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Results for “Bone Malalignment”

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PubMed1995

Proximal tibial derotation osteotomy for anterior knee pain in the miserably malaligned extremity.

In an 18-year review period, 10 patients were identified with debilitating anterior knee pain and severe rotational malalignment of the lower extremity. Eight of the most symptomatic knees in 7 of these patients were treated with a rotational osteotomy of the tibia performed proximal to the tibial tubercle. Six of the 7 patients who fit a previously described spectrum of rotational deformity consisting of mild femoral anteversion, severe external tibial torsion, mild tibia vara, and pes planovalgus deformity, underwent unilateral procedures for external tibial torsion. Duration of preoperative symptoms averaged 6.3 years. Intraoperative torsional correction obtained with internal rotation of the tibia averaged 19.7 degrees. Subjectively, 1 excellent, 5 good, and 1 fair result were obtained. Functionally, 3 excellent and 4 good results were obtained. Follow-up evaluation averaging 10 years revealed no deterioration of the results, proving the success of the procedure in this group of select individuals over the long term.

Bone Malalignment↗

PubMedDate not supplied

Soft-tissue realignment for adolescent patellar instability.

Patellar malalignment or instability is a frequent problem in adolescents. Patients with persistent symptoms require operative correction with procedures often requiring osteotomies of the tibial tubercle. Insall described a soft-tissue procedure to correct instability in adults, and others have used this in adolescents. Short-term results have seemingly been satisfactory in the skeletally immature population. A long-term outcome study was performed to evaluate the effectiveness of soft-tissue realignment for patellar instability in adolescents. From 1980 to 1996, 54 patients (65 knees) underwent Insall proximal-distal soft-tissue realignment. No concomitant bony or other soft-tissue procedures were performed. Follow-up averaged 6 years (range, 2-15 years), assessing stability, strength, range of motion, and congruence angle on the Merchant's view. Eighty-seven percent had a good to excellent result; 8%, a fair result; and 5%, poor results.

Adolescent↗

PubMed2001

Corrective osteotomy for symptomatic increased ulnar tilt of the distal end of the radius.

Twelve wrists in 10 patients with a mean age of 23.6 years were treated for symptomatic increased ulnar inclination of the joint surface with corrective osteotomy of the radius. Diagnoses included mild ulnar dysplasia, posttraumatic deformity, Madelung's disease, and multiple hereditary exostosis. All patients had radial-sided wrist pain and an ulnarly displaced arc of radioulnar deviation. Preoperative radiographs showed excessive ulnar inclination of the distal radius, ulnar carpal translation, adaptive carpal malalignment, and frequent distal radioulnar joint incongruency. The patients had decreased pain and improved wrist function at a mean of 5.1 years (range, 2-10 years) after surgery. Average radial deviation changed from 3 degrees to 16 degrees and ulnar deviation from 48 degrees to 29 degrees; flexion/extension and pronosupination remained unchanged. Realignment of the wrist was shown radiographically by a change of ulnar inclination of the radius from 33 degrees to 21 degrees, an increase in scaphoid height from 16.4 to 20.4 mm, and reversal of ulnar carpal translation as shown by an increase in lunate-covering ratio of 64% to 77%. Reduction of the ulnar inclination to normal values by corrective radial osteotomy restores a more physiologic range of motion, decreases symptomatic wrist pain, reverts adaptive carpal changes to normal, increases lunate coverage, and may prevent abnormal cartilage overload in the ulnar compartment of the wrist.

Adult↗

PubMedDate not supplied

Analysis of lower extremity alignment in achondroplasia: interobserver reliability and intraobserver reproducibility.

This study was designed to evaluate the reliability and reproducibility of frontal plane malalignment measurements using the mechanical axis deviation method in achondroplasia and to determine whether the patient's age has any influence on these measurements. A total of 150 anteroposterior standing radiographs of the lower extremities were randomly selected for the study. Radiographs were divided into three groups according to age: group 1, younger than 6 years of age; group 2, 6 to 10 years of age; group 3, older than 10 years of age. Interobserver agreement for the medial proximal tibial angle and the lateral distal tibial angle measurements were poor (0.32 and 0.38, respectively) in group 1, but agreement increased between observers with increasing patient age. Good to excellent intraobserver reproducibility was found in all groups, except measurement of the medial proximal tibial angle in group 1, where the results were poor (0.36). Significant measurement errors in the proximal and distal tibial joint lines are possible in children less than 6 years of age with achondroplasia.

Achondroplasia↗

PubMed2004

[Corrective osteotomy in primary varus, double varus and triple varus knee instability with cruciate ligament replacement].

Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malaligned knees. We present the indication, operative technique, and results of 57 patients treated by simultaneous high tibial osteotomy and cruciate ligament reconstruction. The indication for simultaneous high tibial valgus osteotomy and ACL reconstruction is chronic anterior knee instability in varus knees of patients under 40 years of age. In these patients, medial meniscus deficiency secondary to prior injuries and/or chronic knee instability have frequently led to unicompartmental (medial) tibiofemoral degenerative changes. The average correction angle of the osteotomy was 7 degrees (4-10). Subjectively, all patients reported an improvement of preoperative swelling, pain, and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications occurred in four patients. Unstable varus malangulated knees can be sufficiently treated by osteotomy and cruciate ligament plasty and is suggested as cost-effective therapy with good short-term results. Performing both operations in one procedure facilitates early rehabilitation and return of the patients back to the activities of daily living and sports.

Adult↗

PubMed2005

Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison.

Malalignment in total knee replacement (TKR) is frequently associated with earlier failure and poor functional results. The authors compare the radiological results achieved in three consecutive series of TKRs using a computer-based alignment system (38 cases), a totally intramedullary alignment system (40 cases) and a totally extramedullary alignment system (37 cases). The frontal-femoral-component angle (FFC), the frontal-tibial-component angle (FTC), the hip-knee-ankle angle (HKA) and the sagittal orientation of the tibial component (slope) were evaluated 12 months after operation. The results did not show any statistically significant differences between the mean values of FFC, FTC, HKA angles and tibial slope among the three groups. However in the extramedullary alignment group there was a statistically higher percentage of TKRs with abnormal FFC and HKA angles. Furthermore all the implants in the computer aligned group were aligned within 4 degrees both of an ideal HKA and tibial slope.

Aged↗

PubMed2003

Hip strength in females with and without patellofemoral pain.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To determine if females with anterior knee pain are more likely to demonstrate hip abduction or external rotation weakness than a similar, asymptomatic, age-matched control group. BACKGROUND: Diminished hip strength has been implicated as being contributory to lower-extremity malalignment and patellofemoral pain. The identification of reliable and consistent patterns of weakness in this population may assist health care professionals establish a more effective treatment plan. METHODS AND MEASURES: Hip abduction and external rotation isometric strength measurements were recorded for the injured side of 15 female subjects with patellofemoral joint pain (mean +/- SD age, 15.7 +/- 2.7 years; age range, 12-21 years). These were compared with strength measurements from the corresponding hip of 15 age-matched female control subjects (mean +/- SD age, 15.7 +/- 2.7 years; age range, 12-21 years). All strength measurements were made using hand-held dynamometers. RESULTS: Subjects with patellofemoral pain demonstrated 26% less hip abduction strength (P<.001) and 36% less hip external rotation strength (P<.001) than similar age-matched controls. CONCLUSIONS: The results indicate that young women with patellofemoral pain are more likely to demonstrate weakness in hip abduction as well as external rotation than age-matched women who are not symptomatic.

Adolescent↗

PubMed2005

Limb positioning is critical for defining patellofemoral alignment and femoral shape.

The source of patellofemoral pain is a common orthopaedic complaint that often is difficult to determine because of the lack of correlation between symptoms and specific clinical measurements. Excessive joint contact stresses resulting from patellofemoral malalignment and pathologic femoral shape often are associated with this pain. These measures are likely sensitive to the limb position (orientation and position relative to the imaging system with which they are quantified). Because of this sensitivity, the measures have large variations and do not show correlations with subjective symptoms. The purpose of this study was to determine if varying limb position resulted in significant changes in standard clinical measures of patellofemoral alignment and femoral shape. This dependence was investigated by simulating alterations in limb position through resectioning of three-dimensional magnetic resonance image sets (20 healthy knees) to create axial images with altered orientation (eight images) or location (four images) relative to a fixed reference. By quantifying the variability of the clinical measures across all images, it was determined that simulated alterations in limb position produced greater variability in femoral shape and patellofemoral alignment measures than the variability seen across control subjects. This indicated that a standardized method for establishing limb position relative to the imager is warranted.

Adult↗

PubMed2001

Activity-related knee injuries and pain in athletic adolescents.

