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PubMed1995

The plantar flexor muscle attachments on the tibia. A cadaver study.

Thirty-six tibiae from 11 female and 7 male cadavers were dissected. Anatomical and histological examinations of the plantar flexor muscle origins at the posteromedial border of the tibia were performed. Many individual variations in the type and size of muscle origin were observed. Muscle fibers and/or connective tissue in different proportions attached the muscle to the periosteum or directly to the cortical bone. The length of the attachments varied greatly and there was a considerable overlap of the muscles in some individuals. The attachments of the flexor digitorum longus overlapped the tibialis posterior and the flexor digitorum longus muscle was overlapped by the soleus muscle. In two cases the soleus muscle did not attach to the tibia at all. Our findings may shed some light on the question as to why some athletes sustain posteromedial tibial stress fractures and others develop shin splits or other posteromedial injuries from similar precipitating activity.

Aged↗

PubMed2006

Bone loss from the human distal tibia epiphysis during 24 days of unilateral lower limb suspension.

Bone loss during immobilization is well documented. Currently, the only means of studying this in human beings is bed rest, which is resource intensive and inconvenient for the subjects. Unilateral lower limb suspension (ULLS) has been suggested as an alternative, but has not previously been demonstrated to cause bone loss. The main aim of our study was to test the hypothesis that ULLS would cause bone loss determined by peripheral quantitative computed tomography (pQCT). We investigated eight young healthy volunteers (19.1 +/- 0.7 years; body mass index, 22.4 +/- 2.6 kg m(-2)), who underwent ULLS for 24 days; their right foot was suspended with a strap attached to the shoulder so the knee angle was 10 deg and they wore a left shoe with a 7.5 cm sole to allow clearance of the right foot and used bilateral crutches to perambulate. Bone scans were obtained by pQCT from the distal epiphyses and from the diaphyses of the tibia in each leg twice before suspension, at days 7, 14 and 21 of the ULLS, and at days 4, 9, 35 and 90 of recovery. After 21 days of ULLS, bone mineral content of the peripheral portion of the epiphysis of the suspended tibia was reduced by 0.89 +/- 0.48% (from 280.9 +/- 34.5 to 278.4 +/- 34.2 mg mm(-1), P < 0.001) but no changes were observed in its central portion or in the unsuspended tibia. In the peripheral epiphyseal portion, significant bone loss (by 0.32 +/- 0.54%, P = 0.045) occurred as early as day 7 of ULLS. We have demonstrated, for the first time, that in humans bone is lost during ULLS at rates comparable to those seen with bed rest, without alteration in limb fluid volumes thus validating the technique and raising important questions about the mechanisms involved.

Adult↗

PubMed1989

A new device to measure the structural properties of the femur-anterior cruciate ligament-tibia complex.

Previous studies of biomechanical properties of femur-anterior cruciate ligament-tibia complex (FATC) utilized a wide variety of testing methodologies, particularly with respect to ligament orientation relative to loading direction. A new device was designed and built to test the anterior-posterior displacement of the intact porcine knee at 30 and 90 deg of flexion, as well as the tensile properties of the FATC at any loading direction and flexion angle. Tensile tests were performed with the knees at 30 and 90 deg of flexion with the loading direction along either the axis of the tibia (tibial axis) or the axis of the anterior cruciate ligament (ligament axis). The results showed that the stiffness, ultimate load and energy absorbed were all significantly increased when the FATC was tested along the ligament axis. This study demonstrates the importance of alignment in the evaluation of the biomechanical characteristics of the femur-ACL-tibia complex.

Animals↗

PubMed1992

Repeated measurements of tibia lead concentrations by in vivo x ray fluorescence in occupational exposure.

A group of workers occupationally exposed to lead have had measurements of their tibia lead concentrations made on two occasions separated by five years; on the second occasion calcaneus lead concentrations were also measured. The results serve to confirm the reliability of the measurement technique and to illustrate the improved precision achieved through technical improvements. More importantly, the relation between tibia lead concentration and cumulative blood lead found in this longitudinal study was entirely consistent with that previously reported, which had been based on cross sectional studies. Furthermore, the relation between lead concentrations in the tibia and in calcaneus found here was similar to that previously found in a larger cross sectional survey. It is concluded that this technique of measuring bone lead concentrations non-invasively is likely to be used increasingly as a biological monitor of cumulative exposure to lead.

