Journal articles on the topic 'Knee joint line convergence angle'
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1
Chun, Dong-Il, Jahyung Kim, Sung Hun Won, Jaeho Cho, Jeongku Ha, Minkyu Kil, and Young Yi. "Changes in Coronal Alignment of the Knee Joint after Supramalleolar Osteotomy." BioMed Research International 2021 (February 19, 2021): 1–8. http://dx.doi.org/10.1155/2021/6664279.
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Background. Assessing knee joint orientation changes after SMO may help clinical advancement in managing patients with ipsilateral ankle and knee joint arthritis. However, knee joint changes after supramalleolar osteotomy (SMO) have not been reported. We investigated changes in coronal alignment of the knee joint after SMO. Methods. In this multicentre study, from January 2014 to December 2018, 47 ankles with varus osteoarthritis treated with SMO were retrospectively identified. Ankle joint changes were assessed using the tibiotalar angle, talar tilt angle, and lateral distal tibial angle (LDTA); knee joint changes using the medial proximal tibial angle (MPTA), medial and lateral joint space widths (mJSW and lJSW, respectively), and medial and lateral joint line convergence angles (JLCA); and lower limb alignment changes using mechanical axis deviation angle (MADA) and the hip-knee-ankle (HKA) angle measured on full-length anteroposterior radiographs of the lower extremity. Correlation analysis and binary logistic regression analysis were performed. Results. Postoperatively, LDTA ( p < 0.001 ) and tibiotalar angle ( p < 0.001 ) significantly changed, indicating meaningful improvement in the ankle joint varus deformity. Regarding the knee joint changes, JLCA significantly changed into valgus direction ( p = 0.044 ). As for lower limb alignment changes, MADA significantly decreased ( p < 0.001 ), whereas the HKA angle significantly increased ( p < 0.001 ). In univariate and multivariate logistic regression analyses, changes in the MADA ( p < 0.001 ) and the HKA angle ( p < 0.001 ) were significantly correlated with the correction angle. Conclusions. SMO remarkably improves ankle joint varus deformity, followed by significant lower limb alignment changes. Despite meaningful changes in JLCA, the relationship between the amount of osteotomy near the ankle joint and improvement in knee joint radiographic parameters was not significant. Radiographic parameters of the knee joint would less likely be changed following SMO.
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Park, Jun-Gu, Seong-Il Bin, Jong-Min Kim, and Bum-Sik Lee. "Using the Lower Limb Adduction Angle to Predict Postoperative Knee Joint-Line Obliquity After Open-Wedge High Tibial Osteotomy." Orthopaedic Journal of Sports Medicine 9, no. 5 (May 1, 2021): 232596712110039. http://dx.doi.org/10.1177/23259671211003991.
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Background: Knee joint-line orientation is altered after open-wedge high tibial osteotomy (OWHTO), and excessive joint-line obliquity (JLO) can adversely affect outcomes. Little is known regarding preoperative prediction of postoperative knee JLO. Purpose/Hypothesis: The purpose of this study was to assess the correlation between the amount of lower limb adduction and changes in knee JLO after OWHTO. The hypothesis was that postoperative knee JLO could be predicted using the amount of lower limb adduction after OWHTO. Study Design: Case series; Level of evidence, 4. Methods: The records of 67 patients (77 knees) who underwent OWHTO for medial compartment osteoarthritis were retrospectively reviewed. The mechanical hip-knee-ankle (HKA) axis, lateral distal femoral angle, medial proximal tibial angle (MPTA), knee JLO, ankle JLO, and joint-line convergence angle were measured on standing whole-leg plain radiographs preoperatively and at 1 year postoperatively. The limb adduction angle was defined as the angle between the native weightbearing line (WBL) and the planned WBL on preoperative standing whole-leg plain radiographs. The predicted knee JLO was calculated as the sum of the preoperative knee JLO and the limb adduction angle. Multivariable linear regression analysis was used to identify the preoperative radiologic factors associated with the postoperative knee JLO. The agreement between postoperative and predicted values was determined using intraclass correlation coefficients (ICCs). Results: The estimated limb adduction angle was 4.2° ± 1.3°, and the predicted knee JLO was 4.9° ± 3.0°. The actual postoperative knee JLO was 4.5° ± 2.4°, which was a significant increase from 0.7° ± 2.4° preoperatively ( P < .001). Excellent agreement was found between the predicted knee JLO and postoperative knee JLO (ICC = 0.928; P < .001). Limb adduction angle and changes in preoperative MPTA were significantly associated with changes in knee JLO ( P < .001). On multivariable linear regression analysis, preoperative knee JLO and limb adduction angle were significantly associated with postoperative knee JLO ( P < .001; R 2 = 0.83). Conclusion: Changes in knee JLO after OWHTO were associated with adduction of the lower limb after OWHTO. During preoperative planning, postoperative knee JLO can be predicted as the sum of the preoperative knee JLO and the limb adduction angle between the preoperative WBL and planned WBL.
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Lee, Sung-Sahn, Young Keun Lee, Il Su Kim, Dong Jin Ryu, Eui Yub Jung, Do Kyung Lee, and Joon Ho Wang. "Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy." Orthopaedic Journal of Sports Medicine 10, no. 8 (August 1, 2022): 232596712211191. http://dx.doi.org/10.1177/23259671221119152.
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Background: Time-dependent changes in lower extremity alignment after an opening-wedge high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few studies have investigated risk factors of postoperative alignment change. Purposes: To investigate time-dependent alignment changes and identify predictive factors for postoperative alignment change after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent OWHTO between March 2010 and September 2018. A total of 142 knees with a mean follow-up of 42 months were included and classified as the change group when the amount of hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the no-change group. HKA angle was obtained at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively. Multiple regression analysis was performed to identify the factors that were correlated with the changes in the HKA angle from 3 months to the final follow-up. Results: Among the 142 knees, 59 (42%) were included in the change group. The overall postoperative HKA angles progressed serially toward varus after OWHTO. The mean angles of the 6 time points were 8.5°, –3.7°, –3.6°, –3.3°, –3.1°, and –2.7°, respectively. The mean HKA angles of the change and no-change groups were 9.1°, –4.3°, –3.4°, –2.8°, –2.0°, and –1.4° and 8.1°, –3.3°, –3.8°, –3.6°, –3.8°, and –3.7°, respectively. Greater change in the HKA angle was predicted by preoperatively greater valgus stress joint line convergence angles and less medial joint space width. Conclusion: Of the cases of OWHTO, 42% showed correction loss of >1° at a mean follow-up of 42 months. The overall postoperative HKA angles progressed serially to varus angles after OWHTO. Preoperative greater valgus stress joint line convergence angles and less medial joint space width were predictive factors for greater change in alignment toward varus after OWHTO.
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Fürmetz, Julian, Jan Sass, Jalil Jalali, Nikolaus Degen, Wolfgang Böcker, and Peter Thaller. "3D-ANALYSIS OF LOWER LIMB ANATOMY: NORMAL VALUES FOR JOINT ANGLES AND ALIGNMENT." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl4 (May 1, 2020): 2325967120S0029. http://dx.doi.org/10.1177/2325967120s00295.
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Aims and Objectives: The analysis of lower limb anatomy is mandatory in deformity surgery and total knee replacement. Standard values for joint angles and alignment are only available for 2D images using long standing and lateral radiographs. In contrast, 3D bone models realistically represent the anatomy and are independent of position and projection. Using a self-developed, standardised and validated protocol for 3D analysis of lower limb geometry, standard values for specific joint angles and axes can be obtained in a young cohort for the first time. Materials and Methods: After power and sample size analysis, 60 thin-slice CTs of the entire leg were analysed (30 patients, 13 f, 17 m; age = 33.8 [18-50 years]). After segmentation all 24 relevant bony landmarks were set using our standardised analysis method. Results of joint angles and mechanical axis deviation are calculated automatically. Mean values are stated with standard deviations to describe a possible reference range. Results: The mean neck-shaft angle (NSA) was 133±10° and the mean medial proximal femoral angle (MPFA) 85±9°. Around the knee joint, the mean mechanical lateral distal femoral angle (mLDFA) was 87±4° and the medial proximal tibial angle (MPTA) 88±5°. Medial and lateral slope averaged 12±7° and 9±8°. The deviation of the frontal mechanical leg axis from the knee joint center (MAD frontal) was 7±15mm and the mechanical femoro-tibial angle (HKA) 175±6°. Women showed a smaller mLDFA than men (86.4° vs. 87.8°, p<0.05) and a larger joint line convergence angle (JLCA 2.5° vs. 1.4°, p<0.01) representing a more valgiform anatomy. Conclusion: The standardised 3D analysis enabled reference ranges for the relevant joint angles and axes to be defined on the 3D bone model for the first time. The results redefine reference ranges for 3D measurements similar to existing 2D measurements on long standing radiographs. The systematic analysis of the complex 3D anatomy results in a multitude of new questions and possibilities in preoperative planning.
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Shin, Kyun-Ho, Sang-Bum Kim, Ki-Mo Jang, Chul-Soo Lee, and Seung-Beom Han. "Posterior tibial slope is a modifiable predictor of relatively large extension gaps in total knee arthroplasty for degenerative osteoarthritis." Journal of Orthopaedic Surgery 29, no. 1 (January 1, 2021): 230949902110020. http://dx.doi.org/10.1177/23094990211002004.
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Background: During total knee arthroplasty (TKA) for osteoarthritis, the sagittal gap imbalance (SGI) with a relatively large extension gap is an important surgical challenge. We determined the predictors of SGI with a relatively large extension gap and evaluated the surgical outcomes of knees with SGI. Methods: 551 consecutive cases of primary TKA for osteoarthritis were retrospectively reviewed. The cohort was divided into two groups according to the SGI and statistically matched according to baseline characteristics via the inverse probability of treatment weighting method. Multiple linear and logistic regression analyses were performed to determine the predictors of sagittal gap difference (SGD) and SGI. Intergroup differences in clinical and radiological outcomes were analyzed. Results: Of all the knees included, 8.5% (n = 45) presented with SGI with a relatively large extension gap and required femoral sagittal balancing to manage SGI. The hyperextension angle (HA), preoperative joint line convergence angle (JLCA), and the change in posterior tibial slope (PTS) significantly correlated to SGD and predicted SGI with a relatively large extension gap. SGI group showed significant changes in femoral posterior condylar offset and joint line height compared to those without SGI (1.48 vs −0.45, 1.37 vs −0.51, respectively). Postoperative ROM and knee society knee scores were lower in SGI group. Conclusion: Knees requiring sagittal balancing to manage SGI with a relatively large extension gap is not uncommon in TKA for osteoarthritic knees. The change in PTS is an independent and modifiable predictor of SGI.
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Kubota, Mitsuaki, Youngji Kim, Taisuke Sato, Junichiro Yamaguchi, Ryuichi Ohno, Kazuo Kaneko, and Muneaki Ishijima. "The actual knee function was not influenced by joint line obliquity after open-wedge high tibial osteotomy." SICOT-J 6 (2020): 4. http://dx.doi.org/10.1051/sicotj/2020001.