By collecting data from 45 students at a ski high school, we found that a total of 73% of the students reported activity-related pain/injuries of the knee. Sixty-one percent had overuse injuries, 27% malalignment, and 12% had indistinct knee pain. Females suffered more knee pain/injuries (88%) than males (57%). Significantly higher Q-angle degrees were recorded for females (16) than for males (10). "Jumper's knee" was found in all competitive students with a KT manual maximum difference (MMD) of 3 mm or more (mean 4 mm), with a hard endpoint, whereas this was less common among the other competitive students (P < 0.05). The students were given counselling about training and physiotherapy. In the follow-up study 1 year later, a significant reduction of knee pain/overuse injuries, from 73% to 35%, was recorded. This may be related to better equipment, the development of techniques, and training of the muscles. A high volume of training and knee instability, with MMD of 3 mm or more, seemed to be correlated with an increased risk for "jumper's knee" and, possibly, for skiing injuries. By identifying those at increased risk, preseason recommendations can be made and ski injuries may be prevented.

Adolescent↗

PubMed1995

Influence of malalignment of feet on the plantar pressure pattern in running.

When overuse injuries of the lower limbs are diagnosed in athletes, the architecture and function of the foot should be examined. Foot structure was evaluated in 10 male and 14 female athletes. Based on this examination, the subjects were classified into three groups: pes planus, pes cavus, and pes rectus. While running, the plantar pressure pattern of these athletes was assessed with pressure-measuring insoles. Using these measurements, peak pressures and impulses were calculated for different foot anatomical locations. The plantar heel load was distributed significantly (P < 0.05) more toward the anterior part of the calcaneus in the pes planus group compared with the normal group. The relative load under the midfoot region was significantly (P < 0.05) lower in the pes cavus group compared with the other foot types. The relative load of the forefoot was significantly (P < 0.05) higher in the pes cavus group and lower in the pes planus group. Both feet of an athlete showed a similar plantar pressure pattern. Three successive steps were comparable in terms of impulses, but the peak pressures varied significantly from step to step. The local impulse and peak pressure values obtained in barefoot running differed significantly from the values obtained in running with sport shoes.

Adult↗

PubMed2006

Functional outcome following modified Elmslie-Trillat procedure.

The aim of this study was to evaluate the mid- and long-term outcome of the modified Elmslie-Trillat procedure, as well as to detect factors affecting it. Thirty-eight patients (44 procedures) with a mean age of 31 years were included in this study. The reason for operation was patellar instability in 10 cases, anterior knee pain with malalignment of the extensor mechanism in 15 cases and a combination of both in 19 cases. Patients were followed for an average of 40 months (range=18-130 months). The functional outcome was very satisfactory or satisfactory for 73% of patients. According to Cox's criteria it was excellent in 13 cases (30%), good in 18 (41%), fair in 7 (16%) and poor in the remaining 6 (13%). Patients scored an average of 3.5 (range=2-8) in their Tegner Activity Scale, while their score in Activities of Daily Living Scale of the Knee Outcome Survey ranged from 43 to 98 (average=76). Result analysis revealed a better functional outcome when the operation was performed for patellar instability, as well as in the absence of grade 3 or 4 chondral changes in the patellofemoral joint at the time of operation. Elmslie-Trillat procedure satisfactorily restores patellofemoral stability and offers a very good functional outcome, especially in the absence of significant chondral changes in the patellofemoral joint at the time of operation.

Activities of Daily Living↗

PubMed2003

[Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty].

Rotational alignment of the tibial and femoral component plays an important role in modern total knee replacement surgery. After correct frontal alignment and proper soft tissue balancing, the rotational placement of the components represents the "third dimension" in knee endoprosthetic surgery. Improved surgical techniques with modified instruments and better rotational component positioning will lead to better functional outcomes. Patients with painful total knee arthroplasties (TKA) or early failure without evident classic implantation failures or signs of infection should be evaluated for malrotation of the components. In a prospective study in 26 patients with painful TKA and malrotation of the tibia and/or femur component, revision surgery with exchange of the components was performed. Twenty-five cases showed clinically relevant internal malrotation of the tibial component (ø 8.4 degrees ) and/or femoral component (ø 5.6 degrees ). Only one patient had 10 degrees of external malrotation of the femoral component. Combined malrotations of the tibia and femur were found in ten knees (38%). After revision surgery and correction of malrotations, 20 patients (78%) were scored with excellent and good results. Patients with painful TKA resistant to conservative therapy and evident malrotations of the component should be considered for revision surgery with change of the malrotated components.

Adult↗

PubMed2003

Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports.

