The Influence of Alignment on the Musculo-skeletal Loading Conditions at the Knee

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2003 Sep 19

PMID 13680238

Citations 20

Authors

Markus O Heller

William R Taylor

Carsten Perka

Georg N Duda

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

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The role of limb alignment on natural tibiofemoral kinematics and kinetics.

Postolka B, Taylor W, Fucentese S, List R, Schutz P Bone Joint Res. 2024; 13(9):485-496.

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Amjad M, Badshah S, Ahmad S, Badshah M, Jan S, Yasir M PLoS One. 2024; 19(8):e0300270.

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Serial Quantitative Assessment of Load Redistribution After Medial Open-Wedge High Tibial Osteotomy.

Jeong H, Song Y, Kim J, Nam H, Lee W, Lee Y Orthop J Sports Med. 2023; 11(4):23259671231156188.

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Meilak E, Gostling N, Palmer C, Heller M Front Bioeng Biotechnol. 2021; 9:676894.

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References

An K, Kwak B, Chao E, Morrey B . Determination of muscle and joint forces: a new technique to solve the indeterminate problem. J Biomech Eng. 1984; 106(4):364-7. DOI: 10.1115/1.3138507. View

Brand R, Crowninshield R, Wittstock C, Pedersen D, Clark C, van Krieken F . A model of lower extremity muscular anatomy. J Biomech Eng. 1982; 104(4):304-10. DOI: 10.1115/1.3138363. View

Kettelkamp D, Chao E . A method for quantitative analysis of medial and lateral compression forces at the knee during standing. Clin Orthop Relat Res. 1972; 83:202-13. DOI: 10.1097/00003086-197203000-00037. View

Morrison J . The mechanics of the knee joint in relation to normal walking. J Biomech. 1970; 3(1):51-61. DOI: 10.1016/0021-9290(70)90050-3. View

Leutloff D, Tobian F, Perka C . High tibial osteotomy for valgus and varus deformities of the knee. Int Orthop. 2001; 25(2):93-6. PMC: 3620631. DOI: 10.1007/s002640100244. View

Kellis E . Tibiofemoral joint forces during maximal isokinetic eccentric and concentric efforts of the knee flexors. Clin Biomech (Bristol). 2001; 16(3):229-36. DOI: 10.1016/s0268-0033(00)00084-x. View

Duda G, Brand D, Freitag S, Lierse W, Schneider E . Variability of femoral muscle attachments. J Biomech. 1996; 29(9):1185-90. DOI: 10.1016/0021-9290(96)00025-5. View

Prodromos C, Andriacchi T, Galante J . A relationship between gait and clinical changes following high tibial osteotomy. J Bone Joint Surg Am. 1985; 67(8):1188-94. View

Mielke R, Clemens U, Jens J, Kershally S . [Navigation in knee endoprosthesis implantation--preliminary experiences and prospective comparative study with conventional implantation technique]. Z Orthop Ihre Grenzgeb. 2001; 139(2):109-16. DOI: 10.1055/s-2001-15040. View

10.

Weidenhielm L, Wykman A, Lundberg A, Brostrom L . Knee motion after tibial osteotomy for arthrosis. Kinematic analysis of 7 patients. Acta Orthop Scand. 1993; 64(3):317-9. DOI: 10.3109/17453679308993634. View

11.

Brand R, Pedersen D, Friederich J . The sensitivity of muscle force predictions to changes in physiologic cross-sectional area. J Biomech. 1986; 19(8):589-96. DOI: 10.1016/0021-9290(86)90164-8. View

12.

Wang J, Kuo K, Andriacchi T, Galante J . The influence of walking mechanics and time on the results of proximal tibial osteotomy. J Bone Joint Surg Am. 1990; 72(6):905-9. View

13.

Morrey B . Upper tibial osteotomy for secondary osteoarthritis of the knee. J Bone Joint Surg Br. 1989; 71(4):554-9. DOI: 10.1302/0301-620X.71B4.2768296. View

14.

Reimann I . Experimental osteoarthritis of the knee in rabbits induced by alteration of the load-bearing. Acta Orthop Scand. 1973; 44(4):496-504. DOI: 10.3109/17453677308989085. View

15.

Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J . Hip contact forces and gait patterns from routine activities. J Biomech. 2001; 34(7):859-71. DOI: 10.1016/s0021-9290(01)00040-9. View

16.

Bergmann G, Graichen F, Siraky J, Jendrzynski H, Rohlmann A . Multichannel strain gauge telemetry for orthopaedic implants. J Biomech. 1988; 21(2):169-76. DOI: 10.1016/0021-9290(88)90009-7. View

17.

Durselen L, Claes L, Kiefer H . The influence of muscle forces and external loads on cruciate ligament strain. Am J Sports Med. 1995; 23(1):129-36. DOI: 10.1177/036354659502300122. View

18.

Andriacchi T . Dynamics of knee malalignment. Orthop Clin North Am. 1994; 25(3):395-403. View

19.

Challis J . Producing physiologically realistic individual muscle force estimations by imposing constraints when using optimization techniques. Med Eng Phys. 1997; 19(3):253-61. DOI: 10.1016/s1350-4533(96)00062-8. View

20.

Heller M, Bergmann G, Deuretzbacher G, Durselen L, Pohl M, Claes L . Musculo-skeletal loading conditions at the hip during walking and stair climbing. J Biomech. 2001; 34(7):883-93. DOI: 10.1016/s0021-9290(01)00039-2. View