External torsion in a proximal tibia and internal torsion in a distal tibia occur independently in varus osteoarthritic knees compared to healthy knees

Mochizuki, Tomoharu; Tanifuji, Osamu; Koga, Yoshio; Hata, Ryosuke; Mori, Takahiro; Nishino, Kazuhiko; Satō, Takashi; Kobayashi, Koichi; Omori, Go; Sakamoto, Makoto; Tanabe, Yuji; Endo, Naoto

doi:10.1016/j.jos.2017.01.002

Cited by 20 publications

(17 citation statements)

References 23 publications

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“…The healthy and osteoarthritic knees showed similar rotational directions when comparing the functional plane and tibial anatomical plane, although we detected a large rotational deviation between the two planes in the femur. When humans walk in a forward direction, the functional planes defining the pelvis, hip, and knee joints should coincide [17,18,24]; extensor mechanisms, such as quadriceps femoris, should be maintained in the forward position during walking; the anatomical and functional planes of the tibia will then coincide. However, as shown here, the femur in OA patients demonstrated different associations between the two planes.…”

Section: Discussionmentioning

confidence: 99%

“…For healthy knees, either the femoral or tibial anteroposterior anatomical plane assumingly corresponds to the gait direction. However, in individuals with knee OA, anatomical plane may not correspond to the gait direction due to torsional deformities of the bone and/or rotational mismatch between the femur and tibia [17][18][19]. Previous reports documented the association of external rotation gait with osteoarthritic knees [20,21], a possible example of discordance between the anteroposterior anatomical plane and the gait direction.…”

Section: Introductionmentioning

confidence: 99%

“…As such, use of AOA as the sole means of evaluation for the lower extremity alignment is not sufficient; a means for the evaluation of functional alignments based on both position and motion [functionally oriented alignment (FOA)] will be necessary for a full assessment of joint dysfunction. When humans walk in a forward direction, the functional plane defining the pelvis, hip, and knee joints coincides [17,18,24]; extensor mechanism, such as the quadriceps femoris, is assumingly maintained in the forward position as the gait direction. In other words, the gait direction can reflect the function of the lower extremity, such as extensor mechanism.…”

Section: Introductionmentioning

confidence: 99%

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Functionally Oriented Alignment of the Lower Extremity Reflecting the Direction of Gait for Healthy Elderly, Knee Osteoarthritis, and Total Knee Arthroplasty Subjects

et al. 2020

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Purpose The objective of this study was to evaluate the functional lower extremity alignment based on both position and motion [functionally oriented alignment (FOA)] of the knee in healthy elderly, varus osteoarthritis (OA), and total knee arthroplasty (TKA) subjects. Methods This study evaluated 87 knees in 24 healthy elderly (72 ± 5 years), 39 varus OA (72 ± 6 years), and 24 TKA (75 ± 4 years) subjects. A 3D assessment system was used on 3D models and biplanar long-leg radiographs with the toe angle reflecting gait direction, by applying a 3D-to-2D image registration technique. In the world coordinate system, the y-, z-, and x-axes were defined as gait direction, gravity direction, and the cross product of y- and z-axes, respectively. The parameters were: (a) coronal inclination, sagittal inclination, and transverse direction of the femur and tibia relative to the ground and (b) the difference between the yz-plane of the world coordinate system (functional plane) and the yz-plane of the femoral or tibial coordinate system (anatomical plane). Results The femur had more medial and posterior inclination and the tibia had more lateral and anterior inclination in osteoarthritic knees as compared to healthy knees, and TKA knees had inclinations similar to healthy knees. Rotation was similar or different in the anatomical and functional planes among the subjects with the healthy, knee OA, and TKA. Conclusions The association between the anatomical and functional planes and the position of each bone relative to gravity varied depending on the condition of the knees. Level of Evidence: Level of III

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functionally Oriented Alignment of the Lower Extremity Reflecting the Direction of Gait for Healthy Elderly, Knee Osteoarthritis, and Total Knee Arthroplasty Subjects

et al. 2020

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“…Since tibial torsion showed different directions in both the proximal and distal regions, the traditional method that evaluates proximal and distal torsion together cannot completely reflect the true tibial torsion. Although Mochizuki et al [13] studied tibial torsion separately, they did not compare postoperative alignment. Thus, the effect of tibial torsion on postoperative alignment was unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional tibial torsion measurements were made according to the method suggested by Mochizuki et al [13]. Traditional tibial torsion measurements were made according to the method by Mochizuki et al, which is the angle between the line connecting the medial end with the lateral end on the proximal tibial joint surface and the line connecting the tip of the medial malleolus of the ankle joint with the tip of the lateral malleolus of the fibula.…”