STUDY DESIGN: Case report. OBJECTIVE: To describe an alternative treatment approach for patellofemoral pain. BACKGROUND: Weakness of the hip, pelvis, and trunk musculature has been hypothesized to influence lower-limb alignment and contribute to patellofemoral pain. Two patients who had a chief complaint of patellofemoral pain and demonstrated lack of control of the hip in the frontal and transverse planes during functional movements were treated with an exercise program targeting the hip, pelvis, and trunk musculature. METHODS AND MEASURES: The patients presented in these 2 case reports did not exhibit obvious patellar malalignment or tracking problems; however, on qualitative assessment, both demonstrated excessive hip adduction, internal rotation, and knee valgus during gait and while performing a step-down maneuver. In addition, both patients exhibited weakness of the hip abductors, extensors, and external rotators, as demonstrated by hand-held dynamometry testing. Treatment in both cases occurred over a 14-week period and focused on recruitment and endurance training of the hip, pelvis, and trunk musculature. Functional status, pain, muscle force production, as well as subjective and objective assessment of lower-extremity kinematics during gait and a step-down maneuver were assessed preintervention and postintervention. RESULTS: Both patients experienced a significant reduction in patellofemoral pain, improved lower-extremity kinematics during dynamic testing, and were able to return to their original levels of function. Gluteus medius force production improved by 50% in patient A and 90% in patient B, while gluteus maximus force production improved 55% in patient A and 110% in patient B. Objective kinematic improvements in the step-down task also were demonstrated in patient A. CONCLUSION: Assessment and treatment of the hip, pelvis, and trunk musculature should be considered in the rehabilitation of patients who present with patellofemoral pain and demonstrate abnormal lower-extremity kinematics.

Adult↗

PubMed2003

The short-term outcome of surgical treatment for painful varus arthritis in association with chronic ACL deficiency.

A review of patients with anterior cruciate ligament (ACL) insufficiency, symptomatic medial compartment osteoarthritis, and varus malalignment of the knee was performed. Twenty-six patients met the inclusion criteria. Twelve patients were treated with a valgus closing-wedge high tibial osteotomy (group 1). Fourteen patients were treated with a valgus closing-wedge high tibial osteotomy combined with arthroscopic ACL reconstruction (group 2). Twenty-five patients were available for follow-up at a minimum of 2 years. For group 1 patients, high tibial osteotomy alone had no effect on the Lachman test or pivot shift phenomena. For group 2 patients, combined high tibial osteotomy/ACL reconstruction resulted in a grade 1 Lachman test in 11 of 13 patients, and a negative pivot shift in 12 of 13 patients. No deficits in range of motion were noted in either group. Prior to surgery, 14 (56%) patients participated in recreational sports; 23 (92%) patients were able to participate in recreational sports at follow-up. Radiographs demonstrated osteoarthritic progression in group 1 and 2 patients (P<.05). The results of this study suggest that high tibial osteotomy alone and combined high tibial osteotomy/ACL reconstructions are effective in the surgical treatment of varus, ACL-deficient knees with symptomatic medial compartment arthritis; however, good or excellent results were more often seen after the combined procedure.

Adult↗

PubMed2003

[Gait-analytical studies in patients treated by valgus tibial head osteotomy].

So far, the use of imaging methods has been the only way of evaluating unicompartmental gonarthritis caused by malalignment of lower extremity axes and the results of operative correction. Unfortunately, radiological visualization does not give any information about the actual loads on the joint, i.e.the forces and moments acting on it under dynamic conditions. These can be determined by means of gait-analytical measurements. The authors explain how the anomalous loading that occurs in the knee joint in the case of varus gonarthritis can be calculated and assessed. The mean maximum varus moment of knee joints in a group of patients with varus deformity was 0.74 Nm\kg, which was significantly higher than that in a control group (0.63 Nm\kg). Even after correction of the axes, increased maximum moments--some of them independent of the angle of the knee and of the correction angle--were observed in 30% of the cases investigated. These cases were found to be characterized by a predisposition to revarization. Knee joints in which the preoperative varus moment was significantly high or there was a tendency to under-correction were especially likely to show these features. For these reasons, valgus tibial head osteotomies should generally be performed with slight overcorrection. If the preoperative gait analysis has already confirmed that significantly increased varus forces are in play, a definite overcorrection to about 5 degrees beyond the physiological angle should be the aim.

Adult↗

PubMed2026

The knee-ankle link: impact of knee varus severity on distal joint malalignment and concomitant pathologies.

