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PubMed2005

Gender differences in frontal and sagittal plane biomechanics during drop landings.

PURPOSE: To determine gender differences in lower-extremity joint kinematics and kinetics between age- and skill-matched recreational athletes. METHODS: Inverse dynamic solutions estimated the lower-extremity flexion-extension and varus-valgus kinematics and kinetics for 15 females and 15 males performing a 60-cm drop landing. A mixed model, repeated measures analysis of variance (gender (*) joint) was performed on select kinematic and kinetic variables. RESULTS: Peak hip and knee flexion and ankle dorsiflexion angles were greater in females in the sagittal plane (group effect, P < 0.02). Females exhibited greater frontal plane motion (group (*) joint, P = 0.02). Differences were attributed to greater peak knee valgus and peak ankle pronation angles (post hoc tests, P = 0.00). Females exhibited a greater range of motion (ROM) in the sagittal plane (group main effect, P = 0.02) and the frontal plane (group (*) joint, P = 0.01). Differences were attributed to the greater knee varus-valgus ROM, ankle dorsiflexion, and pronation ROM (post hoc tests). Ground reaction forces were different between groups (group (*) direction, P = 0.05). Females exhibited greater peak vertical and posterior (A/P) force than males (post hoc tests). Females exhibited different knee moment profiles (Group main effect, P = 0.01). These differences were attributed to a reduced varus moment in females (post hoc tests). CONCLUSION: The majority of the differences in kinematic and kinetic variables between male and female recreational athletes during landing were observed in the frontal plane not in the sagittal plane. Specifically, females generated a smaller internal knee varus moment at the time of peak valgus knee angulation.

Adult↗

PubMed1991

[Malunited supracondylar and condylar humeral fractures].

We present three important types of posttraumatic deformity of the distal humerus: varus deformity, valgus deformity and complex deformity. Their primary causes are discussed. Slight varus deformities are the result of purely lateral slip of supracondylar fractures or radial overgrowth after a lateral condylar fracture. Severe varus deformities occur after ulnar slip of the distal fragment following supracondylar fracture caused by a rotational deformity. The results after correlation of varus deformities with a rotational deformity are poor. The only way of obviating this problem is to recognize a rotational deformity as soon as possible before adaptation of the elbow occurs, and also to correct it early, if necessary. Valgus deformities occur mostly after radial malunion. Depending on the size of the fragment and the disability of the patient, the fragment should be stabilized-but the potential involvement of the malunion in the elbow function must be borne in mind. Complex deformities and their unknown origins are also discussed. The correction of such deformities depends exclusively on the elbow function. More aggressive primary regimens are urgently needed to prevent the necessity for such secondary corrections, which are very demanding and, depending on the type, have a high failure rate.

Adolescent↗

PubMed1990

The effects of transection of the anterior cruciate ligament on healing of the medial collateral ligament. A biomechanical study of the knee in dogs.

The effect of concurrent injury to the anterior cruciate ligament on the healing of injuries of the medial collateral ligament was studied in dogs. In Group I, isolated transection of the medial collateral ligament was performed; in Group II, transection of the medial collateral ligament with partial transection of the anterior cruciate ligament; and in Group III, complete transection of both the medial collateral ligament and the anterior cruciate ligament. The three groups of animals were examined six and twelve weeks postoperatively with respect to varus-valgus rotation of the knee and tensile properties of the femur-medial collateral ligament-tibia complex. The varus-valgus rotation of the knee was found to be the largest in Group-III specimens at all time-periods and was 3.5 times greater than the control values at twelve weeks. Group-I and Group-II specimens also showed large varus-valgus rotations at time zero, but the rotations returned to the control values by twelve weeks. For the structural properties of the femur-medial collateral ligament-tibia complex, the values for ultimate load for Groups I and II reached the control values by twelve weeks, while that for Group III remained at only 80 per cent of the control value. Both energy absorbed at failure and linear stiffness for all three groups were less than those for the controls at six weeks, and only linear stiffness returned to the control values by twelve weeks. For the mechanical (material) properties of the healed ligament substance, the values for modulus and tensile strength were markedly lower than the control values for all groups at six weeks. By twelve weeks, the tensile strength of Group-I specimens had increased to 52 per cent of the control value, while those of Groups II and III were only 45 and 14 per cent, respectively. Our results demonstrate that healing of the transected medial collateral ligament is adversely affected by concomitant transection of the anterior cruciate ligament. Both varus-valgus rotation and mechanical properties of the healed ligament failed to recover in knees that had combined transection of the anterior cruciate and medial collateral ligaments. The structural properties of the femur-medial collateral ligament-tibia complex in tension recovered more rapidly as a consequence of the large mass of reparative tissue that formed in the medial collateral ligament of the anterior cruciate-deficient knees.

