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The influence of alignment on the musculo-skeletal loading conditions at the knee

  • Musculoskeletal Soft Tissue Conditioning
  • Published:
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Abstract

Background and aim

High tibial osteotomies attempt to recreate physiologically normal joint loading. Previous studies have discussed the influence of mal-alignment on the distribution of static loads to the medial and lateral compartments of the knee. The aim of this study was to determine the influence of mal-alignment on the tibio-femoral loading conditions during dynamic activities.

Material and methods

Using a musculo-skeletal model of the lower limb, which had been previously validated with in vivo data, in this study we modified the alignment of the knee in four patients, from a normal position to the extremes of 8° valgus and 10° varus mal-alignment. The resulting tibio-femoral joint contact forces were examined while patients were walking and stair climbing.

Results

Varying the mal-alignment resulted in a highly individual response in joint loads. Deviations from the normal alignment produced an increase in loading, with valgus generating a more rapid increase in loading than a varus deformity of the same amount. Varus deformities of 10° resulted in increases in peak contact force from an average of 3.3-times bodyweight (BW) up to a peak of 7.4 BW (+45% to +114%) while patients were walking, whilst increases of 15% up to 35% were determined for stair climbing. Increases of up to 140% were calculated at 8° valgus during walking and up to 53% for stair climbing.

Conclusion

This study demonstrated a clear dependence of the individual joint loads on axial knee alignment. Based on the sensitivity of joint loading to valgus mal-alignment, more than 3° of over-correction of a varus deformity to valgus should be carefully reconsidered.

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Acknowledgements

This study was supported by a grant from the German Research Society DFG KFO 102/1.

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Authors and Affiliations

  1. Trauma and Reconstructive Surgery, Charité, Humboldt-University of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Markus O. Heller, William R. Taylor & Georg N. Duda

  2. Department of Orthopaedics, Charité, Humboldt-University of Berlin, Berlin, Germany

    Carsten Perka

Authors
  1. Markus O. Heller
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  2. William R. Taylor
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  3. Carsten Perka
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  4. Georg N. Duda
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Correspondence to Markus O. Heller.

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Heller, M.O., Taylor, W.R., Perka, C. et al. The influence of alignment on the musculo-skeletal loading conditions at the knee. Langenbecks Arch Surg 388, 291–297 (2003). https://doi.org/10.1007/s00423-003-0406-2

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  • DOI: https://doi.org/10.1007/s00423-003-0406-2

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