Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach
Abstract Purpose Despite practised for decades, the planning of osteotomy around the knee, commonly using the Mikulicz‐Line, is only empirically based, clinical outcome inconsistent and the target angle still controversial. A better target than the angle of frontal‐plane static leg alignment might b...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40634-021-00324-3 |
| _version_ | 1797321266343968768 |
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| author | Margit Biehl Philipp Damm Adam Trepczynski Stefan Preiss Gian Max Salzmann |
| author_facet | Margit Biehl Philipp Damm Adam Trepczynski Stefan Preiss Gian Max Salzmann |
| author_sort | Margit Biehl |
| collection | DOAJ |
| description | Abstract Purpose Despite practised for decades, the planning of osteotomy around the knee, commonly using the Mikulicz‐Line, is only empirically based, clinical outcome inconsistent and the target angle still controversial. A better target than the angle of frontal‐plane static leg alignment might be the external frontal‐plane lever arm (EFL) of the knee adduction moment. Hypothetically assessable from frontal‐plane‐radiograph skeleton dimensions, it might depend on the leg‐alignment angle, the hip‐centre‐to‐hip‐centre distance, the femur‐ and tibia‐length. Methods The target EFL to achieve a medial compartment force ratio of 50% during level‐walking was identified by relating in‐vivo‐measurement data of knee‐internal loads from nine subjects with instrumented prostheses to the same subjects’ EFLs computed from frontal‐plane skeleton dimensions. Adduction moments derived from these calculated EFLs were compared to the subjects’ adduction moments measured during gait analysis. Results Highly significant relationships (0.88 ≤ R2 ≤ 0.90) were found for both the peak adduction moment measured during gait analysis and the medial compartment force ratio measured in vivo to EFL calculated from frontal‐plane skeleton dimensions. Both correlations exceed the respective correlations with the leg alignment angle, EFL even predicts the adduction moment’s first peak. The guideline EFL for planning osteotomy was identified to 0.349 times the epicondyle distance, hence deducing formulas for individualized target angles and Mikulicz‐Line positions based on full‐leg radiograph skeleton dimensions. Applied to realistic skeleton geometries, widespread results explain the inconsistency regarding correction recommendations, whereas results for average geometries exactly meet the most‐consented “Fujisawa‐Point”. Conclusion Osteotomy outcome might be improved by planning re‐alignment based on the provided formulas exploiting full‐leg‐radiograph skeleton dimensions. |
| first_indexed | 2024-03-08T04:56:05Z |
| format | Article |
| id | doaj.art-fed346b8f4d6493097ed562a3723b5b8 |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-03-08T04:56:05Z |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-fed346b8f4d6493097ed562a3723b5b82024-02-07T15:16:41ZengWileyJournal of Experimental Orthopaedics2197-11532021-01-0181n/an/a10.1186/s40634-021-00324-3Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approachMargit Biehl0Philipp Damm1Adam Trepczynski2Stefan Preiss3Gian Max Salzmann4Fraunhofer Institute for Biomedical Engineering IBMTJoseph‐von‐Fraunhofer‐Weg 166280SulzbachGermanyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermanyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermanyLower Extremity OrthopaedicsMusculoskeletal CenterSchulthess ClinicZurichSwitzerlandLower Extremity OrthopaedicsMusculoskeletal CenterSchulthess ClinicZurichSwitzerlandAbstract Purpose Despite practised for decades, the planning of osteotomy around the knee, commonly using the Mikulicz‐Line, is only empirically based, clinical outcome inconsistent and the target angle still controversial. A better target than the angle of frontal‐plane static leg alignment might be the external frontal‐plane lever arm (EFL) of the knee adduction moment. Hypothetically assessable from frontal‐plane‐radiograph skeleton dimensions, it might depend on the leg‐alignment angle, the hip‐centre‐to‐hip‐centre distance, the femur‐ and tibia‐length. Methods The target EFL to achieve a medial compartment force ratio of 50% during level‐walking was identified by relating in‐vivo‐measurement data of knee‐internal loads from nine subjects with instrumented prostheses to the same subjects’ EFLs computed from frontal‐plane skeleton dimensions. Adduction moments derived from these calculated EFLs were compared to the subjects’ adduction moments measured during gait analysis. Results Highly significant relationships (0.88 ≤ R2 ≤ 0.90) were found for both the peak adduction moment measured during gait analysis and the medial compartment force ratio measured in vivo to EFL calculated from frontal‐plane skeleton dimensions. Both correlations exceed the respective correlations with the leg alignment angle, EFL even predicts the adduction moment’s first peak. The guideline EFL for planning osteotomy was identified to 0.349 times the epicondyle distance, hence deducing formulas for individualized target angles and Mikulicz‐Line positions based on full‐leg radiograph skeleton dimensions. Applied to realistic skeleton geometries, widespread results explain the inconsistency regarding correction recommendations, whereas results for average geometries exactly meet the most‐consented “Fujisawa‐Point”. Conclusion Osteotomy outcome might be improved by planning re‐alignment based on the provided formulas exploiting full‐leg‐radiograph skeleton dimensions.https://doi.org/10.1186/s40634-021-00324-3High tibial osteotomySupracondylar osteotomyMedial compartment force ratioLeg alignmentBiomechanics of osteotomyAdduction moment |
| spellingShingle | Margit Biehl Philipp Damm Adam Trepczynski Stefan Preiss Gian Max Salzmann Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach Journal of Experimental Orthopaedics High tibial osteotomy Supracondylar osteotomy Medial compartment force ratio Leg alignment Biomechanics of osteotomy Adduction moment |
| title | Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach |
| title_full | Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach |
| title_fullStr | Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach |
| title_full_unstemmed | Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach |
| title_short | Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment: a biomechanical approach |
| title_sort | towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment a biomechanical approach |
| topic | High tibial osteotomy Supracondylar osteotomy Medial compartment force ratio Leg alignment Biomechanics of osteotomy Adduction moment |
| url | https://doi.org/10.1186/s40634-021-00324-3 |
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