Animals↗

PubMed1989

Effect of knee component alignment on tibial load distribution with clinical correlation.

To determine ideal alignment and component placement of total knee prostheses, Kinematic (K) and total condylar (TC) devices were physiologically loaded and interface forces were measured. Laboratory observations were correlated with clinical (roentgenographic) findings. Asymmetric loading of the tibial component has been proposed as causing loosening and radiolucent lines. Misalignment of components is one factor that affects load sharing by bone under the medial and lateral regions of the tibial plateau. Tibial components of K and TC prostheses were inserted without cement into the cut surfaces of artificial tibiae. The mating femoral condylar components were mounted. The tibial and femoral components were individually positioned at 0 degrees (horizontal) and at certain angles of varus and valgus. Pressure-sensitive film was placed between the tibial component and the artificial tibia. A vertical load of 1500 N was used. The experiment was replicated twice. The percentages of the load on the medial and lateral regions of the tibial plateau were calculated from quantitative image analysis of the pressure patterns on the film. Roentgenograms from 532 K and 21 TC patients were examined to determine the orientations of the condylar and tibial components and the presence of radiolucent lines around the tibial component. An even distribution (ideal alignment) of load on the medial and lateral regions of the K tibial component occurred at 9 degrees of valgus tilt of the femoral component and 2 degrees of varus tilt of the tibial component and for the TC at 7 degrees valgus and 0 degrees varus. Misalignment by 5 degrees yielded a 7% change in the load distribution under the K plateau and a 40% change for the TC prosthesis; a 10 degrees misalignment produced changes of 34% and 62% for the K and TC, respectively. Small variations in clinical knee alignment produced the same percentage of radiolucent lines for each alignment group. The location of radiolucent lines was distributed among the medial, lateral, and both tibial plateaus regardless of knee alignment, although there were more medial reactions overall. The smallest incidence (8%) of radiolucent lines occurred with the K prosthesis at 7 degrees of knee valgus, the femoral component placed at 9 degrees valgus, and the tibial component at 2 degrees varus. This correlated with the ideal bench-test findings for the K device.

Humans↗

PubMed1988

Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures.

We applied specific forces and moments to the knees of fifteen whole lower limbs of cadavera and measured, with a six degrees-of-freedom electrogoniometer, the position of the tibia at which the ligaments and the geometry of the joint limited motion. The limits were determined for anterior and posterior tibial translation, internal and external rotation, and varus and valgus angulation from zero to 90 degrees of flexion. The limits were measured in the intact knee and then the changes that occurred with removal of the posterior cruciate ligament, the lateral collateral ligament, the popliteus tendon at its femoral attachment, and the arcuate complex were measured. The cutting order was varied, allowing us to determine the changes in the limits that occurred when each structure was cut alone and the amount of motion of the joint that was required for each structure to become taut and to limit additional motion when the other supporting structures had been removed. Removal of only the posterior cruciate ligament increased the limit for posterior tibial translation, with no change in the limits for tibial rotation or varus and valgus angulation. The additional posterior translation was least at full extension and increased progressively, reaching 11.4 millimeters at 90 degrees of flexion. The progressive increase in posterior translation with flexion was apparently due to slackening of the posterior portion of the capsule, as the translation nearly doubled when the posterolateral structures subsequently were removed. Removal of only the posterolateral extra-articular restraints increased the amount of external rotation and varus angulation. The average increase in external rotation depended on the angle of flexion; it was greatest at 30 degrees of flexion and decreased with additional flexion. At 90 degrees of flexion, the intact posterior cruciate ligament limited the increase in external rotation to only 5.3 degrees, less than one-half of the 13.0-degree increase that occurred at 30 degrees of flexion. Subsequent removal of the posterior cruciate ligament markedly increased external rotation at 90 degrees of flexion, resulting in a total increase of 20.9 degrees. The limit for varus angulation was normal as long as the lateral collateral ligament was intact. When the lateral collateral ligament was cut, the limit increased 4.5 degrees (approximately 4.5 millimeters of additional joint opening) when the knee was partially flexed (to 15 degrees).(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗

PubMed1985

[Value of the femorotibial angle in 244 patients without knee arthrosis].

Measurement of the femorotibial angle was performed in 244 patients (134 women and 110 men) without knee arthrosis with roentgenograms taken in the upright position. The values were grouped according to sex and to decade of life. The average value was approximately 0. As defined by the average upper and lower values of the two types of angulation, the normal value in women was 4 degrees of varus and 4 degrees of valgus. In men, the normal value of the right leg was 5 degrees of varus and 5 degrees of valgus; the left leg demonstrated up to 6 degrees of varus and 5 degrees of valgus. After sixty years of age, 5 percent of patients had angulation above these normal values in valgus and varus.

Adult↗

PubMed1984

Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament.

Thirty-five patients with documented absence of the anterior cruciate ligament were tested on the University of California, Los Angeles, instrumented clinical knee-testing apparatus and we measured the response curves for the following testing modes: anterior-posterior force versus displacement at full extension and at 20 and 90 degrees of flexion; varus-valgus moment versus angulation at full extension and 20 degrees of flexion; and tibial torque versus rotation at 20 degrees of flexion. Absolute values of stiffness and laxity and right-left differences for these injured knees were compared with identical quantities measured previously for a control population of forty-nine normal subjects with no history of treatment for injury to the knee. For both the uninjured knees and the knees without an anterior cruciate ligament, at 20 and 90 degrees of flexion the anterior-posterior laxity was greatest at approximately 15 degrees of external rotation of the foot. The injured knees demonstrated significantly increased total anterior-posterior laxity and decreased anterior stiffness when compared with the uninjured knees in all tested positions of the foot and knee. The mean increase in paired anterior-posterior laxity for the injured knees in this group of patients at +/- 200 newtons of applied anterior-posterior force was 3.1 millimeters (+39 per cent) at full extension, 5.5 millimeters (+57 per cent) at 20 degrees of flexion, and 2.5 millimeters (+34 per cent) at 90 degrees of flexion. The mean reduction in anterior stiffness for injured knees was also greatest (-54 per cent) at 20 degrees of knee flexion. Only slight reduction in posterior stiffness (-16 per cent) was measured at 20 degrees of flexion, and this probably reflected the presence of associated capsular and meniscal injuries. In the group of anterior cruciate-deficient knees, the patients with an absent medial meniscus showed greater total anterior-posterior laxity in all three positions of knee flexion than did the patients with an intact or torn meniscus. Varus-valgus laxity at full extension increased an average of 1.7 degrees (+36 per cent) for the injured knees, while varus and valgus stiffness decreased 21 per cent and 24 per cent. Absence of the medial meniscus (in a knee with absence of the anterior cruciate ligament) increased varus-valgus laxity at zero and 20 degrees of flexion.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1978

Myelodysplasia. The influence of the quadriceps and hip abductor muscles on ambulatory function and stability of the hip.