Calcaneus↗

PubMed1995

Normal maturing distal tibia and fibula: changes with age at MR imaging.

PURPOSE: To describe the normal appearance of the maturing distal tibia and fibula at magnetic resonance (MR) imaging. MATERIALS AND METHODS: The authors retrospectively studied 50 MR examinations of patients aged 2 months to 21 years, dividing them into six developmental groups according to the appearance of the distal tibia and fibula. Epiphyseal ossification, physeal closure, and the signal characteristics of physeal cartilage were evaluated. RESULTS: Distal tibial epiphyseal ossification and physeal closure both began anteromedially and usually occurred earlier than in the fibula. The tibial physis developed an anteromedial undulation (Kump hump) before closure; volume averaging at the Kump hump simulated premature closure. The cartilaginous epiphysis had a lower signal intensity than the physis on T2-weighted images. The physis was most conspicuous on gradient-recalled-echo and fat-suppressed spin-echo proton-density-weighted images. CONCLUSION: Developmental cartilaginous and bone changes in the distal tibia and fibula follow a definite pattern and are well seen at MR imaging.

Adolescent↗

PubMedDate not supplied

Percutaneous fixation of comminuted fractures of the femur and tibia. Preliminary study.

OBJECTIVE: To present initial experience of treating patients with comminuted fractures of the diaphyseal and metaphyseal areas of the femur and tibia. SUBJECTS AND METHODS: Sixteen patients were involved in the study. All the 16 patients (11 males and 5 females, average age 34 years) with closed, comminuted fractures of femur (n = 9) and tibia (n = 7) were operated on using the principle of minimal access surgery and biological fixation that maximally preserved the soft tissues and fracture hematoma. RESULTS: All the fractures united, operated limbs had good function, and no complications occurred. CONCLUSION: Our findings indicate that minimal access surgery is a useful fixation method in the treatment of comminuted diaphyseal and metaphyseal fractures of the femur and tibia.

Adolescent↗

PubMed1978

Effect of a dietary rapeseed protein concentrate on the contents of alpha-tocopherol and zinc in serum, liver and tibia of rats.

In order to study the effects of a dietary rapeseed protein concentrate (RPC) on tocopherol and zinc levels in serum, liver and tibia, female rats were fed a tocopherol-reduced diet for a 3-week period and were then transferred to either of a RPC diet or a control diet containing casein at 20% levels of protein. No unfavourable effects on food intakes or weight gains were recorded. The serum zinc content of the RPC group was slightly reduced and the serum tocopherol values significantly lowered in comparison to the control group. Zinc and tocopherol contents of the livers were not changed. Precipitation of sera by dextran sulphate in the presence of calcium ions indicated a reduced level of low density lipoproteins in rats fed RPC diet. In a second experiment, male and female rats were fed diets containing 10% of protein derived either from RPC or casein. Low zinc contents of tibiae indicated a low biological availability of the zinc present in the RPC diet. Rats on RPC diet also showed reduced levels of tocopherol in serum. Despite a lowered zinc status in rats fed RPC diet there was no reduction in food intake, weight gain or growth of tibia in these groups.

Animals↗

PubMedDate not supplied

The position of the tibia during graft fixation affects knee kinematics and graft forces for anterior cruciate ligament reconstruction.

Ten cadaveric knees (donor ages, 36 to 66 years) were tested at full extension, 15 degrees, 30 degrees, and 90 degrees of flexion under a 134-N anterior tibial load. In each knee, the kinematics as well as in situ force in the graft were compared when the graft was fixed with the tibia in four different positions: full knee extension while the surgeon applied a posterior tibial load (Position 1), 30 degrees of flexion with the tibia at the neutral position of the intact knee (Position 2), 30 degrees of flexion with a 67-N posterior tibial load (Position 3), and 30 degrees of flexion with a 134-N posterior tibial load (Position 4). For Positions 1 and 2, the anterior tibial translation and the in situ forces were up to 60% greater and 36% smaller, respectively, than that of the intact knee. For Position 3, knee kinematics and in situ forces were closest to those observed in the intact knee. For Position 4, anterior tibial translation was significantly decreased by up to 2 mm and the in situ force increased up to 31 N. These results suggest that the position of the tibia during graft fixation is an important consideration for the biomechanical performance of an anterior cruciate ligament-reconstructed knee.