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Purpose: Excessive joint line obliquity (JLO) after open-wedge high tibial osteotomy (OWHTO) induces detrimental stress on the articular cartilage. The purpose of this article is to assess the correlation between JLO and the clinical results after OWHTO. Methods: 68 patients were followed up for more than 1 year. JLO was assessed using a long-leg standing anteroposterior radiograph. The knee osteoarthritis outcome score (KOOS) and KSS (Knee Society score) objective knee score were assessed as clinical scores. The Weight-bearing line ratio (WBLR), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint line convergence angle (JLCA) were assessed as radiological parameters. The timed up-and-go (TUG) test and single-leg standing (SLS) test were performed, and the isometric muscle strength of the quadriceps and hamstrings was assessed to evaluate the knee function. The primary outcomes were the correlations between the JLO and the clinical score, radiological parameters and knee function after OWHTO. The secondary objective of this study was to detect the factor with the greatest influence on JLO. Results: There were significant correlations between the postoperative JLO and the KOOS in the subcategories of pain, activities of daily living (ADL), and sports and recreation (r = −0.311, −0.302, −0.282, p = 0.011, 0.014, 0.022, respectively). However, the postoperative JLO was not significantly correlated with the KSS, knee function, or muscle strength. The preoperative LDFA and postoperative MPTA were factors influencing increased JLO after OWHTO. Discussion: There was no significant correlation between the JLO and the actual knee function. The preoperative LDFA and postoperative MPTA were factors that influenced the increase in JLO after OWHTO.
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Xu, Xinghui, Jin Yang, Jun Li, Deping Yao, Pan Deng, Boliang Chen, and Yifei Liu. "Relationship between the height of fibular head and the incidence and severity of knee osteoarthritis." Open Medicine 17, no. 1 (January 1, 2022): 1330–37. http://dx.doi.org/10.1515/med-2022-0523.
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Abstract The purpose of this study was to investigate the correlation between fibular head height and the incidence and severity of osteoarthritis associated with varus knee deformity. The fibular head height, joint line convergence angle (JLCA) and medial proximal tibial angle (MPTA) were measured in a three-dimensional model. Ordinal multivariate logistic regression was used to analyze the correlation between fibular head height and Kellgren–Lawrence (K–L) grade. Pearson correlation was used to analyze the correlation between fibular head height and K–L grade. A total of 232 patients (232 knees) were finally included in the study. There were significant differences in JLCA and hip–knee–ankle angle (P < 0.05), and both JLCA and hip–knee–ankle angle increased with severe aggravation of K–L grade. Both fibular head height and MPTA decreased as the K–L grade was severely aggravated. There was a significant negative correlation between K–L grade and fibular head height (r = −0.812, P < 0.001). Furthermore, there was a significant negative correlation between fibular head height and hip–knee–ankle angle (r = −0.7905, P < 0.001). In addition to body mass index, fibular head height is a risk factor for the pathogenesis of osteoarthritis associated with varus knee deformity; the smaller the fibular head height, the more severe the degree of varus deformity.
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Harrer, Jörg, Max Schenke, Christoph Lutter, Jörg Dickschas, Matthias Feucht, and Thomas Tischer. "Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration." Video Journal of Sports Medicine 1, no. 6 (November 2021): 263502542110466. http://dx.doi.org/10.1177/26350254211046632.
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Background: Lower extremity alignment-correcting procedures for unicompartmental osteoarthritis are experiencing a rapid rise. Medial open-wedge high tibial osteotomy (MOW-HTO) thereby represents the most common technique among osteotomies but is limited in cases of severe malalignment. Some cases make a double-level osteotomy necessary. Indications: If planning of malalignment correction using a MOW-HTO results in a mechanical medial proximal tibial angle (mMPTA) of more than 93° (causing an oblique joint line), double-level osteotomy is indicated to avoid nonphysiological knee kinematics. Technique Description: After clinical examination and detailed analysis of malalignment (full-weight-bearing long-leg radiograph: hip-knee-angle [HKA], mMPTA, mechanical lateral distal femoral angle [mLDFA], joint line convergence angle [JLCA]), as well as individualized planning of the correction, the surgical procedure starts with an arthroscopy to evaluate the cartilage conditions and eventually treat intraarticular pathologies. Then, the femoral supracondylar correction is performed (closed wedge, biplanar osteotomy [ to increase bony healing]) according to the presurgical planning by resecting the osteotomy wedge with the measured length. K-wires are placed to check the correction. An angle-stable plate is used for osteosynthesis. The wedge taken out will be used as bone stock for the MOW-HTO afterward. The biplanar open-wedge tibial osteotomy is then performed subsequently using a medial tibial approach and an angle-stable plate. Opening of the osteotomy is then performed and double checked with intraoperative fluoroscopy using an alignment rod. Postoperative partial weight bearing for 6 weeks is recommended. Results: In recent literature, only few publications report on results of double-level osteotomies. Babis et al reports that it is a valuable procedure for patients with large varus deformity. Nakayama et al noted a significant improvement in patient-registered clinical outcomes in early postoperative evaluation of 20 patients. Schröter et al reports on 37 knees and findings include good clinical results, despite progressive osteoarthritis. Discussion/Conclusion: In cases of severe malalignment, adequate axis correction may require a double-level osteotomy. Exact preoperative planning is essential. Results reported in recent publications are promising. By splitting 1 large correction into 2 smaller ones, complications like hinge fracture and delayed bone healing are lowered.
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McEwen, P., G. Balendra, and K. Doma. "Medial and lateral gap laxity differential in computer-assisted kinematic total knee arthroplasty." Bone & Joint Journal 101-B, no. 3 (March 2019): 331–39. http://dx.doi.org/10.1302/0301-620x.101b3.bjj-2018-0544.r1.
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AimsThe results of kinematic total knee arthroplasty (KTKA) have been reported in terms of limb and component alignment parameters but not in terms of gap laxities and differentials. In kinematic alignment (KA), balance should reflect the asymmetrical balance of the normal knee, not the classic rectangular flexion and extension gaps sought with gap-balanced mechanical axis total knee arthroplasty (MATKA). This paper aims to address the following questions: 1) what factors determine coronal joint congruence as measured on standing radiographs?; 2) is flexion gap asymmetry produced with KA?; 3) does lateral flexion gap laxity affect outcomes?; 4) is lateral flexion gap laxity associated with lateral extension gap laxity?; and 5) can consistent ligament balance be produced without releases?Patients and MethodsA total of 192 KTKAs completed by a single surgeon using a computer-assisted technique were followed for a mean of 3.5 years (2 to 5). There were 116 male patients (60%) and 76 female patients (40%) with a mean age of 65 years (48 to 88). Outcome measures included intraoperative gap laxity measurements and component positions, as well as joint angles from postoperative three-foot standing radiographs. Patient-reported outcome measures (PROMs) were analyzed in terms of alignment and balance: EuroQol (EQ)-5D visual analogue scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS Joint Replacement (JR), and Oxford Knee Score (OKS).ResultsPostoperative limb alignment did not affect outcomes. The standing hip-knee-ankle (HKA) angle was the sole positive predictor of the joint line convergence angle (JLCA) (p < 0.001). Increasing lateral flexion gap laxity was consistently associated with better outcomes. Lateral flexion gap laxity did not correlate with HKA angle, the JLCA, or lateral extension gap laxity. Minor releases were required in one third of cases.ConclusionThe standing HKA angle is the primary determinant of the JLCA in KTKA. A rectangular flexion gap is produced in only 11% of cases. Lateral flexion gap laxity is consistently associated with better outcomes and does not affect balance in extension. Minor releases are sometimes required as well, particularly in limbs with larger preoperative deformities. Cite this article: Bone Joint J 2019;101-B:331–339.
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Choi, Han Gyeol, Joo Sung Kim, Hyun Jin Yoo, You Sun Jung, and Yong Seuk Lee. "The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures." American Journal of Sports Medicine 49, no. 6 (April 1, 2021): 1551–60. http://dx.doi.org/10.1177/03635465211002160.
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Background: Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. Purpose: To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence 3. Methods: A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. Results: The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia ( P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). Conclusion: OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.
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Eberbach, Helge, Julian Mehl, Matthias J. Feucht, Gerrit Bode, Norbert P. Südkamp, and Philipp Niemeyer. "Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity." American Journal of Sports Medicine 45, no. 4 (December 21, 2016): 909–14. http://dx.doi.org/10.1177/0363546516676266.
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Background: Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. Purpose: The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary–based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. Results: Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a straight-leg axis and an anatomic postoperative joint line with a tolerance of ±4°, the ideal site of a corrective osteotomy was tibial in 55.2% of cases and femoral in 19.5% of cases. A double-level osteotomy would be necessary in 25.2% of cases. With a tolerance of ±2°, the ideal osteotomy site was the proximal tibia in 41.0% of cases and the distal femur in 13.6% of cases; a double-level osteotomy would be necessary in 45.5% of cases. Conclusion: In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.
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Kim, Joo-Hwan, Dong Jin Ryu, Sung-Sahn Lee, Seung Pil Jang, Jae Sung Park, Won Jae Kim, Il-Su Kim, and Joon Ho Wang. "Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?" American Journal of Sports Medicine 50, no. 1 (December 1, 2021): 142–51. http://dx.doi.org/10.1177/03635465211059162.
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Background: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon’s preference. However, it is still unclear whether transection of sMCL increases valgus laxity. Purpose: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. Study Design: Case series; Level of evidence, 4. Methods: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. Results: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, –3.5°± 2.0°; 6 months, –3.2°± 2.3°; 1 year, –3.1°± 2.3°; 2 years, –2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, –0.1°± 2.1°; 3 months, –0.2°± 2.4°; 6 months, –0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). Conclusion: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.
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Bode, Lisa, Helge Eberbach, Anna-Sophie Brenner, Ferdinand Kloos, Philipp Niemeyer, Hagen Schmal, Norbert P. Suedkamp, and Gerrit Bode. "10-Year Survival Rates After High Tibial Osteotomy Using Angular Stable Internal Plate Fixation: Case Series With Subgroup Analysis of Outcomes After Combined Autologous Chondrocyte Implantation and High Tibial Osteotomy." Orthopaedic Journal of Sports Medicine 10, no. 2 (February 1, 2022): 232596712210780. http://dx.doi.org/10.1177/23259671221078003.
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Background: Good-to-excellent midterm results after high tibial osteotomy (HTO) to treat medial compartment cartilage defects or osteoarthritis (OA) have been published, but little is known about long-term survival rates in terms of conversion to total knee arthroplasty (TKA) using angular stable internal plate fixation. Purpose: To determine TKA-free survival rates and functional and radiological outcomes at 10 years after HTO. A subgroup analysis of patients who underwent combined HTO and autologous cartilage implantation (ACI) was also performed. Study Design: Case series; Level of evidence, 4. Methods: Included were 125 patients with a mean follow-up of 9.90 ± 2.25 years; 90 patients underwent HTO for medial OA, and 35 patients underwent ACI and HTO for medial focal cartilage defects. Functional outcome measures included visual analog scale (VAS) for pain, Lysholm, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and KOOS4 (average of 4 KOOS subscales: Pain, Symptoms, Sport, and Quality of Life). Radiological outcomes included lateral distal femoral angle, medial proximal tibial angle, and joint line convergence angle. Results: Overall, 16 patients required conversion to TKA at a mean 86.75 ± 25.73 months (10-year survival rate, 87.2%). Only 2 patients in the HTO+ACI subgroup required a conversion to TKA (10-year survival rate, 94.3%). The complication rate for all patients was 8.8%. In both the HTO and HTO+ACI subgroups, VAS pain levels decreased and Lysholm scores increased significantly from pre- to postoperatively ( P < .001). A higher preoperative Tegner score led to a significantly lower risk for conversion to TKA ( P = .001), and a preoperative body mass index of ≥35 was associated with a significantly higher risk ( P = .019), as was female sex ( P = .046). Radiological parameters remained within physiological ranges. The postoperative joint line conversion angle did correlate with postoperative functional outcome but not with TKA conversion. Conclusion: Long-term results of HTO for medial compartment OA or cartilage defects with underlying varus deformity were good to excellent. In particular, patients who underwent HTO+ACI presented excellent long-term survival rates. HTO, therefore, delays or prevents TKA implantation, especially in young, active patients with medial compartment damage.
