Dynamische Analyse der Gelenkbelastung bei Beinachsendeformitäten in der Frontalebene

Stief, Felix; Holder, Jana; Böhm, Harald; Meurer, Andrea

doi:10.1007/s00132-021-04121-9

Cited by 6 publications

(5 citation statements)

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“…Varus alignment induces a mechanical load shift towards the medial joint compartment. This pathological load shift increases the risk of degenerative cartilage changes up to manifest osteoarthritis [ 12 , 33 – 37 ]. Several studies highlight the necessity of an additional dynamic evaluation of the leg axis since dynamic measurements might differ from a solely static view [ 12 , 38 – 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…This pathological load shift increases the risk of degenerative cartilage changes up to manifest osteoarthritis [ 12 , 33 – 37 ]. Several studies highlight the necessity of an additional dynamic evaluation of the leg axis since dynamic measurements might differ from a solely static view [ 12 , 38 – 40 ]. In this context our data reveal the presence of dynamic varus alignment with a mean of 5.1° ± 2.6° in young professional soccer players.…”

Section: Discussionmentioning

confidence: 99%

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Influence of leg axis alignment on MRI T2* mapping of the knee in young professional soccer players

Dalos,

Marshall,

Lissy

et al. 2024

BMC Musculoskelet Disord

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Background Investigation of the association between leg axis alignment and biochemical MRI in young professional soccer players in order to identify a potential influence of the leg axis on cartilage regions at risk. Methods Sixteen professional soccer players (21 ± 3 years) underwent static and dynamic leg axis analysis via radiation free DIERS formetric 4 D as well as 3-T MRI examination of both knees. Quantitative T2* mapping of the knee cartilage was performed and T2* values were evaluated as 144 regions of interest. Subgroup analysis was performed in players with severe varus alignment (> 6°). Results Analysis of the leg axis geometry revealed a mean static alignment of 6.6° ± 2.5 varus and a mean dynamic alignment of 5.1° ± 2.6 varus. Quantitative T2* mapping showed significantly increased T2* values in the superficial cartilage layer compared to the deeper region (p < 0.001) as well as a significant increase in relaxation times in the femoral cartilage from anterior to intermediate to posterior (p < 0.001). Combination of both methods revealed a significant correlation for the degree of varus alignment and the femoral, posterior, deep region of the medial knee compartment (r = 0.4; p = 0.03). If severe varus alignment was present this region showed a significant increase in relaxation time compared to players with a less pronounced leg axis deviation (p = 0.003). Conclusion This study demonstrates that varus alignment in young soccer players is associated with elevated T2* relaxation times in the deep cartilage layer of the medial, posterior, femoral compartment and might therefore be a contributing factor in the early pathogenesis of manifest cartilage lesions. Therefore, these findings should be considered in the development of preventive training programs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of leg axis alignment on MRI T2* mapping of the knee in young professional soccer players

Dalos,

Marshall,

Lissy

et al. 2024

BMC Musculoskelet Disord

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“…Especially in borderline cases, when the malalignment test does not reveal a clear medical indication for or against the guided growth intervention, knee joint moments from instrumented gait analysis are additionally assessed. ( Böhm et al, 2015 ; Stief et al, 2021a ). In particular, the knee adduction moment is a commonly used surrogate measure for medial and lateral compartment knee loading.…”

Section: Introductionmentioning

confidence: 99%

Influence of tension-band plates on the mechanical loading of the femoral growth plate during guided growth due to coronal plane deformities

Hucke

Holder

Drongelen

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Correction of knee malalignment by guided growth using a tension-band plate is a common therapy to prevent knee osteoarthritis among other things. This approach is based on the Hueter-Volkmann law stating that the length growth of bones is inhibited by compression and stimulated by tension. How the locally varying mechanical loading of the growth plate is influenced by the implant has not yet been investigated. This study combines load cases from the gait cycle with personalized geometry in order to investigate the mechanical influence of the tension-band plates.Methods: Personalized finite element models of four distal femoral epiphyses of three individuals, that had undergone guided growth, were generated. Load cases from the gait cycles and musculoskeletal modelling were simulated with and without implant. Morphological features of the growth plates were obtained from radiographs. 3D geometries were completed using non-individual Magnetic Resonance Images of age-matched individuals. Boundary conditions for the models were obtained from instrumented gait analyses.Results: The stress distribution in the growth plate was heterogenous and depended on the geometry. In the insertion region, the implants locally induced static stress and reduced the cyclic loading and unloading. Both factors that reduce the growth rate. On the contralateral side of the growth plate, increased tension stress was observed, which stimulates growth.Discussion: Personalized finite element models are able to estimate the changes of local static and cyclic loading of the growth plate induced by the implant. In future, this knowledge can help to better control growth modulation and avoid the return of the malalignment after the treatment. However, this requires models that are completely participant-specific in terms of load cases and 3D geometry.