Adult↗

PubMedDate not supplied

The effect of anterior cruciate ligament deficiency and functional bracing on translation of the tibia relative to the femur during nonweightbearing and weightbearing.

BACKGROUND: Much of what is known about functional bracing is derived from studies of the knee during unweighted or weightbearing conditions, whereas little is known about the transition between these postures. HYPOTHESIS: Bracing the anterior cruciate ligament-deficient knee during nonweightbearing, throughout the transition to weightbearing, and during weightbearing reduces the abnormal translations of the tibia relative to the femur to within the limits of normal. STUDY DESIGN: Controlled laboratory study. METHODS: Subjects with chronic anterior cruciate ligament tears were studied with and without braces. Anteroposterior shear and compressive loads were applied to the knee, and translations of the tibia relative to the femur were measured while subjects were nonweightbearing, throughout the transition to weightbearing, and during weightbearing. RESULTS: Bracing the anterior cruciate ligament-deficient knee resulted in a significant reduction of anteroposterior laxity values, to a level within the limits of the normal knee during nonweightbearing and weightbearing postures. In contrast, when the anterior cruciate ligament-deficient knees transitioned from nonweightbearing to weightbearing, the anterior translation of the tibia relative to the femur was 3.5 times greater than in the normal knee, and bracing did not reduce this to within the limits of normal. CONCLUSIONS: Bracing a knee with a chronic anterior cruciate ligament tear was effective in reducing abnormal anteroposterior laxity during nonweightbearing and weightbearing; however, braces were not effective in reducing the abnormal anterior translations produced by the change between these postures. CLINICAL RELEVANCE: This study explains why subjects with anterior cruciate ligament tears gain partial control of pathologic anteroposterior laxity with the use of a brace but may continue to experience abnormal translations during activity.

Adult↗

PubMed2005

Compaction of a bone dowel in the tibial tunnel improves the fixation stiffness of a soft tissue anterior cruciate ligament graft: an in vitro study in calf tibia.

BACKGROUND: Despite increasing attention on fixation of a soft tissue anterior cruciate ligament graft in the tibia, there have been no studies on the use of a bone dowel as a joint line fixation device for promoting fixation properties, especially stiffness at the time of implantation. PURPOSE: To determine whether compacting a bone dowel into the tibial tunnel improves fixation stiffness, yield load, and resistance to slippage of a soft tissue anterior cruciate ligament graft. STUDY DESIGN: Controlled laboratory study. METHODS: A double-looped tendon graft was fixed at the distal end of the tibial tunnel with a WasherLoc in 24 calf tibias. The tibial tunnels were treated with or without a dowel of cancellous bone. The bone dowel was harvested from the tibial tunnel and then compacted into a tapered space anterior to the anterior cruciate ligament graft as a joint line fixation device. A cyclic load and measurement test was administered to determine fixation stiffness, yield load, slippage, and failure mode. RESULTS: The specimens with the bone dowel had 58 N/mm more stiffness (P = .04); however, the yield load and resistance to slippage were similar in specimens with and without the bone dowel. CONCLUSIONS: A bone dowel harvested from the tibial tunnel can be used as a joint line fixation device in series with a distal fixation method to improve initial fixation stiffness and increase the fit, which is known to enhance tendon graft-to-bone healing in the tibia.

Animals↗

PubMed2003

Salvage technique for treatment of periplafond tibial fractures: the modified fibula-pro-tibia procedure.

We describe a technique of fixation for treatment of distal tibia periplafond fractures and nonunions that uses a modification of the principle of the fibula-pro-tibia procedure (fusing the tibia and fibula together to create a one-bone lower leg). The fibula is plated, and the screws are brought across to the medial tibial cortex. The procedure is accomplished with or without a tibial buttress plate and always includes iliac crest bone grafting of the nonunion site and synostosis. We have used this technique in five patients with satisfaction.

Adult↗

PubMed2003

Evaluation of the fibular incisura of the tibia with magnetic resonance imaging.