In an analysis of motor function, ambulatory function, and hip stability in sixty-five patients with myelodysplasia, four motor-function groups based on the strength of the quadriceps and hip abductor muscles were identified. Retrospectively, it was evident that based on these groups, it would have been possible to predict which hips would remain stable, what level of ambulatory function the patients could achieve, and whether treatment to reduce and stabilize the hips was indicated. Fifty-seven of fifty-eight hips in the twenty-nine patients with functioning quadriceps muscles but non-functioning hip-abductor muscles were either subluxated or dislocated. Thirty-nine of the remaining forty-six patients with functioning quadriceps muscles could walk. In this series, three operative procedures were used to treat hip subluxation: varus osteotomy, varus osteotomy combined with iliopsoas transfer, and iliopsoas transfer alone. One shelf procedure was also done. Varus osteotomy was the best procedure for hip subluxation while posterior iliopsoas transfer, either alone or in combination with a varus osteotomy, was of questionable value. Treatment of hip instability (subluxation or dislocation) in patients without quadriceps function was not necessary.

Adolescent↗

PubMed1982

Developmental orthopaedics. III: Toddlers.

The most common orthopaedic problems seen in toddlers are: (1) in-toeing due to femoral torsion, internal tibial torsion, talar torsion (persistent medial deviation of the neck of the talus), or metatarsus adductus; (2) genu valgus (bow-leg) and genu varus (knock-knee); and (3) pes valgus (flat-feet). In most cases these conditions will resolve spontaneously, as has been substantiated by a number of published studies. However, a small percentage of the disorders will persist if untreated. To prevent the deformity from becoming established and irreversible, treatment must begun while the patient is still young. Therefore the orthopaedist needs objective criteria to select those children in whom the deformity is likely to persist and who thus require prompt management. If femoral torsion persists, it becomes fixed by the time the child reaches eight years of age. Surgery is the only definitive treatment which can be offered, although gait training by augmented feedback methods may result in correcting by increasing the range of external rotation of the hip. Internal tibial torsion or talar torsion usually resolve spontaneously before the children reach seven years of age. However, in 8 per cent of cases in-toeing persists; it is cosmetically objectionable in the adult. I advise simple brace treatment in infants up to the age of 18 months if the medical deviation of the foot from the mid-sagittal plane is greater than 10 degrees. Because metatarsus adductus corrects spontaneously in many cases, some authors suggest that this condition should not be treated. However, I think it is prudent to use serial plaster-casts for infants under eight months of age in whom the deformity is moderate or severe. If treatment is withheld while the patient is observed, and if spontaneous correction does not occur, the deformity will become fixed and correctable only with surgery. Genu valgus and varus correct without treatment in the majority of patients. However, some cases of genu varus appear to develop into the progressive form of the disorder, Blount's disease. When the varus femoral-tibial angle exceeds the norm for age, early treatment with the Danish night-splint appears to prevent the development of this serious disease. 'Flat foot' (pes valgus) must be defined carefully by physical and radiographic examination. Treatment and radiographic examination. Treatment might be considered only for those feet classified as pes valgus with plantar flexed talus of 50 degrees or more. For children with this disorder between the ages of two and six years, a corrective moulded plastic shoe-insert may help to improve the abnormal anatomy while natural ligamentous tightening occurs.

Adolescent↗

PubMed1981

Tibial osteotomy for osteoarthritis of the knee. A five to ten-year follow-up study.

Of the 141 osteoarthritic knees treated by tibial osteotomy at the Kotka Central Hospital from 1969 to 1974, 103 (ninety-two with a varus deformity and eleven with normal alignment) were followed for at least five years, the average follow-up being 6.9 years. In eighty-six knees (83.5 per cent) the result was good or fair. In the ninety-two knees with a varus deformity, the best results were achieved when the postoperative femorotibial angle was 167 to 175 degrees. In the eleven knees with normal preoperative alignment, the osteotomy was designed to shift the load to the compartment in which there was less osteoarthritis involvement. In nine of these eleven knees there was an average change in angulation (varus or valgus) of 5.3 degrees (range, 3 to 9 degrees) and the result was good or fair. All osteotomies united without reoperation. The incidence of delayed union was 3.6 per cent when the osteotomy was proximal and 14 per cent when it was distal to the tibial tubercle. The elimination of the tethering effect of the fibula by osteotomy or release of the proximal tibiofibular joint did not prevent the recurrence of varus deformity. At an average of 3.4 years after the osteotomy, deterioration was demonstrable in twenty-six knees in which the initial result had been good. This is a higher incidence of deterioration than in previously published series. In sixteen of the 103 knees, a total arthroplasty subsequently was performed because of a poor result, at an average of 7.6 years after the osteotomy.

