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At least 1,081 records · Page 60Linked to original sources

PubMed2005

Neuromuscular biomechanical modeling to understand knee ligament loading.

PURPOSE: This article examines our use of EMG-driven neuromuscular biomechanical models to study how muscles stabilize the knee. EMG can be used to establish which activation patterns are used by people for knee stabilization. However, it does not reveal the effectiveness of these patterns. The EMG-driven models provide quantitative comparisons of the effectiveness of the different knee-stabilizing activation patterns. METHODS: Subjects performed static tasks and common sporting maneuvers that challenged knee joint stability. EMG, joint posture and motion, and external forces and moments were measured during these tasks. These data were used to calibrate the EMG-driven neuromuscular biomechanical model. We then used the model to predict the role of muscles in supporting varus and valgus moments at the knee. RESULTS: We found specific muscle activation patterns to support varus and valgus moments. The most potent activation pattern to stabilize the knee is when the hamstrings or quadriceps are required to generate flexion or extension moments, respectively. The next most effective knee-stabilizing pattern is cocontraction of the hamstring and quadriceps. The small biarticular muscles at the knee provided the least support of varus and valgus moments. In the sporting tasks, sidestepping was found to place the anterior cruciate ligament at high risk of injury. We found that the muscles are the main defense against knee ligament injuries in these tasks. CONCLUSION: Traditional biomechanical and neurophysiological methods have shown that there are specific activation patterns used to stabilize the knee. By also using the EMG-driven neuromuscular biomechanical model, we have shown how effective muscles are in stabilizing the knee. This modeling method provides a new tool to understand knee joint stabilization.

Biomechanical Phenomena↗

PubMed1980

Instability of the ankle after injury to the lateral ligament.

Ligamentous instability of the ankle joint can be confirmed by radiographs taken in two planes. The place of the anteroposterior varus stress view is established, but the lateral view which shows anterior subluxation of the talus is frequently omitted. The anatomical significance of the two stress views has been determined by dividing different components of the lateral ligament of 20 cadaveric ankles and noting the subluxation that resulted from these procedures. A clinical assessment was then made of 54 ankles (46 patients) with radiological evidence of instability when subjected to varus and anterior stress. Anterior subluxation was found to be considerably more common than varus tilt, and it is therefore suggested that the lateral stress view should be an essential part of the investigation of the unstable ankle.

Adolescent↗

PubMed1987

Residual adduction of the forefoot. A review of the Turco procedure for congenital club foot.

Forty-four feet in 28 children previously treated by a one-stage posteromedial release operation (the Turco procedure) were reviewed clinically and radiologically to determine the cause of residual adduction of the forefoot. In 21 clinically adducted feet (48%) the main cause of residual deformity was metatarsus varus alone or metatarsus varus in spite of talonavicular overcorrection; in five feet the cause was talonavicular subluxation. There was no residual adduction in 23 feet (52%) but only 12 had normal radiographic measurements. In the remaining feet, various forms of spurious correction of metatarsus varus and talonavicular subluxation or both were seen, resulting in normal-looking feet. Recession of the origin of abductor hallucis and release of the short plantar muscles and fascia at the time of posteromedial release is recommended. The forefoot adduction was satisfactorily corrected in 91% of the feet subsequently operated on using this modified procedure.

Child↗

PubMed2000

Radiological changes five years after unicompartmental knee replacement.

Failure of a unicompartmental knee replacement (UKR) may be caused by progressive osteoarthritis of the knee and/or failure of the prosthesis. Limb alignment can influence both of these factors. We have examined the fate of the other compartments and measured changes in leg alignment after UKR. A total of 50 UKRs was carried out on 45 carefully selected patients between 1989 and 1992. At operation, deliberate attempts were made to avoid overcorrection of the deformity. Four patients died, one patient was lost to follow-up and two knees were revised before review which was at a minimum of five years. Standard long-leg weight-bearing anteroposterior views of the knee and skyline views of the patellofemoral joint were taken before and at eight months and five years after operation. The radiographs of the remaining 43 knees were reviewed twice by blind and randomised assessment to measure the progression of osteoarthritis within the joints. Overcorrection of the deformity in the coronal plane was avoided in all but two knees. Only one showed evidence of progression of osteoarthritis within the patellofemoral joint, and this was only identified in one of the four assessments. Deterioration in the state of the opposite tibiofemoral compartment was not seen. Varus deformity tended to recur. Recurrent varus of 2 degrees was observed between eight months and five years after operation. There was no correlation between the postoperative tibiofemoral angle and the extent of recurrent varus recorded at five years. Changes in alignment may be indicative of minor polyethylene wear or of subsidence of the tibial component. The incidence of progressive osteoarthritis within the knee was very low after UKR. Patients should be carefully selected and overcorrection of the deformity be avoided.