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Kim, Kang-Il, Jun-Ho Kim, Sang-Hak Lee, Sang-Jun Song, and Myeong-Guk Jo. "Mid- to Long-Term Outcomes After Medial Open-Wedge High Tibial Osteotomy in Patients With Radiological Kissing Lesion." Orthopaedic Journal of Sports Medicine 10, no. 7 (July 1, 2022): 232596712211018. http://dx.doi.org/10.1177/23259671221101875.
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Background: Although medial open-wedge high tibial osteotomy (MOWHTO) is the treatment of choice for patients with mild to moderate osteoarthritis with varus malalignment, concerns about inferior outcomes in patients with preoperative radiological kissing lesion (RKL) remain. Purpose: To compare the mid- to long-term clinical and radiological results and survivorship after MOWHTO in patients with versus without preoperative RKL. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 122 knees in patients who underwent MOWHTO with a medial locked plate and had minimum 5-year follow-up data. The mean age at surgery was 55.9 years (range, 38-65 years), and the mean follow-up was 7.5 years (range, 5-12.8 years). All patients had undergone second-look arthroscopy around 2 years after MOWHTO. The knees were divided into an RKL group (n = 17) and no-RKL group (n = 105) based on preoperative standing radiographs. The authors compared postoperative American Knee Society (AKS) knee and function scores, range of motion, and improvements in AKS scores between groups, as well as hip-knee-ankle angle, medial proximal tibial angle, and joint-line convergence angle from preoperatively to postoperatively. Also compared were the degree of cartilage regeneration between first- and second-look arthroscopy and the survival rate after index surgery. Results: Preoperative AKS scores were significantly lower in the RKL group versus the no-RKL group (AKS knee, 79.6 ± 7.5 vs 83.8 ± 3.9, P = .037; AKS function, 68.8 ± 9.3 vs 76.0 ± 5.1, P = .006). Likewise, postoperative AKS scores were significantly lower in the RKL group versus the no-RKL group (AKS knee: 91.3 ± 4.2 vs 94.4 ± 1.6, respectively, P = .008; AKS function: 90.0 ± 10.0 vs 97.6 ± 4.5, respectively, P = .007). However, all patients had excellent postoperative AKS knee and function scores (>80). Moreover, there were no between-group differences in pre- to postoperative improvement in AKS scores, postoperative radiological changes, or grade of cartilage regeneration. The survival rates in the RKL and no-RKL groups were 100% and 97.1%, respectively ( P ≥ .999). Conclusion: Although the latest clinical scores were lower in the RKL group than in the no-RKL group, comparable results in postoperative clinical improvement, cartilage regeneration, and survivorship were observed in patients with RKL at mid- to long-term follow-up.
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Kubota, M., H. Kaneko, K. Kobayashi, K. Yoshida, and M. Ishijima. "MEDIAL JOINT SPACE WIDTH AND JOINT LINE CONVERGENCE ANGLE WERE CORRELATED WITH CLINICAL RESULTS AFTER HIGH TIBIAL OSTEOTOMY(HTO) IN PATIENTS WITH MEDIAL KNEE OSTEOARTHRITIS." Osteoarthritis and Cartilage 30 (April 2022): S428. http://dx.doi.org/10.1016/j.joca.2022.02.583.
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Lee, O.-Sung, Seung Hoon Lee, and Yong Seuk Lee. "Comparison of the Radiologic, Arthroscopic, and Clinical Outcomes between Repaired versus Unrepaired Medial Meniscus Posterior Horn Root Tear During Open Wedge High Tibial Osteotomy." Journal of Knee Surgery 34, no. 01 (July 9, 2019): 057–66. http://dx.doi.org/10.1055/s-0039-1692992.
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AbstractThe efficacy and outcomes for the concurrent repair of medial meniscus posterior horn root tear (MMPHRT) during open wedge high tibial osteotomy (OWHTO) are unclear. This study compared the radiologic, arthroscopic, and clinical outcomes between repaired and unrepaired MMPHRT during OWHTO. Fifty-seven patients were prospectively enrolled from 2014 to 2016. The radiologic, arthroscopic, and clinical outcomes were compared between 25 patients who underwent OWHTO with all-inside repair of MMPRT using FasT-Fix (repaired group) and 32 patients who underwent OWHTO without repair of MMPRT (unrepaired group) with a mean 2-year follow up in both groups. The meniscal healing status was classified as complete, partial, or no healing, according to second-look arthroscopic findings. The medial meniscal extrusion (MME) was evaluated using magnetic resonance imaging. The width of medial joint space, joint line convergence angle (JLCA), posterior tibial slope (PTS), Kellgren–Lawrence (KL) grade, hip-knee-ankle angle, and weight-bearing line ratio was evaluated on simple standing. The clinical outcomes were evaluated using the Knee Society score and the Western Ontario and McMaster University score. Healing rates (partial and complete) of the MMPHRT showed a statistical difference between the two groups (repaired group vs. unrepaired group, 19/25 (76%) vs. 13/32 (40.6%), p = 0.008). The postoperative MME showed no statistical differences between groups (repaired versus unrepaired group: 4.5 ± 1.3 mm vs. 4.5 ± 2.1 mm, p = 0.909). The postoperative width of medial joint space, JLCA, PTS, and KL grade all showed no statistical differences between groups after 2 years of OWHTO. Other radiologic parameters and clinical outcomes showed no statistical differences between groups. Repair of the MMPHRT during OWHTO showed a superior healing rate to the unrepaired MMPHRT. However, repair of the MMPHRT was not related to the radiologic and clinical outcomes. Therefore, there is no clear evidence of the need for the MMPHRT repair during OWHTO.
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Ryu, Dong Jin, Sung-Sahn Lee, Eui Yub Jung, Joo Hwan Kim, Tae Soo Shin, and Joon Ho Wang. "Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy." Orthopaedic Journal of Sports Medicine 9, no. 10 (October 1, 2021): 232596712110341. http://dx.doi.org/10.1177/23259671211034151.
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Background: Soft tissue laxity around the knee joint has been recognized as a crucial factor affecting correction error during medial open-wedge proximal tibial osteotomy (MOWPTO). Medial laxity in particular, which represents the changes in joint-line convergence angle (JLCA), affects soft tissue correction. Purpose: The purpose of this study was to quantify medial laxity and develop a preoperative planning method that considers medial laxity. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed 139 knees in 117 patients who underwent navigation-assisted MOWPTO from January 2014 to July 2019 for symptomatic medial compartment osteoarthritis with varus alignment >5°. We compared the results of 2 preoperative planning methods: conventional Miniaci (n = 47) and latent medial laxity reduction (LMLR) (n = 92). We evaluated the incidence of undercorrection, acceptable correction, and overcorrection. The radiologic parameters were analyzed using multiple linear regression with a stepwise selection model to establish an equation for the optimal preoperative planning method. The intraclass correlation coefficients (ICCs) of intraobserver, interobserver, and intermethod reliability were calculated. Results: The Miniaci method showed a higher incidence of overcorrection (55.3%) than the LMLR method (22.8%) at postoperative 6 months ( P = .0006). Multiple linear regression with a stepwise selection model revealed a high correlation coefficient ( R 2 = 0.888) for the following equation: Adjusted planned correction angle = 0.596 + 0.891 × Target correction angle – 0.255 × Δ JLCA valgus. Upon simplification, the following equation showed the highest intermethod ICC value (0.991): Target correction angle – ⅓Δ JLCA valgus, while the Miniaci method showed a relatively low ICC value of 0.875. Conclusion: There was a risk of overcorrection after MOWPTO using the conventional Miniaci method. An equation that considers medial laxity may help during preoperative planning for optimal correction during MOWPTO.
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Griffiths-Jones, William, Darren B. Chen, Ian A. Harris, Johan Bellemans, and Samuel J. MacDessi. "Arithmetic hip-knee-ankle angle (aHKA): An algorithm for estimating constitutional lower limb alignment in the arthritic patient population." Bone & Joint Open 2, no. 5 (May 1, 2021): 351–58. http://dx.doi.org/10.1302/2633-1462.25.bjo-2021-0028.r1.
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Aims Once knee arthritis and deformity have occurred, it is currently not known how to determine a patient’s constitutional (pre-arthritic) limb alignment. The purpose of this study was to describe and validate the arithmetic hip-knee-ankle (aHKA) algorithm as a straightforward method for preoperative planning and intraoperative restoration of the constitutional limb alignment in total knee arthroplasty (TKA). Methods A comparative cross-sectional, radiological study was undertaken of 500 normal knees and 500 arthritic knees undergoing TKA. By definition, the aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA). The mechanical HKA (mHKA) of the normal group was compared to the mHKA of the arthritic group to examine the difference, specifically related to deformity in the latter. The mHKA and aHKA were then compared in the normal group to assess for differences related to joint line convergence. Lastly, the aHKA of both the normal and arthritic groups were compared to test the hypothesis that the aHKA can estimate the constitutional alignment of the limb by sharing a similar centrality and distribution with the normal population. Results There was a significant difference in means and distributions of the mHKA of the normal group compared to the arthritic group (mean -1.33° (SD 2.34°) vs mean -2.88° (SD 7.39°) respectively; p < 0.001). However, there was no significant difference between normal and arthritic groups using the aHKA (mean -0.87° (SD 2.54°) vs mean -0.77° (SD 2.84°) respectively; p = 0.550). There was no significant difference in the MPTA and LDFA between the normal and arthritic groups. Conclusion The arithmetic HKA effectively estimated the constitutional alignment of the lower limb after the onset of arthritis in this cross-sectional population-based analysis. This finding is of significant importance to surgeons aiming to restore the constitutional alignment of the lower limb during TKA. Cite this article: Bone Jt Open 2021;2(5):351–358.
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Elbardesy, Hany, André McLeod, Hazem S. Ghaith, Samir Hakeem, and Philip Housden. "Outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity. A systematic review." SICOT-J 8 (2022): 7. http://dx.doi.org/10.1051/sicotj/2022009.