Adult↗

PubMedDate not supplied

Circumferential and axial strain in the proximal femur: effect of prosthesis type and position.

Because the Charnley-Müller prosthesis inserted in a varus position has been found subject to loosening, circumferential and longitudinal strain patterns were determined in proximal cadaver femora that had been instrumented with strain gauge rosettes and implanted with total hip replacement femoral prostheses. Both Charnley and Charnley-Müller prostheses were inserted in the varus, valgus, and neutral positions. An intact femur was similarly studied. Strain patterns in the test femora were altered by implant insertion, mainly by reducing longitudinal strain. Prosthesis type did not alter strain patterns but prosthesis position did. Valgus position produced compressive axial strain laterally and tensile strain medially at the tip of the prosthesis which was the reverse of that seen with varus position. Valgus position produced biaxial compressive strain at the medial calcar whereas varus position produced circumferential tension and axial compression at that location.

Biophysical Phenomena↗

PubMedDate not supplied

Results of three different therapeutic groups in Perthes' disease.

Three groups of patients with Legg-Calvé-Perthes disease (LCPD) were treated with the following 3 different methods of treatment: conservative treatment alone; immediate varus osteotomy; osteotomy alone when risk factors occurred. The best results were obtained by the immediate varus osteotomy operation. The risk factors were significantly less in this group. Immediate varus osteotomy probably avoids or reduces the occurrence of risk factors. Immediate osteotomy is not prescribed for all patients because in some the operation would be unnecessary. A good result is often possible by conservative treatment alone. As it is often difficult to classify the patients into the 4 standard groups defined by Catterall, at the time of onset of the disease, the age of the patient is a critical factor in the decision for conservative versus operative treatment. In our patients risk factors were significantly less in children younger than 6 years of age, and good results were found in 80% of these patients in Group I with conservative treatment alone. Since 1976, the following procedure has been used: conservative treatment (Thomas splint) in patients younger than 6 years of age; immediate varus osteotomy in the older patients.

Braces↗

PubMed1980

The evaluation of intertrochanteric osteotomy in relation to osteotomized angle and leg-length discrepancy for osteoarthritis of the hip.

A series of 103 joints in 93 patients with secondary osteoarthritis were treated by intertrochanteric osteotomy, and investigated on a nationwide basis. The types of osteotomy were classified as varus, 35 joints (62.5%); valgus, 22 joints (55%). The total number of cases with a combined error of 5 degrees was 48 with varus (85.7%) and 31 with valgus (77.5%) corrections. This indicates that a slight deficiency or excess of angulation does not significantly influence the clinical results. Cases with increased center-edge angle after varus osteotomy or with decreased AHI after valgus osteotomy demonstrated a relatively high rating of clinical improvement. Postoperative discrepancies of the leg length were more serious after varus osteotomy (with angulation of 25 degrees or more) than valgus osteotomies. The clinical results after either type, graded by the method of Tanaka were generally satisfactory.

Adolescent↗

PubMed1994

[Patterns of failed internal unicompartmental knee prostheses, allowing persistence of undercorrection].