Aged↗

PubMed2002

Dislocation of the bearing of the Oxford lateral unicompartmental arthroplasty. A radiological assessment.

When the Oxford unicompartmental meniscal bearing arthroplasty is used in the lateral compartment of the knee, 10% of the bearings dislocate. A radiological review was carried out to establish if dislocation was related to surgical technique. The postoperative radiographs of 46 lateral unicompartmental arthroplasties were analysed. Five variables which related to the position and alignment of the components were measured. Dislocations occurred in six knees. Only one of the five variables, the proximal tibial varus angle, had a statistically significant relationship to dislocation. This variable quantifies the height of the lateral joint line. The mean proximal tibial varus angle for knees the bearings of which had dislocated was 9 degrees and for those which had not it was 5 degrees. In both groups it was greater than would be expected in the normal knee (3 degrees). Our study suggests that a high proximal tibial varus angle is associated with dislocation. The surgical technique should be modified to account for this, with care being taken to avoid damage to or overdistraction of the lateral soft tissues.

Aged↗

PubMed2004

The flexion gap in normal knees. An MRI study.

Varus and valgus joint laxity of the normal living knee in flexion was assessed using MRI. Twenty knees were flexed to 90 degrees and were imaged in neutral and under a varus-valgus stress in an open MRI system. The configuration of the tibiofemoral joint gap was studied in slices which crossed the epicondyles of the femur. When a varus stress was applied, the lateral joint gap opened by 6.7 +/- 1.9 mm (mean +/- SD; 2.1 to 9.2) whereas the medial joint gap opened by only by a mean of 2.1 +/- 1.1 mm (0.2 to 4.2). These discrepancies indicate that the tibiofemoral flexion gap in the normal knee is not rectangular and that the lateral joint gap is significantly lax. These results may be useful for adequate soft-tissue balancing and bone resection in total knee arthroplasty and reconstruction surgery on ligaments.

Adolescent↗

PubMed1996

Motion of the ankle in a simulated supination-external rotation fracture model.

UNLABELLED: An experimental study was undertaken with use of axially loaded, unconstrained cadaver ankles to determine the motion patterns seen with progressive stages of the supination-external rotation type of fracture. As described by Lauge-Hansen, these fractures were modeled by transection of the anterior aspect of the capsule and the anterior tibiofibular ligament (stage I), followed by oblique fibular osteotomy ending at the level of the ankle joint (stage II), transection of the posterior aspect of the capsule (stage III), and sequential sectioning of the superficial and deep fibers of the deltoid ligament (stage IV). Thirteen specimens were tested on an apparatus that allowed for controlled loading while the ankle was passed through a physiological range of dorsiflexion and plantar flexion. The ankles were unconstrained about the axial (internal and external rotation) and coronal (varus and valgus angulation) axes. Measurements were made throughout the range of motion in these axes in order to define the kinematic behavior. In the intact specimens, maximum plantar flexion was associated with a mean (and standard deviation) of 1.9 +/- 4.12 degrees of internal rotation of the talus and maximum dorsiflexion, with a mean of 7.2 +/- 3.88 degrees of external rotation. Varus angulation increased slightly with plantar flexion compared with the value in dorsiflexion (2.4 +/- 2.40 compared with 0.3 +/- 1.96 degrees). Internal and external rotation was not affected by fibular osteotomy or by transection of the superficial fibers of the deltoid ligament. Transection of the deep fibers of the deltoid ligament caused a significant (p < 0.02) increase in external rotation of the talus at maximum plantar flexion; this was corrected incompletely by insertion of an anatomical fibular plate. With the numbers available for study, we could not show that varus or valgus angulation was significantly affected by any combination of sectioning of the deltoid ligament and fibular osteotomy. These experiments were repeated with the addition of fixation of the subtalar joint with a talocalcaneal screw. With the number of specimens available, we could detect no significant difference, with respect to axial rotation, due to fixation of the subtalar joint. However, along the coronal axis, increased valgus angulation (p < 0.02) was seen during plantar flexion when either the deep or the superficial fibers of the deltoid ligament had been cut. CLINICAL SIGNIFICANCE: These results indicate that stability of the loaded ankle is primarily due to the deltoid ligament, which exerts a restraining influence on external rotation of the talus. Complete fibular osteotomy did not cause abnormal motion of the ankle in the absence of a medial injury. In the presence of a complete injury, lateral reconstruction only partially restored the mechanical integrity of the ankle. The results provide justification for the non-operative treatment of isolated fractures of the lateral malleolus. The data also suggest that a lateral fracture associated with a major injury of the deltoid ligament should be treated with anatomical lateral fixation followed by immobilization without early motion, to allow adequate healing of the deltoid ligament at its resting length.