Section: Methodsmentioning

confidence: 99%

Analysis of the effect of tibial torsion on tibial osteotomy in knee arthroplasty using a three-dimensional computed tomography-based modelling technique

Gao

Lu-Ding

et al. 2019

BMC Musculoskelet Disord

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Background Extramedullary systems are commonly used in knee arthroplasty, with the rod location being determined from the tibial torsion line during surgery. The traditional method for tibial torsion measurement is not in accordance with clinical practice. This study aimed to evaluate proximal and distal tibial torsion using 3-dimensional (3D) computed technology to establish a new evaluation method, as well as to investigate the association between tibial torsion and postoperative alignment deviation. Methods Fifty-five osteoarthritis tibias with >10°varus preoperatively were divided into valgus, neutral, and varus groups based on their postoperative alignment deviation. A new method based on clinical practice was built using a 3D tibial model. Proximal and distal tibial torsions were measured by both the new and traditional methods. In addition, tibial osteotomy that followed the intramedullary osteotomy system was simulated on the 3D model in the varus and valgus groups to investigate the association between tibial torsion and alignment deviation. Results Proximal tibial torsion was smaller and distal torsion was greater in the valgus group than the other two groups, according to the new method ( p = 0.03 and p = 0.02, respectively). No significant difference was found when comparing these torsions by the traditional method ( p = 0.782 and p = 0.753, respectively). In the valgus group, the postoperative alignment deviation improved after simulated osteotomy guided by the intramedullary system, while no significant improvement was found in the varus group. Conclusion According to this new tibial-rotation evaluation method, valgus deviation in knee arthroplasty was identified as the main cause for knees in which the proximal tibial internal torsion is too small and the distal external torsion is too great. The use of an intramedullary system may help reduce this deviation. Trial registration Prospectively registered.

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Articular surface of the medial proximal tibia is aligned parallel to the ground in three-dimensional space under weight-bearing conditions in healthy and varus osteoarthritic knees

Mochizuki

Koga

Mori

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose To test the hypothesis that an inclined articular surface on the medial proximal tibia is aligned more parallel to the ground in three-dimensional (3D) space under weight-bearing (WB) conditions (parallel phenomenon) than under non-WB (NWB) conditions in healthy and varus osteoarthritic knees. Methods We examined 55 healthy knees (26 women, 29 men; mean age, 70 ± 6 years) and 108 varus osteoarthritic knees (66 women, 16 men; mean age, 74 ± 7 years). For the evaluation under WB conditions, a 3D assessment system was used on biplanar long-leg radiographs and 3D bone models using a 3D-to-2D image registration technique. In addition, the least square method was used to determine the approximation plane. The angles between the normal vector for the approximation plane of an articular surface on the medial proximal tibia and each axis of the tibial or world coordinate system were calculated. Results Morphologically, the inclination of the approximation plane was steeper in osteoarthritic knees than in healthy knees (p < 0.0001). The approximation plane was aligned more parallel to the ground under WB conditions than under NWB conditions in healthy (p < 0.0001) and osteoarthritic knees (p < 0.0001). Conclusions The parallel phenomenon in the medial proximal tibia was confirmed for healthy and varus osteoarthritic knees. The medial proximal tibia plays an important role in the parallel phenomenon, assumingly associated with varus alignment and varus thrust. The inclination of the medial proximal tibia may become a new parameter for imaging investigations. Level of evidence III. KeywordsKnee osteoarthritis • Weight-bearing conditions • Inclined articular surface in the medial compartment of the proximal tibia • Approximation plane • Parallel phenomenon

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External torsion in a proximal tibia and internal torsion in a distal tibia occur independently in varus osteoarthritic knees compared to healthy knees

Cited by 20 publications

References 23 publications

Functionally Oriented Alignment of the Lower Extremity Reflecting the Direction of Gait for Healthy Elderly, Knee Osteoarthritis, and Total Knee Arthroplasty Subjects

Functionally Oriented Alignment of the Lower Extremity Reflecting the Direction of Gait for Healthy Elderly, Knee Osteoarthritis, and Total Knee Arthroplasty Subjects

Analysis of the effect of tibial torsion on tibial osteotomy in knee arthroplasty using a three-dimensional computed tomography-based modelling technique

Articular surface of the medial proximal tibia is aligned parallel to the ground in three-dimensional space under weight-bearing conditions in healthy and varus osteoarthritic knees

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