Document Detail

The influence of alignment on the musculo-skeletal loading conditions at the knee.
MedLine Citation:
PMID:  13680238     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM: High tibial osteotomies attempt to recreate physiologically normal joint loading. Previous studies have discussed the influence of mal-alignment on the distribution of static loads to the medial and lateral compartments of the knee. The aim of this study was to determine the influence of mal-alignment on the tibio-femoral loading conditions during dynamic activities. MATERIAL AND METHODS: Using a musculo-skeletal model of the lower limb, which had been previously validated with in vivo data, in this study we modified the alignment of the knee in four patients, from a normal position to the extremes of 8 degrees valgus and 10 degrees varus mal-alignment. The resulting tibio-femoral joint contact forces were examined while patients were walking and stair climbing. RESULTS: Varying the mal-alignment resulted in a highly individual response in joint loads. Deviations from the normal alignment produced an increase in loading, with valgus generating a more rapid increase in loading than a varus deformity of the same amount. Varus deformities of 10 degrees resulted in increases in peak contact force from an average of 3.3-times bodyweight (BW) up to a peak of 7.4 BW (+45% to +114%) while patients were walking, whilst increases of 15% up to 35% were determined for stair climbing. Increases of up to 140% were calculated at 8 degrees valgus during walking and up to 53% for stair climbing. CONCLUSION: This study demonstrated a clear dependence of the individual joint loads on axial knee alignment. Based on the sensitivity of joint loading to valgus mal-alignment, more than 3 degrees of over-correction of a varus deformity to valgus should be carefully reconsidered.
Markus O Heller; William R Taylor; Carsten Perka; Georg N Duda
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-09-12
Journal Detail:
Title:  Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie     Volume:  388     ISSN:  1435-2443     ISO Abbreviation:  Langenbecks Arch Surg     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-30     Completed Date:  2004-03-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9808285     Medline TA:  Langenbecks Arch Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  291-7     Citation Subset:  IM    
Trauma and Reconstructive Surgery, Charité, Humboldt-University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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MeSH Terms
Bone Malalignment / physiopathology
Femur / physiopathology*
Knee Joint / physiopathology*
Middle Aged
Muscle, Skeletal / physiopathology
Tibia / physiopathology*

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