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。.

scholarly journals 20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Lawrence DiDomenico ◽  
Danielle Butto
Keyword(s):  
Ankle Joint ◽  
Deformity Correction ◽  
Total Ankle Arthroplasty ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Ankle Arthroplasty ◽  
Initial Surgery ◽  
Post Traumatic ◽  
Ankle Valgus

Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.

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 Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jae-Young Park ◽  
Chong Bum Chang ◽  
Dong-Wan Kang ◽  
Sohee Oh ◽  
Seung-Baik Kang ◽  
...  
Keyword(s):  
Linear Regression ◽  
Knee Joint ◽  
High Tibial Osteotomy ◽  
Linear Regression Analysis ◽  
External Validation ◽  
Joint Line ◽  
Line Orientation ◽  
Tibial Osteotomy ◽  
Correction Angle ◽  
Anatomical Alignment

Abstract Background Maintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO. Methods A total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution. Results After HTO, KJLO increased from − 0.8° to 2.9° (P < 0.001). Based on the multivariable linear regression analysis, an equation was derived that can estimate postoperative KJLO after HTO; postoperative KJLO(°) = 1.029 + 0.560 × preoperative KJLO(°) + 0.310 × preoperative tibia plateau inclination(°) + 0.463 × aimed correction angle(°). The adjusted coefficients of determination value for this equation was 0.721. The equation also showed good calibration and predictability in external validation with predicted squared correlation coefficient of 0.867. Conclusions This study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO.

scholarly journals Changes of ankle inclinations after total knee arthroplasty

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0010
Author(s):  
Murat Celal Sözbilen ◽  
Elcil Kaya Biçer ◽  
Semih Aydoğdu ◽  
Hakkı Sur
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Ankle Joint ◽  
Knee Arthroplasty ◽  
Joint Line ◽  
X Rays ◽  
Group I ◽  
Total Knee ◽  
Group Ii ◽  
Line Inclination

Aim: To evaluate the changes in ankle joint line inclination in patients who had total knee arthroplasty due to degenerative osteoarthritis. Material/Method: Sixty-two knees (with a mean age of 71,66±6,78 years, follow-up 52,34±27,42 months) which had undergone total knee arthroplasty between November 1996 and May 2014 were included in this retrospective study. The knee joint line orientations (KJLO) of the prosthesis and ankle joint line inclination (AJLI) relative to the floor were evaluated on postoperative standard standing long-leg X-rays. The AJLI relative to the floor was defined as the angle between the tangent to the subchondral plate of the talus and the horizontal grid line on radiographs. In order to determine the effects of KJLO and high varus on AJLI, patients were divided into two each groups that were pre-operative mechanical axes (MA) as <20° (n=35, group1) and >=20° (n=27, group2) and post-operative MA <3° (n=32, group a) and >=3° (n=30, group b). In addition, the changes in AJLI were compared between each group. The patients were regrouped as either <=3° (n=28, group i) or >3° (n=34, group ii), in terms of the postoperative KJLO. Inclination angles of the prosthesis were compared between each groups. Statistical analysis was performed with SPSS v18. Results: Mean MA of pre-operative and post-operative were 16,35±6,56° and 3,92±3,35°, respectively. All ankle inclinations were lateralized. AJLI, were significantly decreased from pre-operative mean 7,37°±3,19° to post-operative mean 3,71°±2,22° (p<0,0001). The mean of change was 3,65°±3,03°. However, pre-operative AJLIs were significantly increased in high varus group (group1: 6,34°±2,54°, group2: 8,70°±3,48°, p=0,003); post-operative AJLIs did not differ significantly (group1: 3,55°±2,36°, group2: 3,92°±2,05°, p=0,516) with respect to the MA. The changes in preop-postop AJLI’s were significantly higher in high varus group again (p=0,009). When the KJLO groups were compared, pre-operative AJLIs were significantly different (group i: 6,25°±2,33°, group ii: 8,29°±3,53°, p=0,004) while post-operative AJLIs did not differ significantly (group i: 3,46°±2,38°, group ii: 3,92°±2,08°, p=0,489). Conclusion: Pre-operatively high varus knees also had high ankle varus, hence ankle deformity was corrected by the restoration of the optimal lower limb aligment. Obtaining parallel orientation of the components relative to the ground, restored the AJLI. Pre-operative planning and convenient implantation of the components lead to achieve optimum knee orientation which restored the ankle joint line orientation independent from mechanical axes. Not only the goal of optimum mechanical axes but also optimum knee joint line orientation’s importance was demonsrated.

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.

Joint Line Obliquity Does Not Affect the Outcomes of Opening Wedge High Tibial Osteotomy at an Average 10-Year Follow-up

2021 ◽  
pp. 036354652110598
Author(s):  
Federica Rosso ◽  
Roberto Rossi ◽  
Antonino Cantivalli ◽  
Carola Pilone ◽  
Davide Edoardo Bonasia
Keyword(s):  
Joint Line ◽  
Function Score ◽  
Opening Wedge ◽  
Kaplan Meier ◽  
Ankle Angle ◽  
Joint Line Obliquity ◽  
The Mean ◽  
And Function ◽  
Hip Knee Ankle Angle

Background: A significant number of high tibial osteotomies (HTOs) result in an overcorrected tibia and subsequent excessive lateral joint line obliquity (JLO). The correlation between excessive JLO and poor outcomes is controversial. Purpose: To evaluate the prognostic factors (including a pathological postoperative JLO) related with the outcomes of opening wedge HTO at 10 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing HTO between 2004 and 2017 for medial osteoarthritis and with a postoperative hip-knee-ankle angle between 176° and 185° were included. Clinical evaluation included Knee Society Score (KSS; knee score and function score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale for pain. Several mechanical and anatomic angles were measured pre- and postoperatively on long-leg weightbearing radiographs. Abnormal JLO was defined as a Mikulicz–joint line angle (MJL) ≥94° or a mechanical medial proximal tibial angle (mMPTA) ≥95°. Regression analysis was performed to evaluate the association between independent variables and each outcome. A Kaplan-Meier cumulative survival analysis was performed. Results: A total of 92 knees in 76 patients were included. The mean age of the patients was 53.5 years (SD, 9.7 years), and the mean follow-up was 129.4 months (SD, 44.4 months). Increased JLO was associated with a significant preoperative varus deformity (small preoperative hip-knee-ankle angle), increased mechanical lateral distal femoral angle, increased joint line congruency angle, and increased knee-ankle joint angle. Male sex was associated with better WOMAC scores ( P = .0277), and increased body mass index (BMI) was associated with inferior WOMAC scores ( P = .0024). A good preoperative range of motion was associated with better knee score ( P = .0399) and function score ( P = .0366) on the KSS. An increased BMI was associated with inferior KSS function scores ( P = .0317). MJL ≥94° and mMPTA ≥95° were not associated with inferior WOMAC or KSS outcomes. With indication to total knee arthroplasty as an endpoint, Kaplan-Meier analysis showed a survival rate of 98.7% at 5 years, 95.5% at 10 years, and 92.7% at 12 years. Conclusion: Increased lateral JLO (MJL ≥94° or mMPTA ≥95°) was not correlated with the clinical outcomes of opening wedge HTO at 10 years of follow-up.

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
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