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Rupp MC, Hochberger F, Berthold DP, Muench LN, Imhoff AB, Siebenlist S, Willinger L. Tibiofemoral Subluxation on Radiograph as a Predictor of Location and Size of Osteochondritis Dissecans Lesions of the Knee. Orthop J Sports Med 2024; 12:23259671241232397. [PMID: 38455152 PMCID: PMC10919139 DOI: 10.1177/23259671241232397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/09/2024] Open
Abstract
Background Lower limb malalignment has been associated with osteochondritis dissecans (OCD). However, the location of the OCD lesion often is not concordant with the mechanical leg axis. Other potentially modifiable alignment parameters may influence the propensity for impingement of the femoral condyles. Purpose To assess differences in lower limb alignment (LLA) and relative tibiofemoral position between patients with medial (MFC-OCD) or lateral OCD (LFC-OCD) of the femoral condyle. Study Design Cohort study; Level of evidence, 3. Methods Patients ≤30 years old who were diagnosed with unicondylar OCD between January 2010 and January 2020 were eligible for this study. Included were 55 patients (age, 20.8 ± 4.5 years)-46 with MFC-OCD and 9 with LFC-OCD. Preoperative standing long-leg radiographs were studied to obtain primary outcomes-including LLA and mechanical alignment analyses-and secondary outcomes-including knee joint obliquity angle; rotation angle; medial, central (c-subluxation), and lateral subluxation (L-subluxation) of the tibia relative to the femur in the coronal plane; and tibiofemoral joint line center distance (TFJCD). Results With regard to primary outcomes, LLA was significantly different between MFC-OCD (1.7°± 3.1° varus) and LFC-OCD (2.7 ± 3.1° valgus) (P < .001), and 78% (36/46) of patients with MFC-OCD had varus alignment, whereas 78% (7/9) of patients with LFC-OCD had valgus alignment (P < 0.002). With regard to secondary outcomes, patients with MFC-OCD had a more medial tibial position in relation to the femur, with a significantly smaller rotation angle (5.6°± 2.4° vs 9.6°± 3.6°; P < .001), a smaller C-subluxation (7.2 ± 6.6 vs 14.9 ± 8.8 mm; P < .01), a smaller L-subluxation (2.3 ± 2.6 vs 4.4 ± 2.7 mm; P < .05), and reduced TFJCD (3.5 ± 1.7 vs 6.6 ± 1.8 mm; P < .001) compared with the LFC-OCD group. For patients with MFC-OCD, the size of the OCD was significantly correlated with C-subluxation (r = 0.412; P = .006). Conclusion LLA was significantly different according to OCD location. In patients with MFC-OCD, the tibia was subluxated medially, resulting in a change of joint geometry by approximation of the medial tibial eminence toward the medial femoral condyle, potentially causing excessive pressure overload and microtrauma of the cartilage. Interestingly, the extent of subluxation was correlated with OCD size.
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Affiliation(s)
| | - Felix Hochberger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Daniel P. Berthold
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU Munich), Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | | | - Lukas Willinger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
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Turati M, Anghilieri FM, Bigoni M, Rigamonti L, Tercier S, Nicolaou N, Accadbled F. Osteochondritis dissecans of the knee: Epidemiology, etiology, and natural history. J Child Orthop 2023; 17:40-46. [PMID: 36755551 PMCID: PMC9900014 DOI: 10.1177/18632521221149063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/14/2022] [Indexed: 01/29/2023] Open
Abstract
Osteochondritis dissecans of the knee is a disease that typically affects skeletally immature patients. Clinically manifested with knee pain, limping, and joint disfunction, this condition has remained misunderstood and undervalued for a long period. Although being a rare condition, its awareness is of utmost clinical interest because of the possible severe consequences it can bring when misrecognized or inadequately treated. Its etiology remains unclear and is still debated. Many theories have been proposed, including inflammation, local ischemia, subchondral ossification abnormalities, genetic factors, and repetitive mechanical microtrauma, with a likely interplay of the same. This review article aims to deliver and discuss current and up-to-date concepts on epidemiology, etiology, and natural history of this pediatric condition. Level of evidence: level V.