Knowledge of the distal tibiofibular syndesmosis should be helpful in determining the normal position of the fibula in the incisural notch. The purpose of this study was to determine the anatomic characteristics of the fibular incisura of the tibia on MR imaging. One hundred fifty lower limbs (43 male, 32 female volunteers) were examined with MRI. The length of the anterior facet was 10.4 mm in males and 8.9 mm in females, and the length of the posterior facet was 10.4 mm in males and 8.9 mm in females. The angle between anterior and posterior facets was 138.6 degrees in males and 139.9 degrees in females. The depth of the fibular incisura of the tibia was 3.6 mm in males and 2.9 mm in females. The vertical distance of tibiofibular overlapping was 7.9 mm in males and 7.0 mm in females. The distance between anterior margin of the tibia and anterior margin of the fibula was 14.3 mm in males and 12.5 mm in females. All of these parameters of men (except the angle between anterior and posterior facets) were significantly higher than the parameters of women (p<.001, p<.001, p<.05, p<.05, p<.01, respectively).

Adolescent↗

PubMed2005

Local bone graft harvested from the distal tibia or calcaneus for surgery of the foot and ankle.

BACKGROUND: Numerous operative procedures around the foot and ankle use bone graft to augment healing. Autologous bone graft remains the preferred type for these procedures. This can be harvested from the iliac crest, but complications are frequent. The purpose of our study was to investigate the option of harvesting the bone graft from the ipsilateral distal tibia or calcaneus. METHOD: Bone graft was harvested in 114 patients from the distal tibia (70 patients) or calcaneus (44 patients). The patients were followed postoperatively for an average of 16 (range 5 to 28) months and were evaluated for complications (minor and major), satisfaction, and healing rates. RESULTS: There were no major complications. Ten patients (8.7%) had minor complications including initial incisional sensitivity or local numbness, none of which affected function or required additional treatment. Satisfaction rate for the procedure was 100%. CONCLUSION: Use of autologous bone graft harvested from the ipsilateral distal tibia or calcaneus is a safe and reliable alternative to iliac crest bone graft harvest for operative procedures of the foot and ankle.

Adolescent↗

PubMed2006

Bone graft harvest from the proximal tibia in foot and ankle arthrodesis surgery.

BACKGROUND: Fresh autogenous cancellous bone graft is the material of choice in reconstruction and fusion procedures in foot and ankle surgery. There are many potential donor sites for graft harvest, all with recognized minor and major complications. The proximal tibia is one such potential site and is particularly suited to foot and ankle surgery, because it is within the operative field and under tourniquet control. METHODS: A retrospective review was performed of 148 procedures using bone graft from the proximal tibia performed over a period of 5 years. Minimum followup was 3 months. Data were obtained from operative notes and patient interviews to establish pain, morbidity, and overall satisfaction. RESULTS: Most patients had no pain (78%) or very mild pain (20%) at the site of graft harvest immediately after surgery. At followup, 96% had no pain and 4% had very mild pain with certain activities such as kneeling. There were no major complications. Four patients (2.7%) had persisting areas of paresthesia at followup, but none were troubled by it. One patient had a superficial wound infection that resolved. The period of nonweightbearing, usually 2 to 3 weeks, was dictated by the primary procedure. There were no complications related to early weightbearing CONCLUSIONS: The proximal tibia is a suitable and safe site for bone graft harvest for foot and ankle surgery. There is no need for additional restrictions in weightbearing after this procedure.

Adult↗

PubMed1996

Control of the residual tibia in transtibial amputation.

Eight transtibial amputees had localized unremitting discomfort and pain in the distal anterior residual limb during prosthetic wear while weightbearing. Modification of the prosthetic socket did not change this pain. It was not consistent with "phantom limb" or causalgia/reflex sympathetic dystrophy-type etiologies. Thirteen randomly selected, pain-free, transtibial amputees were selected for comparison. The subjects in both groups used similar total-contact, "patellar tendon-bearing" prosthetic sockets fabricated and aligned with similar technique. The angles formed between the femur and tibia, femur and prosthetic socket, and tibia and socket were measured. Significant differences were found at each angle measurement between those patients who experienced pain and those who did not. The variable of tibia length had no effect. We conclude that bone alignment within the transtibial total-contact prosthetic socket may be partially dependent on surgical technique and not solely on prosthetic socket configuration.