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“…1,2 Without a spontaneous resolution, genu valgum and genu varum can lead to a range of developmental problems, resulting in cosmetic, functional, and gait abnormalities. 2,3 Idiopathic frontal plane alignment abnormalities of the lower extremities may be asymptomatic during adolescence; however, the unequal load distribution on articular surfaces resulting from malalignment increases the risk of development and progression of osteoarthritis in the knee. 4 Treatment may be sought or recommended to address appearance or symptoms, but surgical intervention is commonly proposed to prevent future problems including early arthritic changes associated with adverse joint loading.…”

mentioning

confidence: 99%

“…Angular deformities at the knee may arise from neuromuscular, genetic, traumatic, or idiopathic etiologies in a pediatric setting 1,2. Without a spontaneous resolution, genu valgum and genu varum can lead to a range of developmental problems, resulting in cosmetic, functional, and gait abnormalities 2,3. Idiopathic frontal plane alignment abnormalities of the lower extremities may be asymptomatic during adolescence; however, the unequal load distribution on articular surfaces resulting from malalignment increases the risk of development and progression of osteoarthritis in the knee 4…”

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confidence: 99%

Patient-reported Outcomes of Adolescents Treated With Guided Growth to Correct Idiopathic Genu Valgum

Carroll

Stotts

Pearson

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Guided growth is commonly used to treat frontal plane alignment deformities in skeletally immature individuals. Treatment aims are to correct the biomechanical loading of the knee and to avoid more invasive surgery that would be required after skeletal maturity. There is little published evidence of pain perception or functional limitations in this population. In addition, the intervention has the potential to worsen pain and function with hardware implantation, and symptoms may not fully resolve after removal. Understanding of pain and function limitations in this population is important to guide the clinical expectations. Methods: Individuals with idiopathic knee genu valgum who underwent hemiepiphysiodesis with tension plate constructs were identified through a medical records database search. Patient-reported outcomes measurement information system Physical Function/Mobility and Pain Interference domain scores were assessed before hemiepiphysiodesis, immediately before hardware removal, and after hardware removal. Radiographs were also assessed at these times to record the zones and angles of deformity and correction. Results: Twenty-eight subjects (53 operative limbs) contributed to the analysis. Mobility and pain interference as measured by the patient-reported outcomes measurement information system were below typical values in a small percentage of the population studied, only 3.6% scored in the moderate and none in the severe categories for both domains. Valgus by radiographic zone was corrected in all patients without significant rebound at follow-up. Compared with preoperative levels, mobility scores improved before hardware removal. Pain Interference scores improved both before hardware removal and at the final follow-up. Conclusions: Frontal plane knee deformities in the idiopathic population do not cause pain or limit mobility in most subjects. This is critical information, emphasizing that surgical decisions may be made based on the deformity alone, presence of symptoms, and possible future morbidity secondary to valgus deformity. If surgery is postponed because an individual is asymptomatic, the window for correction with guided growth may be lost. Individuals undergoing hemiepiphysiodesis can expect that their pain and function will not be worse during the time that hardware is in place and that surgery is likely to improve any pain they may be experiencing. Level of Evidence: Level III; retrospective comparative study.

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Dynamische Analyse der Gelenkbelastung bei Beinachsendeformitäten in der Frontalebene

Cited by 6 publications

References 30 publications

Influence of leg axis alignment on MRI T2* mapping of the knee in young professional soccer players

Influence of leg axis alignment on MRI T2* mapping of the knee in young professional soccer players

Influence of tension-band plates on the mechanical loading of the femoral growth plate during guided growth due to coronal plane deformities

Patient-reported Outcomes of Adolescents Treated With Guided Growth to Correct Idiopathic Genu Valgum

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