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Affiliation(s)
- Marco Turati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | | | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Luca Rigamonti
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Stephane Tercier
- Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Nicolaou
- Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Franck Accadbled
- Department of Orthopedics, Children’s Hospital, Toulouse University Hospital, Toulouse, France
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Andriolo L, Crawford DC, Reale D, Zaffagnini S, Candrian C, Cavicchioli A, Filardo G. Osteochondritis Dissecans of the Knee: Etiology and Pathogenetic Mechanisms. A Systematic Review. Cartilage 2020; 11:273-290. [PMID: 29998741 PMCID: PMC7298596 DOI: 10.1177/1947603518786557] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The purpose of this manuscript is to analyze the evidence regarding etiopathogenesis of knee osteochondritis dissecans (OCD) lesions through a systematic review, so to summate the current understanding of the origin and progression of this pathologic articular processes. DESIGN A systematic review of the literature was performed on the PubMed and Cochrane databases on October 2017 by 2 independent authors and included all levels of evidence. This included all English language literature, pertaining specifically to etiopathology of knee OCD with exclusions for review articles and expert opinion. Of 965 identified records, 154 full-text articles were assessed for eligibility and 86 studies met the inclusion criteria. RESULTS According to these studies, the etiology of OCD can be of a biological or mechanical origin: 40 articles proposed a biological hypothesis, including genetic causes (27), ossification center deficit (12), and endocrine disorders (9); conversely, 52 articles supported a mechanical hypothesis, including injury/overuse (18), tibial spine impingement (5), discoid meniscus (16), and biomechanical alterations (20) as the cause of the onset of OCD. The pathogenic processes were investigated by 36 of these articles, with a focus on subchondral bone fracture and ischemia as the ultimate events leading to OCD. CONCLUSIONS Biological and mechanical factors are found to result in subchondral bone remodeling alterations, acting independently or more likely synergically in the progression of knee OCD. The former includes genetic causes, deficit of ossification centers and endocrine disorders; the latter, tibial spine impingement, discoid meniscus, and biomechanical alterations, together with injuries and overuse. The resultant subchondral bone ischemia and/or fracturing appears to determine the onset and progression of OCD. LEVEL OF EVIDENCE Systematic review of level II-IV studies, level IV.
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Affiliation(s)
- Luca Andriolo
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Dennis C. Crawford
- Department of Orthopaedics &
Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Davide Reale
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy,Davide Reale, II Orthopaedic and
Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano,1/10, 40136
Bologna, Italy.
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - Alessia Cavicchioli
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giuseppe Filardo
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy
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Cavaignac E, Perroncel G, Thépaut M, Vial J, Accadbled F, De Gauzy JS. Relationship between tibial spine size and the occurrence of osteochondritis dissecans: an argument in favour of the impingement theory. Knee Surg Sports Traumatol Arthrosc 2017; 25:2442-2446. [PMID: 26658568 DOI: 10.1007/s00167-015-3907-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/26/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Pathophysiology of osteochondritis dissecans (OCD) of the medial femoral condyle remains uncertain. Specifically, the relationship between the size of the anterior tibial spine (ATS) and the presence of OCD has not been explored. The purpose of this study was to evaluate the relationship between ATS size and the occurrence of OCD. METHODS Seventy-nine children between 8 and 17 years of age were included in two groups: OCD (n = 37) and control (n = 42). The groups were matched in terms of age, gender, BMI and weight. Two independent observers performed an MRI analysis of the size of the tibial spine and intercondylar notch relative to the size of the respective epiphyses. For this study, the "S ratio" was calculated by dividing the height of the tibial spine by the height of the tibial epiphysis. The "N ratio" was calculated by dividing the height of the notch by the height of the femoral epiphysis. These two ratios for both groups were compared using Student's t test. RESULTS The mean value of the S ratio in the OCD group was 0.39 ± 0.06; the mean value of the S ratio in the control group was 0.32 ± 0.03 (P = 0.004). The mean value of the N ratio in the OCD group was 0.70 ± 0.08; the mean value of the N ratio in the control group was 0.70 ± 0.07 (n.s.). CONCLUSION This study's findings confirm our hypothesis that patients with OCD have a more prominent tibial spine than in patients without OCD. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 1 place Baylac, 31000, Toulouse, France.