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Background: When correcting severe genu varus deformity, knee surgeons must choose between performing a single or double-level osteotomy. This systematic review aims to provide this equipoise with some clarity. Patients and methods: We conducted this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies evaluating the effect of the double level osteotomy (DLO) or those comparing it to high tibial osteotomy (HTO) from all regions and written in any language were included. Results: Six studies were included in this systematic review. They were prepared and analysed using Review Manager V5.0 [Computer Program] (RevMan5). Performing DLO resulted in restoring patellar height, joint-line convergence angle (JLCA), and mMPTA to normal values. DLO was also more successful at avoiding joint line obliquity (JLO) in severe varus deformity when compared to HTO (P < 0.001). No significant difference was reported between the two cohorts regarding the mLPTA. DLO resulted in satisfactory short term KOOS and IKDC scores. The complication rate after DLO was 2.28%. Conclusions: DLO showed a low complication rate and satisfactory short term KOOS and IKDAC scores. Randomised control trials with long term follow-up comparing the DLO and HTO are recommended.
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Goshima, Kenichi. "Editorial Commentary: Early Postoperative Knee Joint Space Width Change Is Attributable to Change in the Joint Line Convergence Angle After High Tibial Osteotomy and May Not Reflect Cartilage Regeneration." Arthroscopy: The Journal of Arthroscopic & Related Surgery 37, no. 11 (November 2021): 3324–25. http://dx.doi.org/10.1016/j.arthro.2021.05.067.
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Shim, Seung Jae, Ho Won Jeong, Saeil Kim, Yong-Geun Park, and Yong Seuk Lee. "Factors Associated With Unfavorable Radiological Outcomes After Opening-Wedge High Tibial Osteotomy for Varus Knees." Orthopaedic Journal of Sports Medicine 10, no. 11 (November 1, 2022): 232596712211365. http://dx.doi.org/10.1177/23259671221136501.
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Background: Corrective osteotomy around the knee is based on deformity profiles of the femoral and tibial sides. Opening-wedge high tibial osteotomy (OWHTO) can be favored if the outcomes are not different, even if there is a certain degree of abnormal parameters after correction. Purpose/Hypothesis: The purpose of this study was to identify the factors associated with unfavorable radiological outcomes after OWHTO for varus knees. Our hypothesis was that there would be an optimal situation in which double-level osteotomy (DLO) has advantages over isolated OWHTO and an optimal cutoff value of structural parameters for which DLO should be considered in patients with severe varus knees. Study Design: Case-control study; Level of evidence, 3. Methods: The radiological and clinical outcomes of 337 patients who underwent OWHTO were retrospectively evaluated. A subgroup analysis was performed according to the weightbearing line ratio (WBLR) (group 1: <25th percentile; group 2: 25th-75th percentile; and group 3: >75th percentile) and factors associated with unfavorable radiological outcomes. For the assessment of cutoff values of the parameters favoring DLO, unfavorable radiological outcomes were categorized as follows: (1) medial proximal tibial angle (MPTA) >95°, (2) joint-line convergence angle (JLCA) >4° (insufficient medial release), (3) JLCA <0° (medial instability), (4) recurrence of a varus deformity, and (5) lateral hinge fracture. Results: The mean follow-up period was 66.2 ± 19.1 months. A low preoperative WBLR was related to a larger preoperative to postoperative change (Δ) in the WBLR, a larger reduction in coronal translation, a larger ΔMPTA, a wide preoperative lateral joint space, and a narrow preoperative medial joint space ( P < .001, P < .001, P < .001, P = .016, and P = .003, respectively). However, only an MPTA >95° was significantly related to a low WBLR in the subgroup analysis according to unfavorable radiological outcomes ( P = .038). The cutoff value of ΔWBLR causing an MPTA >95° was 46.5%, which showed a good area under the curve of 0.800, with a sensitivity of 74.4% and a specificity of 82.7%. The clinical outcomes significantly improved at the final follow-up compared with those preoperatively, with no significant differences between the WBLR groups. Conclusion: A ΔWBLR ≥46.5% led to an MPTA >95°. However, clinical outcomes were not affected. DLO should be considered if the surgeon desires a postoperative MPTA ≤95°.
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Park, Cheol Hee, Dae Kyung Bae, Kang Il Kim, Jong Whan Lee, and Sang Jun Song. "Serial Changes in the Joint Space Width and Joint Line Convergence Angle After Closed-Wedge High Tibial Osteotomy." American Journal of Sports Medicine 45, no. 14 (September 29, 2017): 3254–61. http://dx.doi.org/10.1177/0363546517729153.
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Background: There have been little data concerning serial changes in the joint space width (JSW) and joint line convergence angle over the course of follow-up periods after closed-wedge high tibial osteotomy (CWHTO). Purpose: To evaluate serial changes in the JSW and joint line convergence angle after CWHTO. Study Design: Case series; Level of evidence, 4. Methods: A total of 100 computer-assisted CWHTOs with a minimum follow-up period of 3 years (mean, 4.4 years) were analyzed. Clinically, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was evaluated. Radiographically, the mechanical axis was measured preoperatively and postoperatively. The minimal JSW was measured as the shortest distance between the femur and the tibia. The convergence angle was measured as the angle between the tangent to the subchondral plates of the femoral condyle and the tibial plateau. Serial changes in these measurements were analyzed preoperatively; at 3 months, 6 months, 1 year, and 2 years postoperatively; and at the final follow-up. The intraclass correlation coefficients for all measurements were greater than 0.8. Results: The mean WOMAC score improved from 41.4 preoperatively to 14.9 at the final follow-up. The preoperative and postoperative mean mechanical axis was 8.1° varus and 1.6° valgus, respectively. The mean minimal JSW was 2.5, 2.9, 2.9, 3.1, 3.2, and 3.1 mm preoperatively and at 3 months, 6 months, 1 year, 2 years, and the final follow-up, respectively ( P < .001). The mean convergence angle was 4.4°, 3.9°, 4.0°, 4.1°, 4.2°, and 4.3°, respectively, during the same time periods ( P = .068). Conclusion: Cartilage healing, as indicated by the JSW, and clinical improvement were maintained over the minimum 3-year follow-up after CWHTO. Cartilage pressure, as indicated by the convergence angle, remained unchanged after CWHTO.
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Lee, Seung Yeol, Soon-Sun Kwon, and Kyoung Min Lee. "Changes in the Mechanical Axis and Weight-Bearing Line of the Ankle After Varus Knee Correction." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0026. http://dx.doi.org/10.1177/2473011419s00269.
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Category: Ankle, Hindfoot Introduction/Purpose: Varus limb malalignment results in an imbalance of force transmission to the knee joint, resulting in a concentrated load in the medial compartment. A varus knee correction may affect the ankle and subtalar joint, because the weight-bearing load on the lower extremity extends from the hip to the foot. A previous study suggested that the true mechanical axis of the lower limb should be calculated with a line from the center of the femoral head to the lowest point of the calcaneus, not to the center of the tibial plafond. Therefore, we performed this study to evaluate changes in the mechanical axis and weight- bearing line of the ankle after varus knee correction. Methods: Patients with a varus knee who were followed-up after they had undergone high tibial osteotomy (HTO) or total knee replacement arthroplasty (TKA) at an age of >20 years, and who had undergone preoperative and postoperative scanogram were included in this study. The hip-knee-ankle (HKA) angle, mechanical axis, and weight-bearing line (line from the center of the femoral head to the lowest point of the calcaneus) were measured on the radiographs. The point at which the mechanical axis and weight-bearing line passed through the tibial plafond was the ankle joint axis point. The postoperative change in the ankle joint axis point on the mechanical axis and weight-bearing line according to the HKA angle correction was adjusted by multiple factors using a linear mixed model. Results: A total of 257 limbs from 198 patients were included in this study. The preoperative HKA was 7.3 ± 4.7° and corrected to 0.4 ± 3.8°. Although the ankle axis points on both axes moved laterally after HTO and TKA, the ankle joint axis of the weight- bearing line showed a significant larger lateral movement (22.5±35.7%) (Fig.) than that of the mechanical axis (15.7±16.0%) in terms of rate of change (p = 0.006). The ankle joint axis point on the weight-bearing line moved laterally by 0.9% per degree of postoperative HKA angle decrease (p < 0.001). The change in the ankle joint axis point on the mechanical axis was not statistically significant after HTO and TKA (p = 0.223). Conclusion: The mechanical axis and weight-bearing line of the ankle moved laterally after the varus knee correction. The ankle joint axis on the weight-bearing line moved laterally as the HKA angle decreased after the surgery, whereas the varus knee correction did not significantly affect the ankle joint axis on the mechanical axis. The varus knee correction might affect the subtalar joint as well as the ankle joint. Therefore, we believe that our findings warrant consideration in pre- and postoperative evaluations using the weight-bearing line of patients undergoing varus knee correction.
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Hino, Manabu, Shuji Nakagawa, Yuji Arai, Hiroaki Inoue, Hiroyuki Kan, Yuta Fujii, Kazuya Ikoma, and Toshikazu Kubo. "Extensor hallucis longus tendon is a new distal landmark for coronal tibial component alignment in total knee arthroplasty: A study of magnetic resonance imaging." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949902091234. http://dx.doi.org/10.1177/2309499020912340.
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Purpose: In total knee arthroplasty (TKA), various landmarks are generally used to ensure correct osteotomy. In this study, we examined whether the tibialis anterior tendon (TAT) or the extensor hallucis longus tendon (EHLT) could be used as a landmark of the center of the ankle joint in patients with knee osteoarthrosis (OA), using magnetic resonance imaging (MRI). Methods: The subjects were 61 patients with OA in 79 knees (males: 8 with 9 knees and females: 53 with 70 knees). With the ankle joint secured in the intermediate position, MRI from the knee joint to the ankle joint was performed in the same foot position. We prepared individual lines connecting the center of the ankle joint with the TAT or EHLT to measure the angle difference (ΔA) from Akagi’s line in the knee joint. We analyzed whether the ΔA might be affected by deformity of the knee joint or foot region, and tibial torsion. Results: At the ankle joint level, the ΔA of EHLT was the smallest, with an average of 1.6 ± 3.4°. The ΔA for the femorotibial angle, hallux valgus angle, and varus–valgus angle showed no correlations with deformity of the knee joint and foot region, or tibial torsion. Conclusions: MRI findings showed that EHLT would be useful as a landmark of the ankle joint center in extramedullary tibial osteotomy in TKA for medial knee OA. It was also clarified that the landmark would not be affected by severe deformity of the knee joint, deformity of the foot region, or external torsion of the tibia.
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Rosso, Federica, Roberto Rossi, Antonino Cantivalli, Carola Pilone, and Davide Edoardo Bonasia. "Joint Line Obliquity Does Not Affect the Outcomes of Opening Wedge High Tibial Osteotomy at an Average 10-Year Follow-up." American Journal of Sports Medicine 50, no. 2 (December 2, 2021): 461–70. http://dx.doi.org/10.1177/03635465211059811.
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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.
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Hassaballa, Mo, Vijaya Budnar, Herbert Gbejuade, and Ian Learmonth. "Does improved instrumentation result in better component alignment in total knee arthroplasty?" Orthopedic Reviews 3, no. 1 (March 14, 2011): 3. http://dx.doi.org/10.4081/or.2011.e3.