THE PURPOSE OF THIS STUDY: was to investigate how deliberate slight undercorrection of varus deformities influenced the patterns of failure seen following medial unicompartmental knee replacements. METHODS: Between 1980 and 1989, 335 medial unicompartmental knee replacements were performed using the St George Sled prosthesis. The replacements were preformed so that the postoperative mechanical axis, as defined as the line joining the centre of the femoral head to the centre of the talus, passed medial to the centre of the knee joint and through the replaced medial compartment. The mean follow-up for these patients was 6.4 years (range of 2 to 12). By 1992, 33 of these cases had required revision. The radiographs and case notes of cases were available for study. RESULTS: There were no significant differences in the demographic details between those coming to revision and the successful group. Analysis of the post-operative alignments in the successful group revealed that the desired undercorrection was achieved in 73 per cent of cases. 2 per cent were left grossly undercorrected with their mechanical axis passing medially outside the medial compartment. In 20 per cent of cases the mechanical axis was almost fully restored passing through the centre of the knee. 4 per cent of cases had an overcorrection with the mechanical axis passing through the lateral compartment. Early failures (N = 11), classified as those cases in whom satisfactory result were never obtained, were primarily due to poor patient selection or to gross technical errors at surgery. Late failures (N = 22) were those that required revision for symptomatic failure after an initially successful primary arthroplasty and were due to progressive disease (N = 6), prosthetic failure (N = 22) were those that required revision for symptomatic failure after an initially successful primary arthroplasty and were due to progressive disease (N = 6), prosthetic failure (N = 10) and recurrent medial pain (N = 6). DISCUSSION: Patients who otherwise meet the criteria for medial unicompartmental replacement, usually have a mild degree of osteoarthritis in the lateral compartment. Suddenly loading the lateral compartment, by fully correcting a varus deformity, could accelerate the degenerative process in this compartment. Progressive disease in the lateral compartment was seen in only 4 cases in our series. In 6 patients failure was associated with recurrent medial medial joint pain with increasing varus deformity. In these cases the mechanism of failure was probably the result of an excessive medial load from a gross undercorrection of the mechanical axis which passed close to or outside the medial aspect of the knee. The crude revision rate for our series with an average follow-up of 6.4 years was 10 per cent. After excluding the early failures, which resulted largely from the potentially avoidable problems the revision rate was 6.7 per cent. CONCLUSIONS: The results from this series suggest that slight undercorrection of varus deformities does not produce any significant differences in the revision rates for unicompartmental replacements when compared to previous reports. Slight undercorrection would appear, nevertheless, to effect the relative importance of the modes of failure seen. Most notably there are fewer failures from disease in the lateral compartment. This potential advantage, however, is somewhat offset by failures from excessive loading of the medial compartment as technical errors at surgery may result in gross undercorrection of the mechanical axis.

Aged↗

PubMed1996

Medial compartment arthrosis of the knee.

When the resultant forces on the tibial plateau are displaced medially, compressive stresses cause apposition of bony tissue, thus thickening the dense subchondral bone underlying the medial plateau. Loss of the articular cartilage and an increase in subchondral bone density facilitate the progression of osteoarthrosis. Surgical management is dependent on the presence of a varus deformity; patients with medial compartment disease and varus alignment should be considered for high tibial osteotomy (HTO) or unicondylar or total knee arthroplasty (TKA), depending on their age and activity level. Patients without varus deformity and with mechanical symptoms, only mild joint-space narrowing, and pain less than 1 year are likely to benefit from arthroscopic débridement. Patients without varus alignment but with chronic pain associated with loading and more pronounced joint-space loss should be considered for HTO, or unicondylar or TKA.

Arthrodesis↗

PubMed1996

A global verification study of a quasi-static knee model with multi-bundle ligaments.

The ligaments of the knee consist of fiber bundles with variable orientations, lengths and mechanical properties. In concept, however, these structures were too often seen as homogeneous structures, which are either stretched or slack during knee motions. In previous studies, we proposed a new structural concept of the ligaments of the knee. In this concept, the ligaments were considered as multi-bundle structures, with nonuniform mechanical properties and zero force lengths. The purpose of the present study was to verify this new concept. For this purpose, laxity characteristics of a human knee joint were compared as measured in an experiment and predicted in a model simulation study. In the experiment, the varus-valgus and anterior-posterior laxities of a knee-joint specimen containing the ligaments and the articular surfaces only, were determined. From this knee-joint, geometric and mechanical parameters were derived to supply the parameters for a three-dimensional quasi-static knee-joint model. These parameters included (i) the three-dimensional insertion points of bundles, defined in the four major knee ligaments, (ii) the mechanical properties of these ligament, as functions of their relative insertion orientations and (iii) three-dimensional representations of the articular surfaces. With this model the experiments were simulated. If knee-model predictions and experimental results agree, then the multi-bundle ligament models are validated, at least with respect to their functional role in anterior-posterior and varus-valgus loading of the joint. The model described the laxity characteristics in AP-translation and VV-rotation of the cadaveric knee-joint specimen reasonably well. Both display the same patterns of laxity changes during knee flexion. Only if a varus moment of 8 N m was applied and if the tibia was posteriorly loaded, did the model predict a slightly higher laxity than that measured experimentally. From the model-experiment comparisons it was concluded that the proposed structural representations of the ligaments and their mechanical property distributions seem to be valid for studying the anterior-posterior and varus-valgus laxity characteristics of the human knee-joint.

