Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis

Background: Patients with medial compartment osteoarthritis of the knee suffer from pain and stiffness. However, current unloader braces are not being used for extended periods by knee osteoarthritis patients due to interface problems, so compliance is an issue. The aim of this study was to design a new bespoke orthosis that could be comfortable to wear while also providing the required correction to reduce medial compartment loading. Case Description and Methods: A new knee orthosis design was initially tested for its frontal plane correction of knee varus using a surrogate knee model. It was then assessed by a volunteer subject with grade 2 medial compartment knee osteoarthritis using a static standing radiograph. Findings and Outcomes: When fitted to the surrogate knee model, the brace corrected the knee from 10° of varus to neutral alignment in the frontal plane. When worn in situ during static stance on the affected leg of the volunteer patient, it corrected the knee by 6° to a less varus position. Conclusion: The orthosis provided frontal plane correction of the knee during static standing. It could therefore prove to be suitable for use by knee osteoarthritis patients. Clinical relevance This new custom unloader knee orthosis produced a more valgus knee alignment by adjusting the pneumatic components attached to the thigh and leg shells. During static stance, it corrected frontal plane varus knee rotation by 6° in a single subject with knee osteoarthritis.

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Faculty Opinions recommendation of Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1131921.589030 ◽

2008 ◽

Author(s):

Nicola Maffulli ◽

Nikolaos Gougoulias

Keyword(s):

Knee Osteoarthritis ◽

High Tibial Osteotomy ◽

Medial Compartment ◽

Tibial Osteotomy ◽

Sporting Activity

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Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00324-3 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Margit Biehl ◽

Philipp Damm ◽

Adam Trepczynski ◽

Stefan Preiss ◽

Gian Max Salzmann

Keyword(s):

Gait Analysis ◽

Measurement Data ◽

Frontal Plane ◽

Medial Compartment ◽

Knee Adduction Moment ◽

In Vivo Measurement ◽

Force Ratio ◽

Leg Alignment ◽

Alignment Angle

Abstract Purpose Despite practised for decades, the planning of osteotomy around the knee, commonly using the Mikulicz-Line, is only empirically based, clinical outcome inconsistent and the target angle still controversial. A better target than the angle of frontal-plane static leg alignment might be the external frontal-plane lever arm (EFL) of the knee adduction moment. Hypothetically assessable from frontal-plane-radiograph skeleton dimensions, it might depend on the leg-alignment angle, the hip-centre-to-hip-centre distance, the femur- and tibia-length. Methods The target EFL to achieve a medial compartment force ratio of 50% during level-walking was identified by relating in-vivo-measurement data of knee-internal loads from nine subjects with instrumented prostheses to the same subjects’ EFLs computed from frontal-plane skeleton dimensions. Adduction moments derived from these calculated EFLs were compared to the subjects’ adduction moments measured during gait analysis. Results Highly significant relationships (0.88 ≤ R2 ≤ 0.90) were found for both the peak adduction moment measured during gait analysis and the medial compartment force ratio measured in vivo to EFL calculated from frontal-plane skeleton dimensions. Both correlations exceed the respective correlations with the leg alignment angle, EFL even predicts the adduction moment’s first peak. The guideline EFL for planning osteotomy was identified to 0.349 times the epicondyle distance, hence deducing formulas for individualized target angles and Mikulicz-Line positions based on full-leg radiograph skeleton dimensions. Applied to realistic skeleton geometries, widespread results explain the inconsistency regarding correction recommendations, whereas results for average geometries exactly meet the most-consented “Fujisawa-Point”. Conclusion Osteotomy outcome might be improved by planning re-alignment based on the provided formulas exploiting full-leg-radiograph skeleton dimensions.

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Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth?

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00160-0 ◽

2020 ◽

Vol 54 (S1) ◽

pp. 47-51

Author(s):

Najmul Huda ◽

Mir Shahid ul Islam ◽

Hemant Kumar ◽

Ajay Pant ◽

Sandeep Bishnoi

Keyword(s):

Knee Osteoarthritis ◽

Medial Compartment ◽

Fibular Osteotomy

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Cumulative loading of the medial compartment of the knee joint during Tai Chi gait in patients with knee osteoarthritis

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2015.02.820 ◽

2015 ◽

Vol 23 ◽

pp. A106

Author(s):

B. Decoux ◽

J.E. Kovaleski ◽

W. Liu

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

Tai Chi ◽

Medial Compartment

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EVALUATION OF OUTCOME OF MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY FOR UNICOMPARTMENTAL KNEE OSTEOARTHRITIS

10.36106/ijsr/2404839 ◽

2020 ◽

pp. 1-4

Author(s):

R. N. Shewale ◽

Ketan J. Khatri

Keyword(s):

Knee Osteoarthritis ◽

Functional Outcome ◽

High Tibial Osteotomy ◽

Medial Compartment ◽

Functional Score ◽

Tibial Osteotomy ◽

Knee Score ◽

Opening Wedge ◽

Wedge High Tibial Osteotomy ◽

The Mean

Background: Osteoarthritis is often found in weight-bearing joints, the knee being the most common site. Most patients of symptomatic osteoarthritis of knee are associated with varus malalignment that is causative or contributory to painful arthritis. Correcting the malalignment of the knee relieves symptoms by transferring the functional load to the unaffected compartment. The goal of the treatment is to relieve medial compartment knee pain and slow down the arthritic progression. We report the outcome of a simple technique of medial opening wedge high tibial osteotomy in treating the medial compartment osteoarthritis of the knee. Materials and method: A prospective interventional study was carried out over a period of 2 years from November 2017 to October 2019 in a sample size of randomly selected 41 patients having unilateral knee osteoarthritis. All patients after a proper preoperative assessment underwent high tibial osteotomy and the outcome was evaluated using knee society scoring system. Results: The age of the patients ranged from 40 – 65 years with a mean age of 51 years, 13 were males and 28 were females showing female predominance (68.2%). The mean knee score and the mean functional score of the patients before surgery were 60 and 61.95 respectively and post operatively at the end of 6 months the knee score and functional score was 77 and 80.53 respectively. By the end of 6 months out of 41 patients, 12 patients (29.2%) had excellent functional outcome, 18 patients (43.90%) had good functional outcome, 09 patients (21.95%) had fair functional outcome while only 02 patients (04.87%) had poor functional outcome. Conclusions: The present study shows that HTO is a good option in isolated medial compartment OA of knee. Significant increase in the knee score and functional score was found after high tibial osteotomy for the patients of osteoarthritis with varus deformity. Success of high tibial osteotomy relies on appropriate patient selection, proper osteotomy type and precise surgical technique.

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