| | - Geoffroy Perroncel
- Pediatric Radiology Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
| | - Mathias Thépaut
- Pediatric Orthopedic Surgery Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
| | - Julie Vial
- Pediatric Radiology Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
| | - Franck Accadbled
- Pediatric Orthopedic Surgery Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
| | - Jérôme Sales De Gauzy
- Pediatric Orthopedic Surgery Department, Hôpital des enfants, CHU Toulouse, Toulouse, France
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Femoral Version and Tibial Torsion are Not Associated With Hip or Knee Arthritis in a Large Osteological Collection. J Pediatr Orthop 2017. [PMID: 26214325 DOI: 10.1097/bpo.0000000000000604] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tibial torsion and femoral anteversion are common rotational abnormalities in children, and their courses are most often benign and self-resolving. Although neither usually requires surgical treatment, the decision to perform a derotational osteotomy is usually based on the degree of functional impairment. Neither condition is thought to influence the development of osteoarthritis of the hip or knee; however, to date there have been no large scale studies confirming this. METHODS Tibial torsion and femoral version in 1158 cadaveric tibiae and femora were measured using a camera setup based on previously described radiographic landmarks. Any specimens with obvious traumatic, rheumatic, or metabolic abnormalities were excluded. Degenerative joint disease of the hip and knee were each graded from 0 to 6. Correlations between tibial torsion, femoral version, age, race, and sex with osteoarthritis of the hip and knee joints were evaluated with multiple regression analysis. RESULTS The mean and SDs of tibial torsion and femoral anteversion were 7.9±8.8 and 11.4±12.0 degrees, respectively. African Americans had significantly increased tibial torsion (5.1±8.7 vs. 9.2±8.5 degrees, P<0.0005) and greater femoral anteversion (14.1±11.9 vs. 10.2±11.8 degrees, P<0.0005) compared with whites. The average grades for hip and knee osteoarthritis were 3.1±1.4 and 2.7±1.4. Using multiple regression analysis neither tibial torsion nor femoral version were independent predictors of hip or knee arthritis (P>0.05 for all). DISCUSSION This study confirmed previously reported differences in the rotational profiles between races and sexes. However, neither tibial torsion nor femoral anteversion had a significant influence on the development of arthritis of the hip or knee. CLINICAL RELEVANCE These results support the practice of treating tibial torsion and femoral anteversion based on the symptomatology of the patient. Parents of asymptomatic children can be reassured that long-term consequences are unlikely.
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Ishikawa M, Adachi N, Yoshikawa M, Nakamae A, Nakasa T, Ikuta Y, Hayashi S, Deie M, Ochi M. Unique Anatomic Feature of the Posterior Cruciate Ligament in Knees Associated With Osteochondritis Dissecans. Orthop J Sports Med 2016; 4:2325967116648138. [PMID: 27294170 PMCID: PMC4887879 DOI: 10.1177/2325967116648138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Osteochondritis dissecans (OCD) of the knee is a disorder in juveniles and young adults; however, its etiology still remains unclear. For OCD at the medial femoral condyle (MFC), it is sometimes observed that the lesion has a connection with fibers of the posterior cruciate ligament (PCL). Although this could be important information related to the etiology of MFC OCD, there is no report examining an association between the MFC OCD and the PCL anatomy. Purpose: To investigate the anatomic features of knees associated with MFC OCD, focusing especially on the femoral attachment of the PCL, and to compare them with knees associated with lateral femoral condyle (LFC) OCD and non-OCD lesions. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 39 patients (46 knees) with OCD lesions who had undergone surgical treatment. Using magnetic resonance imaging (MRI) scans, the PCL attachment at the lateral wall of the MFC was measured on the coronal sections, and the knee flexion angle was also measured on the sagittal sections. As with non-OCD knees, we reviewed and analyzed 25 knees with anterior cruciate ligament (ACL) injuries and 16 knees with meniscal injuries. Results: MRIs revealed that the femoral PCL footprint was located in a significantly more distal position in the patients with MFC OCD compared with patients with LFC OCD and ACL and meniscal injuries. There was no significant difference in knee flexion angle among the 4 groups. Conclusion: The PCL in patients with MFC OCD attached more distally at the lateral aspect of the MFC compared with knees with LFC OCD and ACL and meniscal injuries.