Aged↗

PubMed2000

Simultaneous femoral osteotomy and total knee arthroplasty for treatment of osteoarthritis associated with severe extra-articular deformity.

BACKGROUND: In the presence of large extra-articular deformity, complex imbalance of the collateral ligaments may result if standard techniques of soft-tissue releases and intra-articular bone resection are used during total knee arthroplasty. The purpose of this paper is to review our experience with simultaneous corrective osteotomy and total knee arthroplasty for the treatment of severe extra-articular femoral deformity associated with ipsilateral osteoarthritis of the knee. METHODS: The results of simultaneous corrective osteotomy and total knee arthroplasty in eleven knees with osteoarthritis and associated extra-articular angular deformity of the femur were reviewed retrospectively. The femoral deformity resulted from fracture malunion in ten knees and from hypophosphatemic rickets in one. There were five primarily uniplanar deformities (four varus deformities and one antecurvatum deformity), five biplanar (varus and antecurvatum) deformities, and one triplanar (varus, antecurvatum, and internal rotation) deformity. Four knees were approached through a standard medial parapatellar arthrotomy and seven, through an anterolateral subvastus approach with an osteotomy of the tibial tubercle. The site of the femoral osteotomy was fixed with a blade-plate in seven patients, a press-fit long-stemmed femoral component in two, and a retrograde femoral nail in two. An extramedullary alignment system was utilized in eight patients, and intramedullary alignment was used in three. RESULTS: The duration of follow-up averaged forty-six months (range, twenty-six to eighty-eight months). According to the classification system of the Knee Society, the mean function score increased from 22 points preoperatively to 81 points at the time of follow-up and the mean knee score increased from 10 points preoperatively to 87 points at the time of follow-up. The mean flexion contracture decreased from 19 degrees preoperatively to 2 degrees at the time of follow-up. The arc of motion averaged 56 degrees (range, 30 to 75 degrees) preoperatively and 89 degrees (range, 65 to 115 degrees) at the time of follow-up. The mechanical alignment in the coronal plane was restored to within 2 degrees of normal in each patient. Ten femoral osteotomy sites healed, and one, in a patient treated with a press-fit long-stemmed femoral component, had not healed by the time of follow-up. All seven sites of the tibial tubercle osteotomies healed. There were no complete radiolucent lines at the prosthetic interfaces, and no total knee arthroplasty was revised. One patient had a nonfatal postoperative pulmonary embolism. As determined by clinical examination and the patients' assessment of function, no ligament imbalance was noted at the time of the most recent follow-up. CONCLUSIONS: Simultaneous femoral osteotomy and total knee arthroplasty is a technically difficult but effective treatment for patients with severe femoral deformity associated with ipsilateral osteoarthritis of the knee. We recommend that the femoral osteotomy site be secured with a plate or a locked intramedullary nail, depending on the location of the deformity and the subsequent osteotomy.

Adult↗

PubMed2000

Axial alignment of the lower extremity in Chinese adults.

