Article

Torsion deformity and joint loading for medial knee osteoarthritis

Department of Orthopaedic Surgery, Kaleida/Buffalo General Hospital, Buffalo, NY 14203, United States.
Gait & posture (Impact Factor: 2.75). 03/2011; 33(4):625-9. DOI: 10.1016/j.gaitpost.2011.02.006
Source: PubMed

ABSTRACT

The consequences of lower limb torsion deformity on knee loading in knee osteoarthritis are poorly understood. The purpose of this study was to quantify the associations between the mechanical axis, tibial torsion and knee loading in subjects with medial knee OA and in controls.
Twenty-four subjects: end-staged medial knee osteoarthritis (OA) with apparent torsion deformity (TKO, n=6) and without torsion deformity (KOA, n=8) and controls (CON, n=10) were imaged using long standing lower extremity (LSLE) radiographs and computed tomography (CT). Medial knee loading was assessed using the internal knee varus moment determined by gait analysis. The LSLE mechanical axis, CT tibial torsion and the foot progression angle were used to predict medial knee loading.
The TKOs had significantly greater mechanical axis varus and knee varus moment compared to KOAs and CONs. The regression model predicting medial knee loading using the mechanical axis (β=0.898), tibial torsion (β=0.264) and foot progression angle (β=-0.369) showed a goodness of fit of 0.774.
Medial knee loading was predicted by the mechanical axis and the foot progression angle. Future longitudinal studies are needed to assess the role of tibial intorsion during disease progression and following total knee replacement surgery.

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Available from: David S Mandeville, Oct 22, 2014
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    • "The purpose of this study was to investigate the impact of femoral torsion disorders in the transverse plane on the moment arms of most muscles of the thigh. Even if several studies reported the repercussion of femoral torsion disorders on gonarthrosis degenerative processes (Goutallier et al., 1997), joint constraint distribution (Krackow et al., 2011; Sobczak et al., 2011a) and joint kinematics (Sobczak et al., 2012), at present, no study has reported in-vitro moment arm changes after this kind of disorders. Moreover, recent literature reports contradictory results. "
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    ABSTRACT: Background: Lower limb torsion disorders have been considered as a factor inducing gonarthrosis and the three-dimensional effect of the surgical correction is not well reported yet. This paper reports an in vitro study aiming at quantifying the relationships between experimental femoral torsion disorders and moment arms of thigh muscles. Methods: Five unembalmed lower limbs were used and fixed on an experimental jig. Muscles were loaded and 6 Linear Variable Differential Transformers were used to measure tendon excursions. Experimental osteotomies were performed to simulate torsions by steps of 6° up to 18°. Moment arms of the main thigh muscles were estimated by the tendon excursion method during knee flexion. Findings: Moment arms of the tensor of fascia latae, the gracilis and the semitendinosus were significantly influenced by experimental conditions while the rectus femoris, the biceps femoris and the semimembranosus did not show modifications. Medial femoral torsion decreased the moment arm of both the gracilis and the semimembranosus. Opposite changes were observed during lateral femoral torsion. The moment arm of the tensor of fascia latae decreased significantly after 30° of knee flexion for 18° of medial femoral torsion. Interpretation: Our results showed that medial and lateral femoral torsion disorders induced alterations of the moment arms of the muscles located medially to the knee joint when applied in aligned lower limbs. These results highlight a potential clinical relevance of the effect of femoral torsion alterations on moment arms of muscles of the thigh which may be related, with knee kinematics modifications, to the development of long-term knee disease.
    Full-text · Article · Jan 2013 · Clinical biomechanics (Bristol, Avon)
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    • "Sobczak et al. (2011a) showed that experimental medial femoral torsion (MFT) induced an increase of cancellous bone deformation of the proximal tibial epiphysis below medial chondral tissue and inversely during lateral femoral torsion (LFT) disorder. A recent in vivo study (Krackow et al., 2011) reported that medial loading could be predicted by the mechanical axis and the foot progression angle. Patients with medial knee osteoarthrosis and an apparent torsion deformity had a significant greater mechanical axis varus and knee varus moment compared to a control group and a group of patients with medial knee osteoarthrosis without apparent torsion deformity. "
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    ABSTRACT: Background: Gonarthrosis is a degenerative disease mainly found in elderly persons. Frontal plane deviations are known to induce lateral and medial gonarthrosis. Nevertheless, patients suffer from gonarthrosis without frontal deviations. Lower limb torsions disorders have been considered as a factor inducing lateral and medial gonarthrosis. This paper reports an in vitro study aiming at quantifying the relationships between experimental femoral torsion disorders and femoro-tibial kinematics. Methods: Five fresh-frozen lower limbs were used. Specimens were fixed on an experimental jig and muscles were loaded. A six-degree-of-freedom Instrumented Spatial Linkage was used to measure femoro-tibial kinematics. Experimental femoral osteotomies were performed to simulate various degrees of medial and lateral torsion. Internal tibial rotation, abduction/adduction and proximo-distal, medio-lateral and antero-posterior translations were measured during knee flexion. Findings: Internal tibial rotation and abduction/adduction were significantly influenced (P<0.001) by femoral torsion disorder conditions. Medial femoral torsion increased tibial adduction and decreased internal rotation during knee flexion. Opposite changes were observed during lateral femoral torsion. Concerning translations, medial femoral torsion induced a significant (P<0.05) decrease of medial translation and inversely for lateral femoral torsion. No interactions between femoral torsion disorders and range of motion were observed. Interpretation: Our results showed that medial and lateral femoral torsion disorders induced alterations of femoro-tibial kinematics when applied in normally aligned lower limbs. These results highlight a potential clinical relevance of the effect of femoral torsion alterations on knee kinematics that may be related to the development of long-term knee disease.
    Full-text · Article · Sep 2012 · Clinical biomechanics (Bristol, Avon)
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    • "Dizde di¤er anormalliklerin (örne¤in; ligaman yaralanmas› , travma) olmad›¤› durumlarda, kondral lezyonlar hemen daima koronal plandaki de¤ifliklikler sonucunda oluflmaktad›r. Dizin iç varus momenti, mekanik aks ve dizin rotasyon merkezini etkileyen güçlerin toplam› olan frontal plan moment koluna ba¤l›d›r.[6]Krackow ve ark. "

    Preview · Article · Jan 2012 · acta orthopaedica et traumatologica turcica
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