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Affiliation(s)
- Masakazu Ishikawa
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Yoshikawa
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seiju Hayashi
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masataka Deie
- Laboratory of Musculoskeletal Functional Research and Regeneration, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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Wechter JF, Sikka RS, Alwan M, Nelson BJ, Tompkins M. Proximal tibial morphology and its correlation with osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:3717-22. [PMID: 25248309 DOI: 10.1007/s00167-014-3289-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 08/28/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE The relationship of proximal tibial morphology to the presence of femoral osteochondritis dissecans (OCD) lesions is unknown. This radiographic study tested the null hypothesis that knees with unilateral medial or lateral OCD lesions would have no difference in the slope of their medial, lateral, or posterior tibial plateau compared with unaffected knees. METHODS There were 72 patients with unilateral OCD lesions of the medial or lateral femoral condyle seen at our institution from 2005 to 2011. On AP and lateral radiographs of the knee, three examiners conducted independent measurements of the tibial plateau posterior slope, as well as medial and lateral slope as measured from the peak of the tibial spine to the edge of the plateau on the side of the corresponding OCD lesion. Measurements were repeated on normal contralateral and matched control knees. RESULTS Knees with medial femoral condyle OCD lesions had greater medial tibial slope compared with normal contralateral knees (p = 0.007) and normal controls (p < 0.04). Knees with lateral femoral condyle OCD lesions had no significant difference in lateral tibial slope compared with the contralateral knee or matched controls. Posterior slope was greater in knees with medial OCD lesions than matched controls (p = 0.007). Intraclass correlation coefficients demonstrated consistency between observers for all measurements. CONCLUSION An assessment of proximal tibial morphology demonstrated greater medial and posterior tibial slope in knees with medial OCD lesions compared with normal knees. The technique for measuring medial and lateral tibial slope was reliable among evaluators. The clinical relevance is that proximal tibial morphology may have a relationship with OCD lesions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- John F Wechter
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA.
| | - Robby Singh Sikka
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA.,TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Mujtaba Alwan
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA
| | - Bradley J Nelson
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA.,TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA.,TRIA Orthopaedic Center, Bloomington, MN, USA
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Papaioannou TA, Digas G, Bikos C, Karamoulas V, Magnissalis EA. Femoral neck version affects medial femorotibial loading. ISRN ORTHOPEDICS 2013; 2013:328246. [PMID: 24959355 PMCID: PMC4045292 DOI: 10.1155/2013/328246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 01/22/2013] [Indexed: 01/26/2023]
Abstract
The aim of this study was to provide a preliminary evaluation of the possible effect that femoral version may have on the bearing equilibrium conditions developed on the medial tibiofemoral compartment. A digital 3D solid model of the left physiological adult femur was used to create morphological variations of different neck-shaft angles (varus 115, normal 125, and valgus 135 degrees) and version angles (-10, 0, and +10 degrees). By means of finite element modeling and analysis techniques (FEM-FEA), a virtual experiment was executed with the femoral models aligned in a neutral upright position, distally supported on a fully congruent tibial tray and proximally loaded with a vertical only hip joint load of 2800 N. Equivalent stresses and their distribution on the medial compartment were computed and comparatively evaluated. Within our context, the neck-shaft angle proved to be of rather indifferent influence. Reduction of femoral version, however, appeared as the most influencing parameter regarding the tendency of the medial compartment to establish its bearing equilibrium towards posteromedial directions, as a consequence of the corresponding anteroposterior changes of the hip centre over the horizontal tibiofemoral plane. We found a correlation between femoral anteversion and medial tibiofemoral compartment contact pressure. Our findings will be further elucidated by more sophisticated FEM-FEA and by clinical studies that are currently planned.
