentar são importantes para o sucesso da reconstrução do ligamento cruzado anterior, mas o mau posicionamento no fémur leva a alterações da biomecânica do joelho significativas que para além de não restituírem a cinemática natural da articulação influenciam decisivamente os esforços suportados pelas restantes estruturas, podendo originar novas patologias.
Este trabalho tinha como objetivo a análise das estruturas sensíveis da articulação tibiofemoral antes e após reconstrução ligamentar. O modelo numérico representativo do joelho saudável foi competente na reprodução de resultados próximos aos consultados na bibliografia e o modelo reconstruído cuja cinemática mais se aproxima de um joelho saudável apresenta posições para o enxerto ligamentar recomendadas e usadas na reconstrução do ligamento cruzado anterior por
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cirurgiões. Face a estas afirmações é admissível considerar que o objetivo proposto para este trabalho foi atingido.
5.2 - Trabalhos futuros
Futuramente, propõe-se o melhoramento dos modelos geométricos, adicionando a patela e o ligamento patelar e caracterizando melhor o ligamento cruzado anterior modelando os dois feixes que o constituem em vez de uma forma única. Os modelos numéricos também podem ser bastante melhorados, modificando as definições dos materiais para que melhor representem o comportamento viscoelástico dos ligamentos, meniscos e cartilagem e aplicando uma condição de fronteira que melhor caracterize as fixações reais dos meniscos. O uso de enxertos diferentes nestas análises também poderia ser proposto.
O desenvolvimento de ligamentos sintéticos viáveis que eliminem a necessidade de colheita de enxertos do paciente apresentam vantagens numerosas. Seria interessante estudar modelos numéricos com diferentes materiais sintéticos para o ligamento cruzado anterior, podendo assim analisar as alterações biomecânicas com esperança de ajudar o desenvolvimento deste tipo de opção.
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