BACKGROUND: The restoration of normal axial alignment of the lower extremity is important to surgeons who perform reconstructive surgery of the knee. However, data on the normal alignment of the lower extremity in Chinese adults are not available. METHODS: The axial alignment of the lower extremity in twenty-five adult male and twenty-five adult female volunteers of southern Chinese origin was measured on weight-bearing radiographs of the entire lower limb. The mean age was twenty-four years for the male volunteers and twenty-three years for the female volunteers. The results were compared with those of two similar studies of white volunteers in the United States. RESULTS: The medial inclination of the tibial plateau in the Chinese subjects (mean and standard deviation, 5.4 +/- 2.5 degrees for women and 4.9 +/- 2.3 degrees for men) was greater than the commonly reported 3 degrees. The extremities of the Chinese women were found to have a mean of 2.2 +/- 2.5 degrees of varus alignment, and those of the Chinese men had a mean of 2.2 +/- 2.7 degrees of varus alignment. CONCLUSIONS: Compared with the white subjects described in the studies by Moreland et al. and Hsu et al., the Chinese subjects had significantly larger medial inclination of the knee joint (knee-joint obliquity) (p < 0.005) and the female Chinese subjects had significantly more varus alignment of the lower extremity (p < 0.025). CLINICAL RELEVANCE: Five degrees of external rotation of the femoral component, instead of the commonly reported 3 degrees, may be required to obtain a rectangular flexion gap in total knee arthroplasty in Chinese patients. The racial difference in the knee-joint obliquity may contribute to the racial difference in the ratio of knee osteoarthritis to hip osteoarthritis. Additional studies are necessary to confirm this relationship.

Adult↗

PubMed2001

Primary repair of intraoperative disruption of the medical collateral ligament during total knee arthroplasty.

BACKGROUND: Intraoperative disruption of the medial collateral ligament during total knee arthroplasty is an uncommon complication that is frequently treated by implanting a prosthesis with varus-valgus constraint. To our knowledge, no data have been published on primary repair or reattachment of the medial collateral ligament and implantation of a minimally constrained posterior-stabilized or cruciate-retaining prosthesis. This retrospective study evaluates the hypothesis that satisfactory clinical results, at a minimum of two years, can be achieved with immediate repair or reattachment of the medial collateral ligament and without a constrained total knee prosthesis. METHODS: Of 600 knees treated with primary total knee arthroplasty, sixteen (in fourteen patients) sustained either a midsubstance disruption of the medial collateral ligament or an avulsion of the ligament from bone during the procedure. Preoperatively, all patients had either neutral or varus alignment and an intact medial collateral ligament. Midsubstance tears were treated with direct primary repair, and avulsions of the ligament off the tibia or femur were treated with suture-anchor reattachment to bone. All patients wore a hinged knee brace, with no limit to the range of motion, for six weeks postoperatively. Clinical and radiographic data were gathered prospectively as part of a database that was ongoing throughout the period of study; the cohort of patients was assembled retrospectively by searching that database. RESULTS: No patients were lost to follow-up. The mean duration of follow-up was forty-five months (range, twenty-four to ninety-five months). The Hospital for Special Surgery knee scores increased from a mean of 47 points (poor) preoperatively to a mean of 93 points (excellent) at the time of final follow-up. On physical examination, no patient had a Hospital for Special Surgery score in the fair or poor range and all patients had regained normal stability in the coronal plane both at full extension and at 30 degrees of flexion. No patient required knee-bracing beyond the initial six-week postoperative period. The range of motion at the time of final follow-up averaged 108 degrees (range, 85 degrees to 125 degrees ), although one knee required manipulation under anesthesia to obtain a satisfactory range of motion. No arthroplasties required revision. Radiographic examination demonstrated appropriate limb alignment in all patients at the time of final follow-up. CONCLUSIONS: Intraoperative disruption of the medial collateral ligament can be treated with primary repair or reattachment of the ligament to bone and postoperative bracing with good results; this avoids the potential disadvantages associated with the use of varus-valgus constrained implants.

Aged↗

PubMed2001

Revision anterior cruciate surgery with use of bone-patellar tendon-bone autogenous grafts.