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Accurate component alignment and joint line reproduction in total knee replacement (TKR) is crucial for successful clinical outcome. Advances in instrumentation and better understanding of the biomechanics can help to achieve better three dimensional alignments of TKR components and joint line restoration. We compared the accuracy of component alignment and joint line restoration with the use of 2 different TKR instrumentation kits (an older Gobot and a newer Xcelerate). Retrospective study of 150 consecutive patients undergoing primary TKR had their pre and post-operative x-rays reviewed. Seventy-five patients (group A) had their TKR using the older instrumentation kit (Gobot) and 75 (group B) had the newer version (Xcelerate). The positioning of the prosthesis components were assessed using the American Knee society radiographic evaluation method and the joint line position using the Figgie’s method. The results from the two groups were statistically compared. There was a significantly greater elevation of the joint line position in TKRs done with the Gobot instrumentation (mean 4.49 mm vs. 2.71 mm in group B, P=0.03), and significant differences in the mean tibial component angle cTCA (group A 88.6º, group B 90.1º, P=0.04) and the mean Q angle (group A 6.28º valgus, group B 8.45º valgus, P=0.04). Use of the newer Xcelerate instrumentation was associated with better restoration of joint line position, however the femoral component flexion and posterior slope of the tibial component ere found to be above the desired level. Hence the overall differences between the two groups were found to be small.
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Lai, Mun Chun, Jerry Yongqiang Chen, Ming Han Lincoln Liow, Darren Keng Jin Tay, Ngai Nung Lo, Hee Nee Pang, and Seng Jin Yeo. "Is constraint implant with metaphyseal sleeve a viable option for revision TKR with preoperative coronal plane instability and bone defect?" Journal of Orthopaedic Surgery 28, no. 2 (January 1, 2020): 230949902092631. http://dx.doi.org/10.1177/2309499020926313.
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Background: Metaphyseal sleeves have been used as metaphyseal filling implants to address bone loss during revision total knee replacements (TKRs). This study aims to compare the 2-year clinical and radiological outcomes of constraint implant with bone defect and constraint implant without or minimal bone defect in revisions TKR with preoperative coronal plane instability. Materials and Methods: Seventeen cases of constraint implants with metaphyseal sleeve matched paired with 34 cases of constrained condylar knee (CCK) prosthesis. Age, gender, body mass index and aetiology for revision surgery were recorded. Clinical outcome measures included Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Oxford Knee Score (OKS), physical component summary (PCS) and mental component summary (MCS). Radiological outcome measures included joint line changes, hip–knee–ankle angle (HKA), coronal femoral angle (CFA) and coronal tibial angle (CTA). Result: Patients in sleeve group showed significant improvement in KSKS, KSFS and OKS (38 ± 7, 35 ± 6 and 20 ± 2 points, respectively, p < 0.001), while they were 19 ± 3 and 6 ± 2 points for PCS and MCS, respectively ( p < 0.001 and p = 0.021). These postoperative scores after surgery were similar between the two groups at 6 months and 2 years. The sleeve provides comparable result in joint line restoration; the postoperative HKA, CFA and CTA were all comparable between the two groups. Conclusion: Metaphyseal sleeve with constraint implant is a viable option for revision TKR with preoperative coronal plane instability and significant bone defect. It is able to achieve similar clinical outcomes and joint line restoration compared to CCK prosthesis at 2-year follow-up.
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Hou, Yingzhou, Shaohua Wang, and Aiguo Wang. "Effect of unicompartmental knee arthroplasty and high tibial osteotomy with tomofix internal fixation in the treatment of unicompartmental knee osteoarthritis." Orthopaedic Journal of Sports Medicine 8, no. 9_suppl7 (September 1, 2020): 2325967120S0054. http://dx.doi.org/10.1177/2325967120s00541.
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Introduction: Knee osteoarthritis is a common degenerative disease in the elderly clinically. Cartilage damage, osteophyte formation, joint space narrowing and bone exposure are the main pathological changes, mainly manifested as joint cartilage degeneration [1]. Since the knee joint load of normal people is mainly conducted through the medial side of the knee joint, it is easy to cause degeneration of the medial compartment and then narrow the joint space, which leads to the medial deviation of the lower limb line and the varus deformity of the knee joint. For patients aged 55-65 years with unilateral ventricular osteoarthritis of the knee, the current surgical methods are mostly high tibial osteotomy (HTO) or unicomartmental knee arthroplasty (UKA)[2,3]. HTO always thought to improve lower limb power line to correct deformities, effectively relieve pain and improve function, is an effective method for treatment of osteoarthritis knee inside, high cut bone is typically used in younger patients and patients from physical activity, can effectively reduce the load and delay of knee joint cartilage lesion replacement time, while UKA is more suitable for old age is not active, activity, and patients needs more intense in terms of pain relief. Hypotheses: To investigate the clinical effect of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with tomofix internal fixation in the treatment of unicompartmental knee osteoarthritis. Methods: 60 patients with unicompartmental knee osteoarthritis and varus deformity of the knee joint were randomly divided into two groups: the UKA group (30 cases) and the HTO group (30 cases). The average follow-up time was 6 months, Scores preoperative and postoperative knee joint function, postoperative complications and postoperative pain satisfaction were compared. Results: The scores of HSS, VAS, femorotibial angle(FTA) and active range of motion(ROM) were 82.6 ± 12.9, 1.9 ± 0.8,173.2 ± 1.4,135.2 ± 1.6 in the group of unicompartmental knee arthroplasty (UKA);The scores of HSS, VAS(Visual Analogue Score), femorotibial angle(FTA) and active range of motion(ROM) after tomofix internal fixation used in the group of high tibial osteotomy (HTO)were 81.9 ± 14.3, 1.8 ± 0.9, 174.5 ± 1.8 and 121.1 ± 2.7 . There was no significant difference between the UKA group and HTO group in the scores of HSS, VAS and femorotibial angle(FTA) (P > 0.05). The active range of motion(ROM) of the HTO group was better than that of UKA group (P < 0.05). Conclusion: Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with tomofix internal fixation can improve the knee joint function and symptoms in the treatment of medial compartment osteoarthritis, but the active range of motion(ROM) in HTO group is better than UKA group.
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Brooke, J. D., and W. E. Mcllroy. "Effect of Knee Joint Angle on a Heteronymous lb Reflex in the Human Lower Limb." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 16, no. 1 (February 1989): 58–62. http://dx.doi.org/10.1017/s0317167100028511.
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ABSTRACT:Altered efficacy, from change in receptor discharge with different positions of the knee, was investigated in a heteronymous lb reflex of the human leg. The electrical stimulus was low threshold, to the common peroneal nerve. The divergence of the group I afferents was studied in the electromyograms (EMGs) of ipsilateral and contralateral thigh muscles. The stimulus evoked ipsilateral, short latency, excitation in the three quadriceps muscles studied and inhibition in the knee flexor semitendinosus (ST), with prior contraction of target muscles. This excitation and inhibition did not alter when studied over the range of the knee joint. The stimulus did not evoke responses in contralateral thigh muscles, contracted or relaxed. It is concluded that (1) any change in convergence from discharge of receptors, during extension of the limb, is small and sub-threshold, and (2) this spinal proprioceptive level of neural control appears to be directed primarily to the single limb.
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Ucpunar, H., S. K. Tas, Y. Camurcu, H. Sofu, M. Mert, and A. I. Bayhan. "The effects of residual hip deformity on coronal alignment of the lower extremity in patients with unilateral slipped capital femoral epiphysis." Journal of Children's Orthopaedics 12, no. 6 (December 2018): 599–605. http://dx.doi.org/10.1302/1863-2548.12.180137.
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Purpose The aim of our explorative study was to compare the differences in the coronal alignments of the hip, knee and ankle on the slip side and non-slip sides in patients with slipped capital femoral epiphysis (SCFE). Methods The study group consisted of 28 patients. On the full-length standing radiographs, measurements of articulo-trochanteric distance (ATD), neck-shaft angle (NSA), femoral offset, hip-knee-ankle axis, femur-tibial angle, mechanical axis deviation ratio (MAD-r), anatomical medial proximal femoral angle (aMPFA), mechanical lateral proximal femoral angle (mLPFA), anatomical lateral distal femoral angle (aLDFA), mechanical lateral distal femoral angle (mLDFA), knee joint line congruency angle, mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), ankle joint line orientation angle (AJOA), and leg length discrepancy (LLD) were performed. The data from the slip side were compared with those from the non-slip side. Results At skeletal maturity, there were significant differences between the slip side and non-slip side in ATD (p <0.001), NSA (p <0.001), MAD-r (p <0.001), aMPFA (p <0.001), aLDFA (p = 0.03), mLDFA (p = 0.04), mLDTA (p = 0.02), AJOA (p <0.001) and LLD (p<0.001). Conclusion Residual deformity in the proximal femur after epiphyseal slip and premature epiphysiodesis could cause changes in the coronal alignment of the lower extremity. We can add lower extremity alignment examination to follow-up protocol to rule out secondary problems in patients with SCFE. Level of Evidence Level III, retrospective comparative study
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Pradhan, Allin, CP Lama, S. Dhungel, and SK Ghosh. "Radiological Assessment of Femoral Bicondylar Angle among Persons Attending a Tertiary Health Care." Nepal Medical College Journal 21, no. 1 (March 31, 2019): 44–47. http://dx.doi.org/10.3126/nmcj.v21i1.24850.
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Femoral bicondylar angle is the angle between an axis through the shaft of the femur and a line perpendicular to the infracondylar plane. This study aims to assess femoral bicondylar angle measured from radiograph of femur and knee joints obtained from teaching hospitals in Kathmandu Nepal. Total of two hundred AP view radiograph of knee joint were collected, out of which, 50 each were of male right and left knee joint and 50 each were of female right and left knee joint. The mean angle for the right male femur was 7.86° with the range of 5°-10° and mean angle for the right female femur was 8.82° with the range of 6°-11°. On the left side, bicondylar angle ranged in male from 6° -10° with the average of 7.46° and in female range was 6°-11° and average was 8.66°. The bicondylar angle was higher in female on both the side, the difference was statistically significant on the left side (P=0.004) and significant on the right side (P=0.001). The finding of the study showed the femoral bicondylar angles were greater in right femur than left femur in both sexes. The difference in the bicondylar angle between the right and left femur was statistically insignificant in both sexes. (male p=0.144, female p=0.541). The result from this study has shown that femoral bicondylar angles were generally greater amongst the females as compared to the males; greater in right femur than left femur in both sexes.
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Matsuzawa, Yuta, Takasuke Miyazaki, Yasufumi Takeshita, Naoto Higashi, Hiroyuki Hayashi, Sota Araki, Shintaro Nakatsuji, Seiji Fukunaga, Masayuki Kawada, and Ryoji Kiyama. "Effect of Leg Extension Angle on Knee Flexion Angle during Swing Phase in Post-Stroke Gait." Medicina 57, no. 11 (November 9, 2021): 1222. http://dx.doi.org/10.3390/medicina57111222.
