Biomechanical Implications of an Oblique Knee Joint Line

2017 ◽  
Vol 31 (08) ◽  
pp. 761-766
Author(s):  
Jessica Hooper ◽  
Peter Walker ◽  
Tzu-Ting Hsu ◽  
Anton Kurtz ◽  
Ryan Reynolds ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tibial Plateau ◽  
Biomechanical Testing ◽  
Joint Line ◽  
Proxy Measure ◽  
Joint Line Obliquity ◽  
Secondary Deformity ◽  
Plane Deformity ◽  
Valgus Alignment ◽  
Contact Pressures

AbstractSurgical correction of multiapical deformities of the lower limb requires careful preoperative planning. Surgeons must account for the potential creation of secondary deformity, such as knee joint line obliquity, and the risks associated with accepting these changes in limb alignment. In this study, we evaluate the effect of knee joint obliquity on tibial plateau contact pressures and knee instability. Three cadaveric knees were dissected and put through biomechanical testing to simulate loading of an oblique knee joint. We observed < 1 mm femoral displacement (proxy measure of instability) between 15 degrees of varus tilt and 10 degrees of valgus tilt, and greater increases in tibial plateau contact pressures with valgus tilt than with varus tilt. Our results suggest that, if the creation of a secondary coronal plane deformity at the knee joint cannot be avoided, up to 15 degrees of varus or 10 degrees of valgus alignment can be tolerated by an otherwise structurally normal knee.

scholarly journals Knee Joint Line Obliquity Causes Tibiofemoral Subluxation That Alters Contact Areas and Meniscal Loading

2021 ◽  
pp. 036354652110204
Author(s):  
Dong Wang ◽  
Lukas Willinger ◽  
Kiron K. Athwal ◽  
Andy Williams ◽  
Andrew A. Amis
Keyword(s):  
Knee Joint ◽  
Tibial Plateau ◽  
Joint Line ◽  
Optical Tracking ◽  
Materials Testing ◽  
Contact Areas ◽  
Joint Line Obliquity ◽  
Joint Contact ◽  
Tibiofemoral Subluxation ◽  
Contact Pressures

Background: Little scientific evidence is available regarding the effect of knee joint line obliquity (JLO) before and after coronal realignment osteotomy. Hypotheses: Higher JLO would lead to abnormal relative position of the femur on the tibia, a shift of the joint contact areas, and elevated joint contact pressures. Study Design: Descriptive laboratory study. Methods: 10 fresh-frozen human cadaveric knees (age, 59 ± 5 years) were axially loaded to 1500 N in a materials testing machine with the joint line tilted 0°, 4°, 8°, and 12° varus (“downhill” medially) and valgus, at 0° and 20° of knee flexion. The mechanical compression axis was aligned to the center of the tibial plateau. Contact pressure and contact area were recorded by pressure sensors inserted between the tibia and femur below the menisci. Changes in relative femoral and tibial position in the coronal plane were obtained by an optical tracking system. Results: Both medial and lateral JLO caused significant tibiofemoral subluxation and pressure distribution changes. Medial (varus) JLO caused the femur to subluxate medially down the coronal slope of the tibial plateau, and vice versa for lateral (valgus) downslopes ( P < .01), giving a 6-mm range of subluxation. The areas of peak pressure moved 12 mm and 8 mm across the medial and lateral condyles, onto the downhill meniscus and the “uphill” tibial spine. Changes in JLO had only small effects on maximum contact pressures. Conclusion: A 4° change of JLO during load bearing caused significant mediolateral tibiofemoral subluxation. The femur slid down the slope of the tibial plateau to abut the tibial eminence and also to rest on the downhill meniscus. This caused large movements of the tibiofemoral contact pressures across each compartment. Clinical Relevance: These results provide important information for understanding the consequences of creating coronal JLO and for clinical practice in terms of osteotomy planning regarding the effect on JLO. This information provides guidance regarding the choice of single- or double-level osteotomy. Excessive JLO alteration may cause abnormal tibiofemoral joint articulation and chondral or meniscal loading.

scholarly journals Is there difference and correlation between medial and lateral tibial plateau coronal obliquity in native knee? A radiographic study