BACKGROUND: A prospective study was done to determine the functional results, patient satisfaction, and graft failure rate after fifty-seven consecutive revision replacements of the anterior cruciate ligament with use of a bone-patellar tendon-bone autogenous graft. METHODS: Fifty-four patients (fifty-five operations) were followed in this study. Concurrent operative procedures were performed during the revision procedure in thirty-seven knees (67%). These procedures included repair of a meniscal tear in twenty knees (36%) and reconstruction of deficient posterolateral or medial ligament structures in seventeen knees (31%). Nine knees (16%) had a high tibial osteotomy to correct varus malalignment before the revision operation. The results were evaluated with the Cincinnati Knee Rating System. RESULTS: There were significant improvements in the scores for pain (p < 0.0001), activities of daily living (p < 0.01), sports participation (p < 0.001), patient satisfaction (p < 0.0001), and overall rating of the knee (p < 0.0001). Thirty-three (60%) of the replaced ligaments were functional, nine (16%) were partially functional, and thirteen (24%) had failed. CONCLUSIONS: Many knees (93%) had compounding problems, including articular cartilage damage, prior meniscectomy, loss of secondary ligament restraints, varus malalignment, and concomitant ligament replacement or meniscal repair. Therefore, the results were generally less favorable than those following primary operations. The rate of graft failure was three times higher than our previously reported failure rate after primary replacements of the anterior cruciate ligament with a bone-patellar tendon-bone autogenous graft. Even so, symptoms and functional limitations with regard to daily and sports activities were found to have decreased and patient satisfaction improved. We advocate correction of varus malalignment prior to anterior cruciate procedures. Associated posterolateral ligament deficiencies should be surgically corrected during anterior cruciate procedures to prevent excessive loading on the graft from abnormal lateral tibiofemoral joint opening. Meniscal tears, including complex tears that extend into the avascular zone, can be concurrently repaired successfully during the revision.

Activities of Daily Living↗

PubMed2002

Total knee arthroplasty for arthritis of the knee with extra-articular deformity.

BACKGROUND: Simultaneous corrective osteotomy of angular deformity and total knee arthroplasty has been considered the treatment of choice for patients with arthritis of the knee associated with ipsilateral extra-articular deformity. However, this procedure is technically demanding, and the functional outcome of the total knee arthroplasty may be jeopardized if the osteotomy fails. This retrospective study was performed to evaluate the clinical results of total knee arthroplasty combined with intra-articular bone resection, without osteotomy, in patients with extra-articular deformity and arthritis of the knee. METHODS: Fifteen patients with arthritis of the knee and extra-articular deformity underwent total knee arthroplasty with bone resection and soft-tissue balancing. All deformities had resulted from fracture malunion. There were ten uniplanar, three biplanar, and two triplanar deformities. The deformity was in the tibia in eight patients and in the femur in seven. The average angle of the femoral deformities was 15.1 degrees in the coronal plane and 8.1 degrees in the sagittal plane. Two femora had a rotational deformity, consisting of 20 degrees of internal rotation in one and 10 degrees of external rotation in the other. The average angle of the tibial deformities was 19 degrees in the coronal plane. RESULTS: The duration of follow-up averaged thirty-eight months. The average Knee Society knee score improved from 22.3 points preoperatively to 91.7 points at the time of the last follow-up, and the average Knee Society function score improved from 28.0 points preoperatively to 87.3 points at the time of the last follow-up. The average arc of knee motion improved from 77.7 degrees preoperatively to 103.7 degrees postoperatively. The average mechanical axis of the knee improved from 22.7 degrees of varus preoperatively to 0.3 degrees of varus at the time of the last follow-up. Two patients had an unsatisfactory clinical result, which was not related to the total knee arthroplasty. There were no complications such as infection, ligament instability, or component loosening. CONCLUSIONS: Total knee arthroplasty in conjunction with intra-articular bone resection is an effective procedure for patients with arthritis of the knee and extra-articular varus deformity of <20 degrees in the femur or 30 degrees in the tibia in the coronal plane.

Aged↗

PubMed2006

Causes of intoeing gait in children with cerebral palsy.