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Affiliation(s)
- T. A. Papaioannou
- Department of Orthopaedics, General Hospital of Xanthi, 67100 Xanthi, Greece
| | - Georgios Digas
- Department of Orthopaedics, General Hospital of Xanthi, 67100 Xanthi, Greece
| | - Ch. Bikos
- Department of Orthopaedics, General Hospital of Xanthi, 67100 Xanthi, Greece
| | - V. Karamoulas
- Department of Orthopaedics, General Hospital of Xanthi, 67100 Xanthi, Greece
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Kenawey M, Liodakis E, Krettek C, Ostermeier S, Horn T, Hankemeier S. Effect of the lower limb rotational alignment on tibiofemoral contact pressure. Knee Surg Sports Traumatol Arthrosc 2011; 19:1851-9. [PMID: 21448663 DOI: 10.1007/s00167-011-1482-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 03/15/2011] [Indexed: 01/26/2023]
Abstract
PURPOSE The effect of the rotational alignment of lower extremities on the tibiofemoral contact mechanics is not known. This study was designed to measure the contact area and pressure within medial and lateral tibiofemoral compartments following controlled serial rotational deformities through femoral and tibial shafts. METHODS Eight lower extremities of fresh frozen cadavers were used. Computed tomography was conducted to measure the rotational profile of the lower extremities. Through a medial parapatellar arthrotomy, pressure sensors were implanted into both tibiofemoral compartments. Femoral and tibial mid-shaft osteotomies were performed and stabilized by non-locked intramedullary nails and external fixators in neutral rotation. The contact area and pressure were measured under axial loading in neutral rotation and following serial malrotations from 40° external to 40° internal malrotation in 10° increments. RESULTS Contact area was not affected by malrotations. Medial compartment contact pressure rose with external and decreased with internal malrotations whether femoral or tibial (P < 0.0001) while lateral pressure was not affected. When correlated with the cadavers' original rotational profile, decreased femoral neck anteversion was associated with increased medial pressure up to 28.5% at 20° of retroversion while it decreased with increased anteversion. On the other hand, decreased tibial torsion angle was associated with decreased medial pressure up to -32% at 10° of internal torsion and it increased with excessive external torsion. Furthermore, there was a strong positive correlation with the total rotational alignment as measured by the neck malleolar angle. CONCLUSION A significant interaction could be detected between the rotational alignment of the lower extremity and medial tibiofemoral compartment contact pressures.
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Affiliation(s)
- Mohamed Kenawey
- Trauma Department, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany.
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Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Association between mechanical axis of the leg and osteochondritis dissecans of the knee: radiographic study on 103 knees. Am J Sports Med 2010; 38:1425-8. [PMID: 20351199 DOI: 10.1177/0363546509359070] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The cause of osteochondritis dissecans (OCD) is unknown, but mechanical factors seem to play a role. PURPOSE To identify a relationship between localization of OCD and mechanical axis of the leg. STUDY DESIGN Case series; Level of evidence, 4. METHODS Using bilateral full-leg standing radiographs, we analyzed the position of the mechanical axis of the leg in a group of 93 adolescent and adult patients (103 knees) with OCD of the medial or lateral femoral condyle. RESULTS The location of OCD and the position of the mechanical axis in the same knee compartment was significantly correlated for both knees with medial (P < .001) as well as lateral (P < .012) compartment OCD. In the medial OCD group, the mean mechanical axis was located in the medial knee compartment (28% medial +/- 2.8%; range, 100% medial to 14% lateral) with a statistically insignificant medial shift with respect to the unaffected side. In lateral OCD, the mean mechanical axis was located laterally (13% lateral +/- 3.9%; range, 13% medial to 60% lateral) with a significant shift from the medial into the lateral knee compartment when comparing unaffected with affected knees. No significant difference was observed between adolescents with open growth plates compared with adults with closed growth plates (P > .05). CONCLUSION We found an association between medial condyle OCD and varus axis and between lateral condyle OCD and valgus axis. This evokes higher loading of the affected than of the unaffected knee compartment, and therefore, axial alignment may be a cofactor in OCD of the femoral condyles.
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Affiliation(s)
- Matthias Jacobi
- Department of Orthopaedic Surgery, Hôpital Cantonal Fribourg, 1708 Fribourg, Switzerland.