Amputation, Surgical↗

PubMed1998

Local bone deformation at two predominant sites for stress fractures of the tibia: an in vivo study.

Local bone deformation was registered at two predominant injury sites for tibial stress fractures in a healthy female volunteer. Two instrumented strain gauge staples were inserted under local anesthesia to the anterior middiaphysis (AM) and to the posteromedial part of the distal tibia (PD). Calibration and reliability of the instrumented staple system have previously been demonstrated in vitro. Concomitant ground reaction forces were registered with a Kistler force plate. Studying peak values, it was shown that during a voluntary 30-cm forward jump, PD deformation was greater during forefoot landing (2700-4200 microstrain) than during a heel strike landing (1200-1900 microstrain) and also compared with the concomitant AM deformation under both above testing conditions (1300-1900 microstrain). The stance phase during walking resulted in PD deformation of 950 microstrain, whereas the concomitant AM deformation was 334 microstrain. The greatest AM deformation (mean, 2128 microstrain) was registered during ground contact after a voluntary vertical drop from a height of 45 cm, concomitant with a PD deformation of 436 microstrain. These data are the first to show different local deformations at various sites of the tibia in vivo. The PD deformation was larger than previously noted from other parts of the tibia, whereas the middiaphysis data are consistent with other reports. The results may support the clinical assumption of different etiologies for stress fractures at these predominant sites.

Adult↗

PubMed1999

Relationship between foot pronation and rotation of the tibia and femur during walking.

The purpose of this study was to test the hypothesis that the magnitude and timing of peak foot pronation would be predictive of the magnitude and timing of peak rotation of tibia and femur. Thirty subjects who demonstrated a wide range of pronation participated. Three-dimensional kinematics of the foot, tibia, and femur segments were recorded during self-selected free walking trials using a six-camera VICON motion analysis system. Regression analysis demonstrated that the magnitude and timing of peak pronation was not predictive of the magnitude and timing of tibial and femoral rotation. The lack of a relationship between peak foot pronation and the rotation of the tibia and femur is contrary to the clinical hypothesis that increased pronation results in greater lower extremity rotation. It would seem, therefore, that the relationship between foot pronation and rotation of the lower extremity segments should be assessed on a patient-by-patient basis.

Adult↗

PubMed2000

In vivo demonstration of load-induced fluid flow in the rat tibia and its potential implications for processes associated with functional adaptation.

Load-induced extravascular fluid flow has been postulated to play a role in mechanotransduction of physiological loads at the cellular level. Furthermore, the displaced fluid serves as a carrier for metabolites, nutrients, mineral precursors and osteotropic agents important for cellular activity. We hypothesise that load-induced fluid flow enhances the transport of these key substances, thus helping to regulate cellular activity associated with processes of functional adaptation and remodelling. To test this hypothesis, molecular tracer methods developed previously by our group were applied in vivo to observe and quantify the effects of load-induced fluid flow under four-point-bending loads. Preterminal tracer transport studies were carried out on 24 skeletally mature Sprague Dawley rats. Mechanical loading enhanced the transport of both small- and larger-molecular-mass tracers within the bony tissue of the tibial mid-diaphysis. Mechanical loading showed a highly significant effect on the number of periosteocytic spaces exhibiting tracer within the cross section of each bone. For all loading rates studied, the concentration of Procion Red tracer was consistently higher in the tibia subjected to pure bending loads than in the unloaded, contralateral tibia. Furthermore, the enhancement of transport was highly site-specific. In bones subjected to pure bending loads, a greater number of periosteocytic spaces exhibited the presence of tracer in the tension band of the cross section than in the compression band; this may reflect the higher strains induced in the tension band compared with the compression band within the mid-diaphysis of the rat tibia. Regardless of loading mode, the mean difference between the loaded side and the unloaded contralateral control side decreased with increasing loading frequency. Whether this reflects the length of exposure to the tracer or specific frequency effects cannot be determined by this set of experiments. These in vivo experimental results corroborate those of previous ex vivo and in vitro studies. Strain-related differences in tracer distribution provide support for the hypothesis that load-induced fluid flow plays a regulatory role in processes associated with functional adaptation.

Adaptation, Physiological↗