Biomechanical Phenomena↗

PubMed1996

[Osteosynthesis of tibial valgus osteotomies by goniometric CH-N external fixator].

INTRODUCTION: The authors present technique and results of a new external fixator, the < < goniometric > > external fixator CH-N for osteosynthesis of high tibial osteotomy for arthritic varus knee deformity on 86 kness (75 patients). MATERIALS AND METHODS: 86 knees in varus deformity with degenerative arthritis of the medial compartment (56 females and 16 males - age 63 +/-8 years) were treated for 5 years (1989-1993) by high tibial osteotomy stabilized by a < < goniometric > > external fixator CH-N. RESULTS: Clinical results were 65,9 per cent excellent, 17, 1 per cent good, 11,8 per cent fair and 5,2 per cent poor 1 year after osteotomy (86 cases analyzed), changing in 60 per cent excellent, 22,3 per cent good, 9, 1 per cent fair and 8,5 per cent at 3 years follow-up (61 cases). Radiological results were: - The preoperative mechanical axis of 13 degrees +/- 5 degrees in varus transformed to 4 degrees +/- 2 degrees in valgus at consolidation and to 2,5 degrees +/- 3 degrees in valgus at one year follow-up. At 3 years follow-up we founded a new loss of correction of 1 degree (mean) in 22 per cent of cases (61 cases). - Subchondral density decreased in 91 per cent of cases (86 cases) one year after and in 82 per cent of cases, 3 years after the osteotomy (61 cases). - In 12 per cent of cases we found a decrease of the overcorrectional angle of the varus deformity 1 year after, and in 22 per cent of cases 3 years after. Two cases needed total knee arthroplasty 4 years after ostcotomy. - Postoperatively, in 86 per cent of cases we did not found increase in both clinical and radiological (pathological) findings of the patellofemoral joint one year after, and in 75 per cent of cases 3 years after. DISCUSSION: The principle of this special < < goniometri > > external fixator is based on the < < goniometric > > central joint in the frontal plane, this allows to guide the screws during osteotomy in the predesigned position and to control the correction during and after the procedure, in contrary to the others current system either internal or external. Any faulty correction can be modified. With its distal screwing axis, it allows axial dynamization. There are only some but not serious incoveniences due to the application of pins (temporary neuromuscular problems and pin-track infections.

Aged↗

PubMedDate not supplied

Split tibialis posterior tendon transfer in the treatment of spastic equinovarus foot.

Sixteen patients with cerebral palsy causing equinovarus deformity were treated surgically. All of these patients underwent preoperative gait analysis by using a CODA-3 motion analyzer. The equinus deformity was assessed by using sagittal kinematics, and in particular, the range of movement of the ankle during stance phase and the maximal dorsiflexion during swing. The varus deformity was assessed by the degree of varus of the foot at prepositioning. The degree of varus was obtained by measuring the angle generated between the plane of progression and a line joining a marker on the heel to a marker on the fifth metatarsal in the transverse plane. All patients underwent split tibialis posterior tendon transfer and, in 13, this was combined with tendo calcaneus lengthening. Clinical assessment and gait analysis repeated 1 year postoperatively confirmed good outcome after split tibialis posterior tendon transfer in combination with gastrocnemius lengthening. This was confirmed by using sagittal kinematic analysis and quantitative assessment of the degree of varus of the foot at the time of prepositioning.

Ankle Joint↗