2021 ◽  
Vol 28 ◽  
pp. 221049172110569
Author(s):  
Thomas Ka Chun Leung ◽  
Will Wai Hong Lau ◽  
Wing Chiu Fung ◽  
Vincent Wai Kwan Chan ◽  
Amy Cheung ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Young Patients ◽  
Joint Line ◽  
Significant Implication ◽  
Lateral Tibial Plateau ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
Joint Line Obliquity

Background/Purpose Knee joint line is commonly defined as a tangent to medial and lateral tibial plateaus in various radiographic measurements. We aim to investigate radiographic differences between medial and lateral knee joint line coronal obliquity. It has significant implication on radiographic analysis following unicompartmental knee arthroplasty. Methods We analysed the knee radiographs of 48 young patients (mean age 25.1 + /-5.6 years) with 50 anterior cruciate ligament-deficient knees. Medial and lateral tibial plateau coronal obliquity were defined as angles between femoral knee joint line and the tangent to articular surface of each tibial plateau. Mediolateral differences and linear correlation were analysed. Results Significant difference was found between medial (mean = -1.5, SD = 2.4 degrees) and lateral obliquity (mean =  + 0.6, SD = 3.0 degrees) ( p < 0.001). The mean mediolateral difference was 3.1 degrees (SD = 2.8, range 0–11.8 degrees), without significant correlation (r = 0.085, p = 0.56). Conclusion Mediolateral differences exist in knee joint line obliquity. Each compartment should be considered separately when measuring knee joint line obliquity.

scholarly journals Knee ankle joint line angle: a critical value at 10。 for decompensated knee joint line obliquity in medial opening wedge osteotomy.

2020 ◽  
Author(s):  
Tzu-Hao Tseng ◽  
Kuan-Hung Hsu ◽  
Jyh-Horng Wang
Keyword(s):  
Linear Regression ◽  
Knee Joint ◽  
Multiple Linear Regression ◽  
Ankle Joint ◽  
Critical Value ◽  
Joint Line ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Line Angle ◽  
Joint Line Obliquity

Abstract Background: Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study aimed to investigate the capacity of the compensation by analyzing the correlation of the knee-ankle joint line angle (KAJA) and the knee joint line obliquity (KJLO).Methods: The correlations between postoperative KJLO and body mass index (BMI), correction amount, KAJA, mechanical lateral distal femoral angle (mLDFA), preoperative medial proximal tibia angle (MPTA), ankle joint line obliquity (AJLO), KJLO and mechanical hip-knee-ankle angle (mHKA) were analyzed using Pearson correlation coefficient. The contribution of significant factors was further analyzed using multiple linear regression. The KJLO between ≦ 5。, 5。-10。And ≧ 10。KAJA groups were compared using Kruskal-Wallis test.Results: Postoperative KAJA and preoperative KJLO moderately correlated to postoperative KJLO. Preoperative MPTA, mHKA, AJLO weakly correlated to postoperative KJLO. After multiple linear regression, only postoperative KAJA, preoperative MPTA and mHKA still showed significant contribution, while preoperative KAJA made the greatest contribution. The KJLO was substantial higher in the ≧ 10。KAJA group with a high rate (68%) of high-degree KJLO.Conclusions: 10。postoperative KAJA is a critical value for decompensated KJLO. The results suggest us carefully assess the KAJA intraoperatively. Double osteotomy should be considered if ideal alignment cannot be achieved when the KAJA reach 10。.

Analysis of Knee Joint Line Obliquity after High Tibial Osteotomy

2016 ◽  
Vol 29 (08) ◽  
pp. 649-657 ◽  
Author(s):  
Kwang-Jun Oh ◽  
Young Ko ◽  
Ji Bae ◽  
Suk Yoon ◽  
Jae Kim
Keyword(s):  
Knee Joint ◽  
High Tibial Osteotomy ◽  
Joint Line ◽  
Tibial Osteotomy ◽  
Joint Line Obliquity

What Is An Acceptable Limit of Joint-Line Obliquity After Medial Open Wedge High Tibial Osteotomy? Analysis Based on Midterm Results