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Mackie T, Wilkins RM. Case report: Osteochondritis dissecans in twins: treatment with fresh osteochondral grafts. Clin Orthop Relat Res 2010; 468:893-7. [PMID: 19662464 PMCID: PMC2816755 DOI: 10.1007/s11999-009-1017-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 07/21/2009] [Indexed: 01/31/2023]
Abstract
Osteochondritis dissecans is a lesion of subchondral bone with subsequent involvement of the overlying cartilage. Although the etiology of the disease is unknown, mechanical, traumatic, and ischemic etiologies have been suggested, in addition to developmental and genetic factors. There are several treatment options depending on the stage of the disease and surgeon preference. The use of a fresh osteochondral allograft for treatment of a lesion of the femoral condyle is relatively new, and we report its use in a unique situation involving identical twins who both presented with osteochondritis dissecans of the same anatomic location within 2 years of each other. Since these were identical lesions in identical twins, this commonality supports the suggestion that some genetic component may be present in the etiology, especially in this situation where a genetic connection existed. We recommend genetic studies to determine the extent of genetic influence on the disease.
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Affiliation(s)
- Timothy Mackie
- The Denver Clinic for Extremities at Risk, Presbyterian/St. Luke’s Medical Center, 1601 East 19th Avenue, Suite 3250, Denver, CO 80218 USA
| | - Ross M. Wilkins
- The Denver Clinic for Extremities at Risk, Presbyterian/St. Luke’s Medical Center, 1601 East 19th Avenue, Suite 3250, Denver, CO 80218 USA
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Stotts AK, Stevens PM. Tibial rotational osteotomy with intramedullary nail fixation. Strategies Trauma Limb Reconstr 2009; 4:129-33. [PMID: 19941168 PMCID: PMC2787209 DOI: 10.1007/s11751-009-0076-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 11/12/2009] [Indexed: 12/02/2022] Open
Abstract
There are several theoretic advantages of using intramedullary rod fixation for tibial osteotomy fixation. We performed a retrospective review of patients who were treated with a mid-diaphyseal osteotomy of the tibia fixed with an intramedullary rod for isolated, symptomatic tibial torsion. Forty patients (59 tibias) were included in the study and were followed for a minimum of 12 months or until rod removal (average follow-up 22.6 months). Major complication rate was 8.5%, which is comparable to alternative methods of fixation. We believe that intramedullary rods are a safe alternative for fixation of tibial rotational osteotomy in patients with physeal closure.
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Affiliation(s)
- Alan K. Stotts
- Orthopaedic Surgery, Primary Children’s Medical Center, University of Utah, 100 Mario Capecchi Drive #4550, Salt Lake City, UT 84113 USA
| | - Peter M. Stevens
- Orthopaedic Surgery, Primary Children’s Medical Center, University of Utah, 100 Mario Capecchi Drive #4550, Salt Lake City, UT 84113 USA
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Garling EH, Kaptein BL, Nelissen RGHH, Valstar ER. Limited rotation of the mobile-bearing in a rotating platform total knee prosthesis. J Biomech 2007; 40 Suppl 1:S25-30. [PMID: 17433337 DOI: 10.1016/j.jbiomech.2007.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The hypothesis of this study was that the polyethylene bearing in a rotating platform total knee prosthesis shows axial rotation during a step-up motion, thereby facilitating the theoretical advantages of mobile-bearing knee prostheses. We examined 10 patients with rheumatoid arthritis who had a rotating platform total knee arthroplasty (NexGen LPS mobile, Zimmer Inc. Warsaw, USA). Fluoroscopic data was collected during a step-up motion six months postoperatively. A 3D-2D model fitting technique was used to reconstruct the in vivo 3D kinematics. The femoral component showed more axial rotation than the polyethylene mobile-bearing insert compared to the tibia during extension. In eight knees, the femoral component rotated internally with respect to the tibia during extension. In the other two knees the femoral component rotated externally with respect to the tibia. In all 10 patients, the femur showed more axial rotation than the mobile-bearing insert indicating the femoral component was sliding on the polyethylene of the rotating platform during the step-up motion. Possible explanations are a too limited conformity between femoral component and insert, the anterior located pivot location of the investigated rotating platform design, polyethylene on metal impingement and fibrous tissue formation between the mobile-bearing insert and the tibial plateau.
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Affiliation(s)
- E H Garling
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands.
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