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The influence of alignment on the musculo-skeletal loading conditions at the knee

The influence of alignment on the musculo-skeletal loading conditions at the knee
The influence of alignment on the musculo-skeletal loading conditions at the knee
Background and Aim
High tibial osteotomies attempt to recreate physiologically normal joint loading. Previous studies have discussed the influence of mal-alignment on the distribution of static loads to the medial and lateral compartments of the knee. The aim of this study was to determine the influence of mal-alignment on the tibio-femoral loading conditions during dynamic activities.

Material and Methods
Using a musculo-skeletal model of the lower limb, which had been previously validated with in vivo data, in this study we modified the alignment of the knee in four patients, from a normal position to the extremes of 8 degrees valgus and 10 degrees varus mal-alignment. The resulting tibio-femoral joint contact forces were examined while patients were walking and stair climbing.

Results
Varying the mal-alignment resulted in a highly individual response in joint loads. Deviations from the normal alignment produced an increase in loading, with valgus generating a more rapid increase in loading than a varus deformity of the same amount. Varus deformities of 10 degrees resulted in increases in peak contact force from an average of 3.3-times bodyweight (BW) up to a peak of 7.4 BW (+45% to +114%) while patients were walking, whilst increases of 15% up to 35% were determined for stair climbing. Increases of up to 140% were calculated at 8 degrees valgus during walking and up to 53% for stair climbing.

Conclusion
This study demonstrated a clear dependence of the individual joint loads on axial knee alignment. Based on the sensitivity of joint loading to valgus mal-alignment, more than 3 degrees of over-correction of a varus deformity to valgus should be carefully reconsidered.
osteotomy, joint contact forces, tibio-femoral joint, muscle forces
1435-2443
291-297
Heller, M.O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Taylor, W.R.
4f1cd2b0-4963-4b10-bbde-da586c069e77
Perka, C.
075d2c0e-b277-4a76-8b14-548bce0bb133
Duda, G.N.
32d09622-34ad-49dd-8314-3f61c99a764e
Heller, M.O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Taylor, W.R.
4f1cd2b0-4963-4b10-bbde-da586c069e77
Perka, C.
075d2c0e-b277-4a76-8b14-548bce0bb133
Duda, G.N.
32d09622-34ad-49dd-8314-3f61c99a764e

Heller, M.O., Taylor, W.R., Perka, C. and Duda, G.N. (2003) The influence of alignment on the musculo-skeletal loading conditions at the knee. Langenbeck's Archives of Surgery, 388 (5), 291-297. (doi:10.1007/s00423-003-0406-2).

Record type: Article

Abstract

Background and Aim
High tibial osteotomies attempt to recreate physiologically normal joint loading. Previous studies have discussed the influence of mal-alignment on the distribution of static loads to the medial and lateral compartments of the knee. The aim of this study was to determine the influence of mal-alignment on the tibio-femoral loading conditions during dynamic activities.

Material and Methods
Using a musculo-skeletal model of the lower limb, which had been previously validated with in vivo data, in this study we modified the alignment of the knee in four patients, from a normal position to the extremes of 8 degrees valgus and 10 degrees varus mal-alignment. The resulting tibio-femoral joint contact forces were examined while patients were walking and stair climbing.

Results
Varying the mal-alignment resulted in a highly individual response in joint loads. Deviations from the normal alignment produced an increase in loading, with valgus generating a more rapid increase in loading than a varus deformity of the same amount. Varus deformities of 10 degrees resulted in increases in peak contact force from an average of 3.3-times bodyweight (BW) up to a peak of 7.4 BW (+45% to +114%) while patients were walking, whilst increases of 15% up to 35% were determined for stair climbing. Increases of up to 140% were calculated at 8 degrees valgus during walking and up to 53% for stair climbing.

Conclusion
This study demonstrated a clear dependence of the individual joint loads on axial knee alignment. Based on the sensitivity of joint loading to valgus mal-alignment, more than 3 degrees of over-correction of a varus deformity to valgus should be carefully reconsidered.

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More information

Published date: October 2003
Keywords: osteotomy, joint contact forces, tibio-femoral joint, muscle forces
Organisations: Bioengineering Group

Identifiers

Local EPrints ID: 348497
URI: http://eprints.soton.ac.uk/id/eprint/348497
ISSN: 1435-2443
PURE UUID: ecee41d7-ec49-4e25-9820-3d7a308c5ede
ORCID for M.O. Heller: ORCID iD orcid.org/0000-0002-7879-1135

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Date deposited: 26 Feb 2013 11:57
Last modified: 03 Dec 2019 01:38

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Contributors

Author: M.O. Heller ORCID iD
Author: W.R. Taylor
Author: C. Perka
Author: G.N. Duda

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