BACKGROUND: Knee varus deformity is traditionally managed as an isolated joint pathology; however, persistent distal symptoms following proximal realignment suggest a more extensive kinetic chain dysfunction. The degree to which knee varus severity dictates distal malalignment and secondary pathologies remains poorly quantified in the current literature. METHODS: This systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines (PROSPERO: CRD420261363327). A comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library was performed from inception to April 2026. Studies examining the relationship between knee varus (HKA angle) and radiographic distal alignment or pathologies were included. Data synthesis utilized random-effects models, with prevalence analyzed via generalized linear mixed models (GLMM). RESULTS: Fourteen studies were included in the final synthesis. While pooling of continuous radiographic parameters was limited by high statistical heterogeneity in Talar Tilt (I2 = 96.5%), individual large-cohort data (Huang et al.) indicated that severe knee varus (HKA > 10°) was associated with increased odds of concomitant ankle osteoarthritis (OR 2.29; 95% CI 1.28-4.11) and a specific cohort prevalence of 37.1%. Furthermore, single-arm prevalence data revealed divergent trends across different study populations, with compensatory hindfoot valgus reaching 69.9% in some cohorts and rigid varus up to 63.9% in others. CONCLUSIONS: Severe genu varum is associated with distal kinetic chain alterations and concomitant ankle pathologies. However, due to the extreme heterogeneity and divergent distal adaptations observed across different cohorts, standardized knee-centric protocols may be insufficient. Further longitudinal and interventional studies are required to establish phenotype-specific rehabilitation guidelines.

Humans↗

PubMed2005

Avoiding rotational malalignment after fractures of the femur by using the profile of the lesser trochanter: an in vitro study.

INTRODUCTION: Intramedullary (IM) nailing has become the preferred method of treatment for femoral shaft fractures in adults. Rotational malalignment is an important complication, established during operation. The incidence of rotational malalignment (> or = 15 degrees) has been reported to be between 20% and 30%. It might be avoided intra-operatively by using quantitative imaging techniques, with the profile of the contralateral lesser trochanter serving as a reference. MATERIALS AND METHODS: With the help of a C-arm image intensifier, five surgeons tried to determine the neutral state of ten prepared cadaver femora. They could only look at the C-arm screen and were blinded to the actual femur. Per observer three measurements were done per femur. The first measurement (method I) was done without a reference, while the second (method II) used a reference image of the femur in a neutral state. The third method (method III) added a lesser trochanter quantifying computer program. After positioning of the femur, the difference in rotational state compared with the neutral state was measured with an inclinometer. RESULTS: Without reference, malrotations up to 27 degrees were found. Methods II and III proved to be significantly better (p < 0.0001). These two methods showed malrotation of 2.2 degrees (+/-1.5 degrees) and 2.3 degrees (+/-1.7 degrees), respectively. External or internal malrotation occurred with all three methods equally frequently. No difference was found between observers. CONCLUSIONS: Using the contralateral lesser trochanter as a reference is an accurate method to minimize malrotation of a femur. Quantifying the profile of the lesser trochanter with computer assistance did not improve these results. Clinical results in the future still have to support these in vitro findings.

Bone Malalignment↗

PubMed2005

Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in knee osteoarthritis: findings at different radiographic stages of disease and relationship to malalignment.

OBJECTIVE: Delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) is used to examine the distribution of glycosaminoglycan in cartilage. This study sought to characterize dGEMRIC in the evaluation of knee osteoarthritis (OA) according to various radiographically determined disease parameters, and to examine the relationship between alignment of the knee joint and the lateral:medial dGEMRIC ratio. METHODS: Thirty-one patients with knee OA underwent MRI with a dGEMRIC protocol at 1.5T. Semiflexed knee radiographs and full-limb radiographs were also obtained for assessment of alignment. RESULTS: Compartments of the knee joint without joint space narrowing had a higher dGEMRIC index than those with any level of narrowing (mean 408 msec versus 365 msec; P = 0.001). In knees with 1 unnarrowed (spared) and 1 narrowed (diseased) compartment, the dGEMRIC index was greater in the spared versus the diseased compartment (mean 395 msec versus 369 msec; P = 0.001). In spared compartments, there was a trend toward a lower dGEMRIC index with increasing Kellgren/Lawrence (K/L) radiographic severity grade; the spared compartments of knees with a K/L grade 2 had a higher dGEMRIC index than those of knees with a K/L grade 4 (mean 425 msec versus 371 msec; P < 0.05). There was a range of dGEMRIC values in the spared compartments within a given K/L grade, demonstrating biochemical differentiation of disease in radiographically comparable compartments. Almost all compartments with narrowing had dGEMRIC indices of <400 msec. Valgus-aligned knees tended to have lower dGEMRIC values laterally, and varus-aligned knees tended to have lower dGEMRIC values medially; as a continuous variable, alignment correlated with the lateral:medial dGEMRIC ratio (Pearson's R = 0.43, P = 0.02). CONCLUSION: The biochemical information provided by dGEMRIC scans may augment radiography by improving the differentiation of disease status within a given radiographic grade, especially in early OA.

Aged↗