2020 ◽  
Vol 48 (12) ◽  
pp. 3028-3035
Author(s):  
Ju-Ho Song ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee
Keyword(s):  
Multivariate Regression ◽  
Tibial Plateau ◽  
Multivariate Regression Analysis ◽  
Joint Line ◽  
Functional Score ◽  
Tibial Osteotomy ◽  
Acceptable Limit ◽  
Joint Line Obliquity ◽  
Wedge High Tibial Osteotomy

Background: Although joint-line obliquity (JLO) after open-wedge high tibial osteotomy (OWHTO) is commonly encountered, especially in cases of overcorrection, its effect has not been fully elucidated or has been assessed only in the short term. The acceptable range of JLO, often recognized as ≤4°, has not been determined as per the midterm outcomes of OWHTO. Hypothesis: Joint-line obliquity exceeding the acceptable limit after OWHTO would accelerate cartilage degeneration and adversely affect midterm clinical outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 109 patients who underwent OWHTO between 2010 and 2015 with a mean follow-up period of 55.0 months (range, 24-102 months) were reviewed. JLO was defined as the angle between the lines parallel to the floor and to the tibial plateau on a long-standing hip-to-ankle radiograph. For radiologic evaluation according to JLO, the medial joint space width (JSW) was measured on a standing 45° flexion posteroanterior view and standardized with the width of the tibial plateau as reference, after which changes in JSW (ΔJSW) between the 6- and 12-month postoperative period and the latest follow-up were calculated. ΔJSW was analyzed according to 2 different cutoff values of JLO: JLO of 4°, which is currently recognized as the acceptable limit, and that derived from the receiver operating characteristic (ROC) curve for the third quartile of ΔJSW. Multivariate regression analysis including JLO as well as other demographic and radiologic factors was performed. Clinical outcomes were evaluated in the same way using Knee Society (KS) objective and functional scores. Results: With a JLO cutoff of 4° in the multivariate regression analysis, JLO was not significantly associated with ΔJSW ( P = .545). However, in the KS objective and functional score analyses, JLO ≥4° was found to be a significant factor ( P = .045 and .005, respectively). The ROC curve showed a cutoff JLO of 6°, which was significantly associated with ΔJSW ( P = .001). JLO ≥6° remained significant in the analyses for KS objective and functional score ( P = .012 and .001, respectively). Conclusion: The adverse effect of JLO on radiologic outcomes was shown when JLO was ≥6°. In clinical aspects, worse outcomes were found in cases of JLO ≥4°.

scholarly journals Biomechanics of a novel extra-articular implant for younger patients with knee osteoarthritis

2018 ◽  
Vol 4 (1) ◽  
pp. 203-205
Author(s):  
Mehdi Saeidi ◽  
Maziar Ramezani ◽  
Piaras Kelly ◽  
Mohd Sabri Hussin ◽  
Thomas Neitzert
Keyword(s):  
Knee Joint ◽  
Cartilage Regeneration ◽  
Stress Distributions ◽  
Element Analysis ◽  
Medial Side ◽  
Pressure Distributions ◽  
Joint Contact ◽  
As Stress ◽  
Joint Contact Pressure ◽  
Contact Pressures

AbstractThis research aimed to study the efficacy of a novel implant for osteoarthritic knees. This implant is designed to eliminate excessive loads through the knee and to provide suitable conditions for possible tibiofemoral cartilage regeneration. The implant was designed for the medial side of the knee joint. Finite Element Analysis (FEA) was performed for an extended knee position of the knee joint. Contact pressure distributions on the medial and lateral compartments were investigated as well as stress distributions throughout the implant’s plates. Results with and without the implant were compared, and it was seen that the contact pressures on the surface of the distal femur were reduced by more than 90% after the introduction of the implant.