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Background and Objectives: Leg extension angle is important for increasing the propulsion force during gait and is a meaningful indicator for evaluating gait quality in stroke patients. Although leg extension angle during late stance might potentially also affect lower limb kinematics during the swing phase, the relationship between these two remains unclear. This study aimed to investigate the relationship between leg extension angle and knee flexion angle during pre-swing and swing phase in post-stroke gait. Materials and Methods: Twenty-nine stroke patients walked along a 16 m walkway at a self-selected speed. Tilt angles and acceleration of pelvis and paretic lower limb segments were measured using inertial measurement units. Leg extension angle, consisting of a line connecting the hip joint with the ankle joint, hip and knee angles, and increments of velocity during pre-swing and swing phase were calculated. Correlation analysis was conducted to examine the relationships between these parameters. Partial correlation analysis adjusted by the Fugl-Meyer assessment-lower limb (FMA-LL) was also performed. Results: On the paretic side, leg extension angle was positively correlated with knee flexion angle during the swing phase (r = 0.721, p < 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.740–0.846, p < 0.001). Partial correlation analysis adjusted by the FMA-LL showed significant correlation between leg extension angle and knee flexion angle during the swing phase (r = 0.602, p = 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.655–0.886, p < 0.001). Conclusions: Leg extension angle affected kinematics during the swing phase in post-stroke gait regardless of the severity of paralysis, and was similar during the pre-swing phase. These results would guide the development of effective gait training programs that enable a safe and efficient gait for stroke patients.
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Park, Jun-Gu, Seung-Beom Han, and Ki-Mo Jang. "Association of Preoperative Tibial Varus Deformity With Joint Line Orientation and Clinical Outcome After Open-Wedge High Tibial Osteotomy for Medial Compartment Osteoarthritis: A Propensity Score–Matched Analysis." American Journal of Sports Medicine 49, no. 13 (October 8, 2021): 3551–60. http://dx.doi.org/10.1177/03635465211044146.
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Background: The correction of lower limb deformity should be performed at the site of deformity to maintain knee joint orientation. However, the effectiveness of open-wedge high tibial osteotomy (OWHTO) for treatment of medial osteoarthritis in varus malalignment without definite tibial varus deformity has not been confirmed. Purpose/Hypothesis: This study aimed to compare the clinical and radiologic outcomes after OWHTO in patients without tibial varus deformity versus patients with tibial varus deformity after matching for confounding factors. We hypothesized that these outcomes would be inferior in patients without tibial varus deformity. Study Design: Cohort study; Level of evidence, 3. Methods: The outcomes of 133 OWHTO operations for medial osteoarthritis in 107 patients were retrospectively reviewed after follow-up for >2 years. The patients were divided into group 1 (tibia with varus deformity, preoperative medial proximal tibial angle [MPTA] <85°) and group 2 (tibia without varus deformity, preoperative MPTA ≥85°). The confounding factors, including patient characteristics, preoperative limb alignment, degree of osteoarthritis, and correction angle, were matched using propensity score matching. The radiologic parameters, including MPTA and joint line obliquity, were evaluated preoperatively, between 6 and 12 months postoperatively, and at the last follow-up. The radiologic outcomes were assessed using the medial joint space width and mechanical hip-knee-ankle angle. The clinical outcomes were evaluated by the Hospital for Special Surgery knee score, Knee Society Score (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The clinical and radiologic outcomes were compared between the groups. The proportions of patients achieving improvement in the clinical outcome beyond the minimal clinically important difference (MCID) or minimally important change were compared between the groups. Results: After propensity score matching, 32 patients were selected for each group. The mechanical hip-knee-ankle angle was corrected without significant difference from a mean ± SD varus angle of 8.0°± 3.3° to valgus angle of −3.2°± 2.5° in group 1 and from varus 8.0°± 3.6° to valgus −3.9°± 1.7° in group 2. The preoperative joint line obliquity was greater in group 2 as compared with group 1 (2.2°± 2.2° vs −0.4°± 1.8°, P < .001). With a similar 10° correction angle, the postoperative MPTA and joint line obliquity were 96.6°± 2.5° and 5.3°± 2.3°, respectively, in group 2, which were greater than 94.0°± 2.6° and 3.5°± 1.8°, respectively, in group 1 (both P < .001). The changes in joint space width and mechanical hip-knee-ankle angle were not significantly different between the groups over the follow-up period. At the last follow-up, the postoperative KSS objective score and WOMAC pain score in terms of symptom improvement were not significantly different between groups ( P = .092 and .068). However, the postoperative KSS and WOMAC functional scores were significantly worse in group 2 than in group 1 (77.3 ± 14.1 vs 84.4 ± 11.6, P = .044; 10.3 ± 9.2 vs 5.6 ± 7.2, P = .001). In group 1, 96.9% and 100% of patients showed improvements of >10 points in the KSS functional score and 15 points in the WOMAC functional score based on MCID or minimally important change. Meanwhile, 65.6% and 81.3% of patients in group 2, which were significantly lower than those of group 1, were improved beyond the MCID or minimally important change ( P = .001 and .024, respectively). Conclusion: In varus malalignment, the knee joint line was more oblique in patients without tibial varus deformity after OWHTO pre- and postoperatively. The clinical outcomes in terms of functional scores were inferior in patients without tibial varus deformity. However, the radiologic outcomes and symptomatic improvement after OWHTO were comparable regardless of the preoperative tibial varus deformity on midterm follow-up.
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Sappey-Marinier, Elliot, Stephen M. Howell, Alexander J. Nedopil, and Maury L. Hull. "The Trochlear Groove of a Femoral Component Designed for Kinematic Alignment Is Lateral to the Quadriceps Line of Force and Better Laterally Covers the Anterior Femoral Resection Than a Mechanical Alignment Design." Journal of Personalized Medicine 12, no. 10 (October 16, 2022): 1724. http://dx.doi.org/10.3390/jpm12101724.
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Background: A concern about kinematically aligned (KA) total knee arthroplasty (TKA) is that it relies on femoral components designed for mechanical alignment (MAd-FC) that could affect patellar tracking, in part, because of a trochlear groove orientation that is typically 6° from vertical. KA sets the femoral component coincident to the patient’s pre-arthritic distal and posterior femoral joint lines and restores the Q-angle, which varies widely. Relative to KA and the native knee, aligning the femoral component with MA changes most distal joint lines and Q-angles, and rotates the posterior joint line externally laterally covering the anterior femoral resection. Whether switching from a MAd- to a KAd-FC with a wider trochlear groove orientation of 20.5° from vertical results in radiographic measures known to promote patellar tracking is unknown. The primary aim was to determine whether a KAd-FC sets the trochlear groove lateral to the quadriceps line of force (QLF), better laterally covers the anterior femoral resection, and reduces lateral patella tilt relative to a MAd-FC. The secondary objective was to determine at six weeks whether the KAd-FC resulted in a higher complication rate, less knee extension and flexion, and lower clinical outcomes. Methods: Between April 2019 and July 2022, two surgeons performed sequential bilateral unrestricted caliper-verified KA TKA with manual instruments on thirty-six patients with a KAd- and MAd-FC in opposite knees. An observer measured the angle between a line best-fit to the deepest valley of the trochlea and a line representing the QLF that indicated the patient’s Q-angle. When the trochlear groove was lateral or medial relative to the QLF, the angle is denoted + or −, and the femoral component included or excluded the patient’s Q-angle, respectively. Software measured the lateral undercoverage of the anterior femoral resection on a Computed Tomography (CT) scan, and the patella tilt angle (PTA) on a skyline radiograph. Complications, knee extension and flexion measurements, Oxford Knee Score, KOOS Jr, and Forgotten Joint Score were recorded pre- and post-operatively (at 6 weeks). A paired Student’s T-test determined the difference between the KA TKAs with a KAd-FC and MAd-FC with a significance set at p < 0.05. Results: The final analysis included thirty-five patients. The 20.5° trochlear groove of the KAd-FC was lateral to the QLF in 100% (15 ± 3°) of TKAs, which was greater than the 69% (1 ± 3°) lateral to the QLF with the 6° trochlear groove of the MAd-FC (p < 0.001). The KAd-FC’s 2 ± 1.9 mm lateral undercoverage of the anterior femoral resection was less than the 4.4 ± 1.5 mm for the MAd-FC (p < 0.001). The PTA, complication rate, knee extension and flexion, and clinical outcome measures did not differ between component designs. Conclusions: The KA TKA with a KAd-FC resulted in a trochlear groove lateral to the QLF that included the Q-angle in all patients, and negligible lateral undercoverage of the anterior femoral resection. These newly described radiographic parameters could be helpful when investigating femoral components designed for KA with the intent of promoting patellofemoral kinematics.
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Lo Presti, Mirco, Giovanni Francesco Raspugli, Davide Reale, Francesco Iacono, Stefano Zaffagnini, Giuseppe Filardo, and Maurilio Marcacci. "Early Failure in Medial Unicondylar Arthroplasty: Radiographic Analysis on the Importance of Joint Line Restoration." Journal of Knee Surgery 32, no. 09 (September 13, 2018): 860–65. http://dx.doi.org/10.1055/s-0038-1669448.
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AbstractSurvivorship of unicondylar knee arthroplasty (UKA) remains a drawback, especially compared with the outcome of total knee arthroplasty. This could be improved by identifying and correcting failure mechanisms. To this purpose, this study aimed at exploring failure modalities of UKA, with particular focus on the role of joint line (JL) position and alignment as variable to be optimized for a successful outcome. This study explored modes of failure in 266 medial UKAs. Radiological comparison was performed between 24 failures and 24 matched controls, to determine the importance of UKA positioning in terms of femorotibial angle (FTA), tibial plateau angle, and posterior tibial slope (PTS). Radiographic comparative analysis showed statistically significant differences in the failure group compared with the control group in terms of variation in FTA (p = 0.0222), PTS (p = 0.0025), and JL height (p = 0.0022). Variations not only in FTA but also PTS and JL height were correlated with failures observed in this series. Thus, based on the results of this study, it emerges that JL position should be carefully controlled in all planes while implanting a UKA. This is a Level III, case–control study.
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Tsuji, Masaki, Yasushi Akamatsu, Hideo Kobayashi, Naoto Mitsugi, Yutaka Inaba, and Tomoyuki Saito. "Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy." Archives of Orthopaedic and Trauma Surgery 140, no. 6 (August 30, 2019): 707–15. http://dx.doi.org/10.1007/s00402-019-03245-0.
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Kazmiruk, Andriy, Volodymyr Banakh, Andriy Vlasov, Anatolij Lopatiev, Oleksandr Tovstonoh, and Natalia Stefanyshyn. "Parameters of the In-Run Position of Juniors’ Body at the Beginning of Take-Off." Teorìâ ta Metodika Fìzičnogo Vihovannâ 17, no. 4 (December 30, 2017): 177–83. http://dx.doi.org/10.17309/tmfv.2017.4.1202.
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The objective is to determine the differences in the technique of the in-run position execution at the beginning of take-off by junior ski-jumpers of different qualification (sports training).Materials and methods. The participants in the study were 22 junior ski-jumpers aged 14-16 (a group of junior ski-jumpers) performing during the Ukrainian Ski-Jumping Championship (October 9, 2010, Vorokhta, Ukraine). The correlation analysis thereof established the relations between the jump length and the angular parameters: in the ankle joint, knee joint, hip joint, and pelvis joint, which condition the positional relationship of the body joints and the position of the ski-jumper at the beginningof take-off. Results. The study established the correlation relations between the jump length and the angular parameters that condition the horizontal positioning of the body. The correlation coefficient for the jump length at the inclination angle of the segment of the straigt line passing through the axes of the ankle and shoulder joints to the direction of the skier’s movement is r=–0.563 (p = 0.006), and that at the inclination angle of the segment of the straight line passing through the general center of body weight and the axis of the ankle joint to the direction of the skier’s movement is r= –0.355 (p = 0.105).Conclusions. A position of lowly groupping at the beginning of the take-off allows to improve the sporting result. The study established the correlation between the jump length and the angle, particularly in the ankle joint, to be r= –0.2244 (p = 0.274), in the knee joint — r= –0.165 (p = 0.464), in the hip joint —r= –0.127 (p = 0.574). It determined the statistically reliable differences in the parameters of the body position at the beginning of the take-off on the jump ramp (p <0.05).
