Biomechanical Implications of an Oblique Knee Joint Line

Abstract

Surgical correction of multiapical deformities of the lower limb requires careful preoperative planning. Surgeons must account for the potential creation of secondary deformity, such as knee joint line obliquity, and the risks associated with accepting these changes in limb alignment. In this study, we evaluate the effect of knee joint obliquity on tibial plateau contact pressures and knee instability. Three cadaveric knees were dissected and put through biomechanical testing to simulate loading of an oblique knee joint. We observed < 1 mm femoral displacement (proxy measure of instability) between 15 degrees of varus tilt and 10 degrees of valgus tilt, and greater increases in tibial plateau contact pressures with valgus tilt than with varus tilt. Our results suggest that, if the creation of a secondary coronal plane deformity at the knee joint cannot be avoided, up to 15 degrees of varus or 10 degrees of valgus alignment can be tolerated by an otherwise structurally normal knee.

Keywords

deformity correction - osteotomies - knee joint obliquity - secondary deformity - secondary

• References

• 1 Probe RA. Lower extremity angular malunion: evaluation and surgical correction. J Am Acad Orthop Surg 2003; 11 (05) 302-311
• 2 Perry J. Gait Analysis: Normal Pathological Function. New York: McGraw-Hill; 1992
• 3 Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994; 25 (03) 425-465
• 4 Paley D. Intra-articular osteotomies of the hip, knee, and ankle. Oper Tech Orthop 2011; 21 (02) 184-196
• 5 Feldman DS, Goldstein RY, Kurland AM, Sheikh Taha AM. Intra-articular osteotomy for genu valgum in the knee with a lateral compartment deficiency. J Bone Joint Surg Am 2016; 98 (02) 100-107
• 6 Shelburne KB, Torry MR, Pandy MG. Contributions of muscles, ligaments, and the ground-reaction force to tibiofemoral joint loading during normal gait. J Orthop Res 2006; 24 (10) 1983-1990
• 7 Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286 (02) 188-195
• 8 Cicuttini F, Wluka A, Hankin J, Wang Y. Longitudinal study of the relationship between knee angle and tibiofemoral cartilage volume in subjects with knee osteoarthritis. Rheumatology (Oxford) 2004; 43 (03) 321-324
• 9 Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012; 470 (01) 45-53
• 10 Sharma L, Hurwitz DE, Thonar EJ. , et al. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis Rheum 1998; 41 (07) 1233-1240
• 11 Schipplein OD, Andriacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res 1991; 9 (01) 113-119
• 12 Noyes FR, Schipplein OD, Andriacchi TP, Saddemi SR, Weise M. The anterior cruciate ligament-deficient knee with varus alignment. An analysis of gait adaptations and dynamic joint loadings. Am J Sports Med 1992; 20 (06) 707-716
• 13 Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis 2002; 61 (07) 617-622
• 14 Wang H, Chen T, Torzilli P, Warren R, Maher S. Dynamic contact stress patterns on the tibial plateaus during simulated gait: a novel application of normalized cross correlation. J Biomech 2014; 47 (02) 568-574
• 15 Verma NN, Kolb E, Cole BJ. , et al. The effects of medial meniscal transplantation techniques on intra-articular contact pressures. J Knee Surg 2008; 21 (01) 20-26