BACKGROUND: Intoeing is a frequent gait problem in children with cerebral palsy. It is essential to determine the cause(s) of intoeing when surgical intervention is being planned. The purpose of this study was to evaluate the prevalence of various causes of intoeing in children with cerebral palsy and to determine whether the causes differ between children with bilateral and those with unilateral involvement. METHODS: The cause of intoeing gait was examined retrospectively, with use of gait analysis, in 412 children with cerebral palsy (587 involved sides). The causes were evaluated separately for the children with bilateral involvement (diplegia or quadriplegia) and those with hemiplegia. RESULTS: Overall, the most common causes of intoeing were internal hip rotation (322 of 587 sides) and internal tibial torsion (296 of 587 sides). Pes varus contributed to intoeing of thirty-five of the eighty-two involved limbs of the patients with hemiplegia and of forty-two of the 505 limbs of the patients with diplegia or quadriplegia. Multiple causes of intoeing were noted in 215 of the 587 involved limbs, including 176 of the 505 limbs of the patients with bilateral involvement and thirty-nine of the eighty-two involved limbs of the patients with hemiplegia. The most common causes of intoeing in the subjects with bilateral involvement were internal hip rotation (288 of 505), internal tibial torsion (261 of 505), and internal pelvic rotation (ninety-two of 505). The most common causes in the hemiplegic children were internal tibial torsion (thirty-five of eighty-two), pes varus (thirty-five of eighty-two), internal hip rotation (thirty-four of eighty-two), and metatarsus adductus (twenty of eighty-two). CONCLUSIONS: More than one-third of children with cerebral palsy have multiple causes of intoeing. Pes varus commonly contributes to intoeing by children with hemiplegic cerebral palsy but rarely contributes to intoeing by those with diplegia or quadriplegia. These findings should be carefully considered prior to surgical correction of the intoeing gait of these patients.

Adolescent↗

PubMed2006

The effect of ankle rotation on cutting of the tibia in total knee arthroplasty.

BACKGROUND: Extramedullary alignment guides are commonly used to prepare the tibia during total knee arthroplasty. One disadvantage is that the guide is easily affected by the position of the ankle joint. The tibia may have a rotational mismatch between its proximal and distal ends. We hypothesized that a rotational mismatch might cause incorrect positioning of an extramedullary alignment guide and evaluated such a mismatch on the predicted postoperative coronal alignment of the tibia. METHODS: Fifty-three osteoarthritic knees with varus deformity in fifty-one patients were evaluated with use of computerized tomography scans before total knee arthroplasty. We defined one anteroposterior axis of the ankle joint and five different anteroposterior axes of the proximal aspect of the tibia using three-dimensional bone models from the computerized tomography data. We measured the rotational angle between the anteroposterior axis of the ankle joint and the proximal part of the tibia. The distal end of the extramedullary guide was placed in front of the center of the ankle joint (on the line of the extended anteroposterior axis of the ankle joint), and the proximal end was placed on the line of the extended anteroposterior axis of the proximal part of the tibia. We established spatial coordinates to evaluate the effect of the rotational angle on the predicted postoperative coronal alignment of the tibia and calculated the presumed tibial coronal alignment. RESULTS: The rotational angle was positive (3.6 degrees to 19.7 degrees) for all of the anteroposterior axes of the proximal aspect of the tibia, indicating that the ankle joint was externally rotated relative to the proximal part of the tibia. The predicted tibial coronal alignment was varus (0.5 degrees to 5.1 degrees) for all of the anteroposterior axes of the proximal part of the tibia. CONCLUSIONS: When an extramedullary alignment guide is used to prepare the tibia in total knee arthroplasty, varus alignment of the tibial component can occur because of a rotational mismatch between the proximal part of the tibia and the ankle joint.

Aged↗

PubMed1994

The frontal plane relationship of the forefoot to the rearfoot in an asymptomatic population.

Physical therapists use biochemical orthotics to treat symptoms attributed to structural abnormalities of the feet. The purpose of this study was to determine the prevalence of forefoot varus, valgus, and neutral positions in a healthy population, and to compare forefoot positions between genders, legs, and age groups. Nonprobability sampling was used to obtain 120 healthy subjects. A repeated-measures, one-group design was used. A forefoot measuring device and a goniometer were used to measure the forefoot-rearfoot frontal plane relationship. Of the 234 measured feet, 86.67% had a varus, 8.75% had a valgus, and 4.58% had a neutral forefoot-rearfoot relationship. No significant difference in position was found between genders or legs within subjects. A certain amount of forefoot varus or valgus may be characteristic of a healthy population; however, future studies should include children and adolescents to determine if forefoot positions are acquired or congenital.