Internal Structural Connections in the Popliteal Muscle Tendon Complex and Their Clinical Significance

2021 ◽  
Author(s):  
WenBin Jiang ◽  
Shi-Zhu Sun ◽  
Ting-Wei Song ◽  
Chan Li ◽  
Wei Tang ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Knee Joint ◽  
Tibial Plateau ◽  
Lateral Meniscus ◽  
Posterior Edge ◽  
Dense Connective Tissue ◽  
Human Knee ◽  
Articular Capsule ◽  
Adjacent Structures ◽  
Popliteus Muscle

Abstract Background:The popliteal muscle-tendon complex (PMTC) belongs to the deep structure of the posterolateral complex (PLC) of human knee, which plays an important role in the posterolateral stability of the knee joint. At present, the anatomical relationship between the popliteal muscle and its adjacent structures remains controversial, especially the posterior cruciate ligament (PCL) and popliteal muscle. The revealation of anatomical connection between the popliteus muscle and its deep structures could provide an anatomical basis for the reconstruction of the PLC injury.Methods: To observe and analyze the relationship between popliteal muscle and the PCL, posterior meniscofemoral ligament (PMFL), lateral meniscus and articular capsule (AC). The dissection of 7 cases of adult human knee joint fixed with formalin, and 9 cases of sagittal P45 plastinated section of the knee joint were involved in this study. Results: For the popliteal muscle, the anatomical dissection showed that at the posterior edge of the platform of the lateral condyle of the tibia, at the tendon-muscle transition, from medial to lateral, separately sent out: dense connective tissue to connect with the PCL, dense fiber bundles to connect with the PMFL, and dense connective tissue band to connect the lateral meniscus. Meanwhile, the results of the P45 section revealed that the popliteal muscle fascia ran superiorly over the posterior edge of the tibialintercondylar eminence, andturned forward to be integrated into the PCL. Laterally, near the posterior edge of the lateral tibial plateau, the popliteal tendon penetrates through the articular capsule, where two dense fiberous bundleswere given off upwards by the popliteal tendon: one was the ventral fiber bundle,which ran superiorly over the posterior edge of the tibial plateau and then moved forwards to connect with the lateral meniscus; the dorsal fibersbundle ascended directly and participated in the AC.Conclusion: Popliteus muscle was connected with PCL, AC, lateral meniscus, and PMFL via the dense connective tissues near its tendon-muscle transition.

scholarly journals A Robot System for Biomechanical Testing of Knee Joint

2018 ◽  
Vol 170 ◽  
pp. 042079
Author(s):  
Lei Hu ◽  
Xinghua Yao ◽  
Jian Zhang ◽  
Hongpeng Liu
Keyword(s):  
Knee Joint ◽  
Biomechanical Testing ◽  
Robot System

scholarly journals Biomechanical Effects of Tibial Plateau Levelling Osteotomy on Joint Instability in Normal Canine Stifles: An In Vitro Study

2020 ◽  
Vol 33 (05) ◽  
pp. 301-307
Author(s):  
Masakazu Shimada ◽  
Tetsuya Takagi ◽  
Nobuo Kanno ◽  
Satoshi Yamakawa ◽  
Hiromichi Fujie ◽  
...  
Keyword(s):  
Joint Instability ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Biomechanical Testing ◽  
In Vitro Study ◽  
Axial Rotation ◽  
Testing System ◽  
Compression Tests ◽  
Cranial Cruciate Ligament

Abstract Objective The aim of the study was to determine the changes in biomechanical characteristics following tibial plateau levelling osteotomy (TPLO) using simulated manual tests. Study Design Twenty-one stifles from healthy Beagle dogs that had undergone TPLO or had not (control) were first tested in the intact form, and then the cranial cruciate ligament (CrCL) was transected in each to provide four test situations: control-intact, control-CrCL-transected, TPLO-intact and TPLO-CrCL-transected. The stifles were then analysed using a robotic joint biomechanical testing system. The craniocaudal drawer, axial rotation and proximal compression tests were applied. Results The craniocaudal displacement during the drawer test was not significantly different between the control-intact and TPLO-intact. However, the displacement was significantly greater in the TPLO-CrCL-transected than in the control-intact. In the axial rotation test, the internal–external (IE) rotation was significantly greater in the TPLO-intact than in the control-intact. Similarly, the IE rotation was significantly greater in the TPLO-CrCL-transected than in the control-CrCL-transected. In the proximal compression test, craniocaudal displacement was not significantly different among the control-intact, TPLO-intact and TPLO-CrCL-transected. Conclusion These findings suggest that TPLO influences the tension of the collateral ligaments and might generate laxity of the tibiofemoral joint. Instability after the osteotomy might be associated with the progression of osteoarthritis.

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