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Takayama, Koji, Kazunari Ishida, Hirotsugu Muratsu, Yuichi Kuroda, Masanori Tsubosaka, Shingo Hashimoto, Shinya Hayashi, et al. "The medial tibial joint line elevation over 5 mm restrained the improvement of knee extension angle in unicompartmental knee arthroplasty." Knee Surgery, Sports Traumatology, Arthroscopy 26, no. 6 (November 9, 2017): 1737–42. http://dx.doi.org/10.1007/s00167-017-4763-8.
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Puspita Arum, Purwa, and Panji Wibowo Nurcahyo. "PERANAN PROYEKSI STITCH VIEW LONG LEG PADA PEMERIKSAAN KNEE JOINT DENGAN INDIKASI OSTEOARTHRITIS." JRI (Jurnal Radiografer Indonesia) 4, no. 2 (November 29, 2021): 70–73. http://dx.doi.org/10.55451/jri.v4i2.90.
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ABSTRACT
Introduction: Long Leg View is an x-ray examination of all parts of the lower extremity using a long vertical cassette which aims to measure the angle between the mechanical axis of the femur and tibia. Knee Joint examination with indications of osteoarthritis at the Radiology Installation of RSUP Dr. Sardjito Yogyakarta uses supine AP projection, Lateral recumbent, Skyline, and Stitch View Long Leg.
Methods: This research is a qualitative research with a case study approach. Collecting data by means of observation, documentation, and in-depth interviews with patients, sending doctors, radiologists, and radiographers. Data collection was carried out in March 2018 at the Radiology Installation of Dr. RSUP. Sardjito Yogyakarta. The data obtained were analyzed using an interactive model.
Results: On the Stitch View Long Leg examination at the Radiology Installation, Dr. Sardjito Yogyakarta uses a collimation area from the pelvis to the ankle joint. According to the resident doctor of orthopedic surgery and traumatology, Dr. Sardjito Yogyakarta, Stitch View Long Leg is able to see the shape of the foot formation, namely the O formation or X formation. In addition, according to radiology specialists, looking at the alignment deviation of the lower extremities can be used to assess the grade of osteoarthritis. Under normal conditions, the anatomical axis of the femur and tibia forms an angle of 6º ± 2º, while the mechanical axis line under normal conditions is 8 mm ± 7 mm medial to the center of the knee joint line. The alignment of varus and valgus has been associated with the development of medial or lateral osteoarthritis.
Conclusion: Stitch View Long Leg aims to assess the grade of osteoarthritis through assessment of lower extremity alignment deviations, see the overall mechanical and anatomical alignment of the lower extremities, help determine the calculation of the angle of bone cutting during Total Knee Replacement surgery, and see the right and left symmetrical balance of genu.
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Chung, Jai Hyun, Chong Hyuk Choi, Sung-Hwan Kim, Sung-Jae Kim, Seung-Kyu Lee, and Min Jung. "Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis." Journal of Clinical Medicine 10, no. 18 (September 21, 2021): 4272. http://dx.doi.org/10.3390/jcm10184272.
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The posterior tibial slope of the tibiofemoral joint changes after medial open wedge high tibial osteotomy (MOWHTO), but little is known about the effect of the sagittal osteotomy inclination angle on the change in the posterior tibial slope of the tibiofemoral joint. The purpose of this study was to investigate the effect of the osteotomy inclination angle in the sagittal plane on changes in the posterior tibial slope after MOWHTO by comparing how anterior and posterior inclination affect the posterior tibial slope of the tibiofemoral joint. The correlation between the osteotomy inclination angle and the postoperative posterior tibial slope angle was also assessed. Between May 2011 and November 2017, 80 patients with medial compartment osteoarthritis who underwent MOWHTO were included. The patients were divided into two groups according to the sagittal osteotomy inclination angle on the 3D reconstructed model. Patients with an osteotomy line inclined anteriorly to the medial tibial plateau line were classified into group A (58 patients). Patients with posteriorly inclined osteotomy line were classified as group P (22 patients). In the 3D reconstructed model, the preoperative and postoperative posterior tibial slope, osteotomy inclination angle relative to medial tibial plateau line in sagittal plane, and gap distance and ratio of the anterior and posterior osteotomy openings were measured. The preoperative and postoperative hip-knee-ankle angle, weight-bearing line ratio, and posterior tibial slope were also measured using plain radiographs. In the 3D reconstructed model, the postoperative posterior tibial slope significantly increased in group A (preoperative value = 9.7 ± 2.9°, postoperative value = 10.7 ± 3.0°, p < 0.001) and decreased in group P (preoperative value = 8.7 ± 2.7°, postoperative value = 7.7 ± 2.7°, p < 0.001). The postoperative posterior tibial slope (group A = 10.7 ± 3.0°, group P = 7.7 ± 2.7°, p < 0.001) and posterior tibial slope change before and after surgery (group A = 1.0 ± 0.8°, group P = −0.9 ± 0.8°, p < 0.001) also differed significantly between the groups. The Pearson correlation coefficient was 0.875 (p < 0.001) for the osteotomy inclination angle, and multivariate regression analysis showed that the only significant factor among the variables was the sagittal osteotomy inclination angle (β coefficient = 0.216, p < 0.001). The posterior tibial slope changed according to the osteotomy inclination angle in the sagittal plane after MOWHTO. The postoperative posterior tibial slope tended to increase when the osteotomy line was inclined anteriorly with respect to the medial tibial plateau line but decreased when the osteotomy line was inclined posteriorly. To avoid inadvertent change of posterior tibial slope, close attention needs to be paid to maintaining the sagittal osteotomy line parallel to the medial joint line during MOWHTO.
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Hsu, Cheng-En, Chao-Ping Chen, Shun-Ping Wang, Jen-Ting Huang, Kwok-Man Tong, and Kui-Chou Huang. "Validation and modification of the Coronal Plane Alignment of the Knee classification in the Asian population." Bone & Joint Open 3, no. 3 (March 1, 2022): 211–17. http://dx.doi.org/10.1302/2633-1462.33.bjo-2022-0001.r1.
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Aims The Coronal Plane Alignment of the Knee (CPAK) classification is a simple and comprehensive system for predicting pre-arthritic knee alignment. However, when the CPAK classification is applied in the Asian population, which is characterized by more varus and wider distribution in lower limb alignment, modifications in the boundaries of arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) should be considered. The purposes of this study were as follows: first, to propose a modified CPAK classification based on the actual joint line obliquity (aJLO) and wider range of aHKA in the Asian population; second, to test this classification in a cohort of Asians with healthy knees; third, to propose individualized alignment targets for different CPAK types in kinematically aligned (KA) total knee arthroplasty (TKA). Methods The CPAK classification was modified by changing the neutral boundaries of aHKA to 0° ± 3° and using aJLO as a new variable. Radiological analysis of 214 healthy knees in 214 Asian individuals was used to assess the distribution and mean value of alignment angles of each phenotype among different classifications based on the coronal plane. Individualized alignment targets were set according to the mean lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) of different knee types. Results A very high concentration, 191 from 214 individuals (89.3%), were found in knee types with apex distal JLO when the CPAK classification was applied in the Asian population. By using aJLO as a new variable, the high distribution percentage in knee types with apex distal JLO decreased to 125 from 214 individuals (58.4%). The most common types in order were Type II (n = 70; 32.7%), Type V (n = 55; 25.7%), and Type I (n = 46; 21.5%) in the modified CPAK classification. Conclusion The modified CPAK classification corrected the uneven distribution when applying the CPAK classification in the Asian population. Setting individualized TKA alignment targets according to CPAK type may be a practical method to recreate optimal LDFA and MPTA in KA-TKA. Cite this article: Bone Jt Open 2022;3(3):211–217.
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Kim, Jung-Taek, Jun Han, Sumin Lim, Quan Hu Shen, and Ye Yeon Won. "Kinematically Aligned TKA Aligns the Ankle Joint Line Closer to Those of the Native Ankle than Mechanically Aligned TKA in Bipedal Stance." Journal of Knee Surgery 32, no. 10 (August 21, 2019): 1033–38. http://dx.doi.org/10.1055/s-0039-1694796.
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AbstractMechanically aligned total knee arthroplasty (MATKA) aims to make alignment of the hip, knee, and ankle straight unexceptionally. However, emerging evidence suggests that unexceptional straightening the mechanical axis of the lower limb may lead to clinical and radiological problems of the ankle joint. By contrast, kinematically aligned total knee arthroplasty (KATKA) strives to restore the articular surface of the prearthritic knee. In this study, we examined results from KATKA and MATKA to determine which surgery restores the ankle joint orientation closer to the native ankle joint in bipedal stance and hypothesized that KATKA, rather than MATKA, would be more effective. Data from long-leg standing radiographs of 60 healthy adults (control group, n = 120 knees), patients who underwent MATKA (n = 90 knees), and patients who underwent KATKA (n = 90 knees) were retrospectively reviewed. The hip–knee–ankle angle, orientation of the tibial plafond and the talar dome relative to the ground (G-plafond and G-talus, respectively), and orientation of the plafond relative to the mechanical axis of the limb (M-plafond and M-talus, respectively) were measured and analyzed for comparison. Results show that bipedal stance alignment in patients who underwent KATKA (G-plafond: −0.65 ± 3.03 and G-talus: −1.72 ± 4.02) were not significantly different to native ankle joint alignment indicated by the control group. Compared with the native ankle joint measured in the control group (G-plafond: −0.76 ± 2.69 and G-talus: −1.30 ± 3.25), the tibial plafond and talar dome significantly tilted laterally relative to the ground in ankle joints after MATKA (G-plafond: −2.32 ± 3.30 and G-talus: −2.97 ± 3.98, p = 0.001 and p = 0.004, respectively). Thus, postoperative ankle joint line orientation after KATKA was horizontal to the floor and closer to that of native ankle joints than those after MATKA. The level of evidence is Level III.
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Herrington, Lee. "Effect of a SERF Strap on Pain and Knee-Valgus Angle During Unilateral Squat and Step Landing in Patellofemoral Patients." Journal of Sport Rehabilitation 22, no. 1 (February 2013): 27–32. http://dx.doi.org/10.1123/jsr.22.1.27.
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Context:A valgus position of the knee on functional loading tasks has been reported to be associated with patellofemoral-joint pain. Training programs to reduce knee valgus have been shown to be effective but take time. It would appear logical to use a brace or strap to help control this knee motion to reduce symptoms.Objective:To assess the impact of the SERF strap on knee valgus and patellofemoral-joint pain.Design:Repeated measures.Setting:University human performance laboratory.Participants:12 women with patellofemoral pain (mean age 24 ± 3.2 y).Intervention:Application of SERF strap.Main Outcome Measures:Knee-valgus angle on single-leg squat and step landing and visual analog scale pain score.Results:The application of the SERF brace significantly reduced the pain (P < .04) and knee valgus (P < .034) during both tasks.Conclusion:The SERF brace brings about a significant reduction in pain during functional tasks. Although the brace brought about a significant reduction in knee valgus, this failed to exceed the smallest-detectable-difference value, so the difference is likely to be related to measurement error. The mechanism as to why this the reduction in pain occurs therefore remains unclear, as this study in line with many others failed to demonstrate meaningful changes in kinematics that could provide an obvious explanation.