Adolescent↗

PubMed2005

The relationship between forefoot, midfoot, and rearfoot static alignment in pain-free individuals.

STUDY DESIGN: Correlational study. OBJECTIVES: To determine whether, and to what degree, a relationship exists between forefoot angle and weight-bearing midfoot and rearfoot position. BACKGROUND: There have been conflicting reports with regard to the degree to which the structure of the foot may influence the function. The influence of forefoot structure on weight-bearing midfoot and rearfoot position has not been extensively investigated. METHODS AND MEASURES: Fifty-one healthy subjects participated in this study (26 male and 25 female). Forefoot angle was measured in prone as varus (positive numbers), neutral (0), or valgus (negative numbers). Navicular drop was measured from subtalar joint neutral to unilateral standing relaxed. Rearfoot angle was measured in relaxed single-limb stance as the angle between a line that bisected the calcaneus and a line that bisected the lower third of the leg. The relationships between forefoot angle and navicular drop, and between forefoot angle and relaxed rearfoot angle, were investigated. The same relationships were also investigated in the neutral forefoot subgroup when the sample was divided in 3 subgroups based on 1 standard deviation of forefoot angle. RESULTS: There is a significant relationship between forefoot angle and relaxed rearfoot angle (r = 0.52, P < .001), as well as between forefoot angle and navicular drop (r = 0.55, P < .001), in the whole sample (n = 51). Average degrees of forefoot angle in the neutral subgroup (between 1.0 degree and 8 degrees of varus) are not associated with predictable positions of relaxed rearfoot angle (r = 0.19, P = .24) or navicular drop (r = 0.01, P = .96). CONCLUSIONS: Based on the results of this study, there is a significant relationship between forefoot angle and relaxed rearfoot angle, as well as between forefoot angle and navicular drop, in healthy subjects. These relationships were not found when forefoot varus values were within a standard deviation of the sample mean.

Adult↗

PubMed1982

The subchondral bone of the proximal tibial epiphysis in osteoarthritis of the knee.

The trabecular bone of the proximal end of the tibia was assessed as an endoprosthesis-bearing structure. The mass and mineral content as well as the activity of subchondral trabecular bone were determined in osteoarthritis knees with varus or valgus deformity. Bone specimens were taken from the lateral condyle, the medial condyle, and centrally from the intercondylar area of seven varus and four valgus knees. The percentage volume of trabecular bone was determined by histomorphometry. On an additional nine knees, five with varus and four with valgus deformity, as well as ten knees from a normal autopsy material, photon absorptiometric determination of the mineral content of the same areas was performed. On average, the loaded condyle had twice the percentage volume of trabecular bone, and accordingly twice the mineral content, of the unloaded condyle. It was remarkable that the mineral content of the latter was of the same order as the condyles of the normal material.

Aged↗

PubMed1982

Deformities, gonarthrosis and function after distal femoral fractures.

Sixty-two patients treated for distal femoral fractures from 1969-1976 were re-examined, after a mean follow-up period of 5 years, to study deformities, gonarthrosis and function. These fractures occur mainly in elderly persons with bone fragility due to age and disease. The deformities were analysed from precisely defined radiographic projections. An anatomical classification into supracondylar, unicondylar and bicondylar fractures, with subdivisions for undisplaced and displaced fractures was used. A special group for transcondylar fractures was included. Displaced bicondylar fractures mostly healed with varus and anterior angulation, medial unicondylar fractures with varus and lateral unicondylar fractures with valgus angulation. Most of the healed supracondylar fractures showed varus angulation. Three patients developed arthrosis in both the femoro-tibial and patellar compartments, and eleven only in the patellar area. Intercondylar or transcondylar diastasis, or difference of level in the joint surface exceeding 3 mm, caused a significant degree of gonarthrosis. Function was assessed using the Knee Disability Sheet prepared at the Hospital for Special Surgery. The necessity of radiographic examination of the patellar joint in the axial projection on admission is stressed. Accurate reduction and adequate stabilization of intra-articular fractures seem to be important for reducing the risk of gonarthrosis and later impairment of function.

Adolescent↗