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Sözbilen, Murat Celal, Elcil Kaya Biçer, Semih Aydoğdu, and Hakkı Sur. "Changes of ankle inclinations after total knee arthroplasty." Orthopaedic Journal of Sports Medicine 5, no. 2_suppl2 (February 1, 2017): 2325967117S0010. http://dx.doi.org/10.1177/2325967117s00102.
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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.
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Maag, Chase, Ioan Cracaoanu, Jason Langhorn, and Mark Heldreth. "Total knee replacement wear during simulated gait with mechanical and anatomic alignments." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 235, no. 5 (January 31, 2021): 515–22. http://dx.doi.org/10.1177/0954411921991269.
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Total knee replacements (TKR) have historically been implanted perpendicular to the mechanical axis of the knee joint, with a commensurate external rotation of the femur in flexion relative to the posterior condylar axis (PCA). Although this mechanical alignment (MA) method has typically offered good long-term survivorship of implants, it may result in alignment of the implant that departs significantly from the native Joint Line (JL) in extension and flexion for a considerable portion of the patient population. There is a growing interest with surgeons to implant TKR components more closely aligned to the natural JL (Anatomic Alignment-AA) of the patient’s knee joint to reduce the need for soft tissue releases during surgery, potentially improving knee function and patient satisfaction. Using a previously-validated finite element model of the lower extremity, implant- and alignment-specific loading conditions were developed and applied in a wear experiment via a six-degree-of-freedom joint simulator. MA was defined as 0° Joint Line (JL), 0° varus hip-knee-ankle (HKA) angle, and 3° external femoral rotation. AA was defined as 5° varus JL, 3° varus HKA, and 0° femoral rotation. The experiment returned wear rates of 3.76 ± 0.51 mg/million cycles (Mcyc) and 2.59 ± 2.11 mg/Mcyc for ATTUNE® cruciate-retaining (CR) fixed bearing (FB) in MA and AA, respectively. For ATTUNE posterior-stabilized (PS) FB in AA, the wear rate was 0.97 ± 1.11 mg/Mcyc. For ATTUNE CR rotating platform (RP), the wear rates were 0.23 ± 0.19 mg/Mcyc, 0.48 ± 1.02 mg/Mcyc in MA and AA respectively. Using a two-way ANOVA, it was determined that there was no significantly difference in the wear rates between AA and MA ( p = 0.144) nor the wear rate of ATTUNE PS FB in AA significantly different from either ATTUNE CR FB or ATTUNE CR RP.
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Nishitani, Kohei, Shinichi Kuriyama, Shinichiro Nakamura, Naoki Umatani, Hiromu Ito, and Shuichi Matsuda. "Excessive flexed position of the femoral component was associated with poor new Knee Society Score after total knee arthroplasty with the Bi-Surface knee prosthesis." Bone & Joint Journal 102-B, no. 6_Supple_A (June 2020): 36–42. http://dx.doi.org/10.1302/0301-620x.102b6.bjj-2019-1531.r1.
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Aims This study aimed to evaluate the association between the sagittal alignment of the femoral component in total knee arthroplasty (TKA) and new Knee Society Score (2011KSS), under the hypothesis that outliers such as the excessive extended or flexed femoral component were related to worse clinical outcomes. Methods A group of 156 knees (134 F:22 M) in 133 patients with a mean age 75.8 years (SD 6.4) who underwent TKA with the cruciate-substituting Bi-Surface Knee prosthesis were retrospectively enrolled. On lateral radiographs, γ angle (the angle between the distal femoral axis and the line perpendicular to the distal rear surface of the femoral component) was measured, and the patients were divided into four groups according to the γ angle. The 2011KSSs among groups were compared using the Kruskal-Wallis test. A secondary regression analysis was used to investigate the association between the 2011KSS and γ angle. Results According to the mean and SD of γ angle (γ, 4.0 SD 3.0°), four groups (Extended or minor flexed group, −0.5° ≤ γ < 2.5° (n = 54)), Mild flexed group (2.5° ≤ γ < 5.5° (n = 63)), Moderate flexed group (5.5° ≤ γ < 8.5° (n = 26)), and Excessive flexed group (8.5° ≤ γ (n = 13)) were defined. The Excessive flexed group showed worse 2011KSSs in all subdomains (Symptoms, Satisfaction, Expectations, and Functional activities) than the Mild flexed group. Secondary regression showed a convex upward function, and the scores were highest at γ = 3.0°, 4.0°, and 3.0° in Satisfaction, Expectations, and Functional activities, respectively. Conclusion The groups with a sagittal alignment of the femoral component > 8.5° showed inferior clinical outcomes in 2011KSSs. Secondary regression analyses showed that mild flexion of the femoral component was associated with the highest score. When implanting the Bi-Surface Knee prosthesis surgeons should pay careful attention to avoiding flexing the femoral component extensively during TKA. Our findings may be applicable to other implant designs. Cite this article: Bone Joint J 2020;102-B(6 Supple A):36–42.
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Tian, Gengshuang, Lishan Wang, Linzhou Liu, Yali Zhang, Lixiong Zuo, and Jianpeng Li. "Kinematic alignment versus mechanical alignment in total knee arthroplasty: An up-to-date meta-analysis." Journal of Orthopaedic Surgery 30, no. 3 (September 2022): 102255362211259. http://dx.doi.org/10.1177/10225536221125952.
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Purpose The purpose of this meta-analysis was to compare the efficacy and imaging parameters of kinematic alignment (KA) and mechanical alignment (MA) in total knee arthroplasty (TKA) and to evaluate whether patients undergoing KA-TKA benefited more than those undergoing MA-TKA. Methods Studies comparing the efficacy of KA-TKA and MA-TKA were included after searching and screening in the database, including PubMed, Embase, Web of Science and Cochrane Database Library. A total of 1420 patients were enrolled in the study, with 736 MA-TKA and 738 KA-TKA. The primary outcomes were postoperative knee function scores including KSS series, WOMAC, KOOS and OKS. Secondary outcomes included the operative time, the length of hospital stay, knee extension/flexion angle, and some imaging parameters. The risk of bias for included studies was assessed using the Cochrane Collaborative risk-of-bias assessment tool or the Newcastle-Ottawa Scale(NOS). Results Sixteen studies were included in this meta-analysis (11 randomized controlled studies and 5 cohort studies). Primary outcomes: Knee Society score (KSS, MD = 8.36, 95% Cl: 0.83–15.90) and combined KSS (MD = 15.24, 95% CI: 5.41–25.07) were higher in KA-TKA than in MA-TKA, and other functional scores were not statistically significant in KA-TKA and MA-TKA, including knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), Knee Function score (KFS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes: KA-TKA resulted in smaller medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) compared to MA-TKA. For other outcome measures, KA-TKA showed similar results compared to MA-TKA, including hip-knee-ankle (HKA) angle, extension/flexion angle, tibial component slope angle, joint line orientation angle (JLOA), the operation time, the length of hospital stay and ligament release rate. Conclusions In our analysis results, patients undergoing KA-TKA benefit as much as patients undergoing MA-TKA. KA may be a viable reference in total knee replacement.
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Pinter, Ilona J., Roos van Swigchem, A. J. Knoek van Soest, and Leonard A. Rozendaal. "The Dynamics of Postural Sway Cannot Be Captured Using a One-Segment Inverted Pendulum Model: A PCA on Segment Rotations During Unperturbed Stance." Journal of Neurophysiology 100, no. 6 (December 2008): 3197–208. http://dx.doi.org/10.1152/jn.01312.2007.
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Research on unperturbed stance is largely based on a one-segment inverted pendulum model. Recently, an increasing number of studies report a contribution of other major joints to postural control. Therefore this study evaluates whether the conclusions originating from the research based on a one-segment model adequately capture postural sway during unperturbed stance. High-pass filtered kinematic data (cutoff frequency 1/30 Hz) obtained over 3 min of unperturbed stance were analyzed in different ways. Variance of joint angles was analyzed. Principal-component analysis (PCA) was performed on the variance of lower leg, upper leg, and head–arms–trunk (HAT) angles, as well as on lower leg and COM angle (the orientation of the line from ankle joint to center of mass). It was found that the variance in knee and hip joint angles did not differ from the variance found in the ankle angle. The first PCA component indicated that, generally, the upper leg and HAT segments move in the same direction as the lower leg with a somewhat larger amplitude. The first PCA component relating ankle angle variance and COM angle variance indicated that the ankle joint angle displacement gives a good estimate of the COM angle displacement. The second PCA component on the segment angles partly explains the apparent discrepancy between these findings because this component points to a countermovement of the HAT relative to the ankle joint angle. It is concluded that postural control during unperturbed stance should be analyzed in terms of a multiple inverted pendulum model.
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Banger, Matthew S., William D. Johnston, Nima Razii, James Doonan, Philip J. Rowe, Bryn G. Jones, Angus D. MacLean, and Mark J. G. Blyth. "Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty: a prospective randomized controlled trial." Bone & Joint Journal 102-B, no. 11 (November 1, 2020): 1511–18. http://dx.doi.org/10.1302/0301-620x.102b11.bjj-2020-1166.r1.
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Aims The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. Methods An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. Results The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). Conclusion Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001). Cite this article: Bone Joint J 2020;102-B(11):1511–1518.
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Cielmski, Łukasz, Damian Kusz, and Michał Wójcik. "Variation in the Posterior Condylar Angle." Ortopedia Traumatologia Rehabilitacja 18, no. 6 (November 30, 2016): 549–61. http://dx.doi.org/10.5604/15093492.1230540.
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Background. Clinical success of TKR depends to a large extent on the correct positioning of the implants. The femur cut is usually made in 3° of external rotation relative to the posterior aspect of the femoral condyles, which is a typical value of the Posterior Condylar Angle (PCA). The aim of this study was to assess variation in the PCA and to identify possible correlations between the value of the PCA and the following parameters: gender, body side, body height and weight (BMI). Material and methods. The study group comprised 75 patients who underwent an Angio-CT study between 2012 and 2014 due to a suspected vascular disorder. For each knee, we measured the Posterior Condylar Angle and the Posterior Twist Angle. Results. The mean Posterior Condylar Angle was 2.7±2.1°. The differences between males and females were not statistically significant. The angles showed a high degree of symmetry between the contralateral knees. Conclusions. 1. Positioning of the femoral component of the knee joint endoprosthesis parallel to the transepicondylar line requires resecting the femur at approximately 3° of external rotation relative to the line tangential to the posterior aspect of the femoral condyles. This angle, however, may vary from 3.6° of internal rotation to 9.0° of external rotation which should be taken into consideration by the operating surgeon. 2. The values of the Posterior Condylar Angle do not correlate with gender, age, Body Mass Index and body side (with notable, near-perfect symmetry between the contralateral limbs). 3. In female patients, height and body weight may influence the Posterior Condylar Angle, but these correlations would require further studies of larger groups of patients. In male patients, we were unable to find such correlations.