Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study

Dagneaux, Louis; Allal, R; Pithioux, Martine; Chabrand, Patrick; Ollivier, Matthieu; Argenson, Jean-Noël

doi:10.1016/j.knee.2018.06.008

Cited by 18 publications

(13 citation statements)

References 18 publications

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“… 20 , 21 Other biomechanical studies showed that internal rotation of the distal femur resulted in increased patellofemoral contact stress. 22 , 23 , 24 Although the magnitude of rotational changes detected in this present study was low (less than 5° in the majority of the cases) compared to the experimental conditions adopted in those cadaveric studies (10° or 15° increments). The present study has shown that changes in rotational alignment are present after DLO and these issues should be taken into consideration in assessment of the surgical outcomes.…”

Section: Discussioncontrasting

confidence: 54%

Three dimensional CT analysis of the change in rotational alignment in double level osteotomy after double level osteotomy performed for varus osteoarthritic knees

Kambara

Nakayama

Kanto

et al. 2021

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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Purpose To analyze the change in rotational alignment caused by double level osteotomy (DLO) based on comparative three-dimensional image analysis of pre- and postoperative CT images. Methods Pre- and postoperative CT examination of the lower extremities were performed with informed consent for 39 consecutive knees undergoing DLO for varus knee deformity. The DLO procedure consisted of closed wedge distal femoral osteotomy (CWDFO) and open wedge high tibial osteotomy (OWHTO). Among those cases, 20 knees complicated with hinge fracture at the osteotomy site were excluded from the analysis to eliminate a confounding factor affecting the results. Consequently, data obtained from 19 knees were subjected to the study analysis while osteotomies with hinge fractures complications were excluded from the study. In the three-dimensional CT image analysis of axial plane images, femoral torsion (the angle between midline along the femoral neck axis and the tangent of the posterior edges of the medial/lateral femoral condyles) and tibial torsion (the angle between the tangent of the posterior edges of the medial/lateral tibial condyles and the transmalleolar axis) were measured. The torsion angle was measured in each of the femurs and the tibias on both pre- and postoperative CT axial images, and the change induced by the osteotomy was calculated and statistically(using Wilcoxon signed-rank test) compared. Results The mean pre- and postoperative femoral torsion (anteversion) angles were 29.3° and 31.4° with a significant postoperative increase in internal rotation of the bony segment distal to the osteotomy(P = 0.002). On the tibial side, the mean pre- and postoperative torsion angles were 26.5° and 25.7°, indicating no significant postoperative change(P = 0.199)（NS）. Conclusions This study showed that the DLO procedure (combining CWDFO and OWHTO) increased torsion (anteversion) of the femur by 2.1° on average while inducing no significant rotational change on the tibial side.

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Section: Discussioncontrasting

confidence: 54%

Three dimensional CT analysis of the change in rotational alignment in double level osteotomy after double level osteotomy performed for varus osteoarthritic knees

Kambara

Nakayama

Kanto

et al. 2021

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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“…7,8 A recent finite element study reported initiation of significantly higher stresses in the patellofemoral joint at 10°maltorsion. 9 Moreover, previous biomechanical work revealed a significantly higher stress in the knee joint at only 5°maltorsion. 1 In case of existing malalignment leading to clinical complaints, a corrective osteotomy has to be considered to restore the physiological and anatomical relationships.…”

Section: Introductionmentioning

confidence: 94%

“…Another long‐term problem following torsional malalignment of the femur is related to the risk of degenerative osteoarthritis of the knee and/or hip 7,8 . A recent finite element study reported initiation of significantly higher stresses in the patellofemoral joint at 10° maltorsion 9 . Moreover, previous biomechanical work revealed a significantly higher stress in the knee joint at only 5° maltorsion 1 .…”

Section: Introductionmentioning

confidence: 99%

In vivo test of a radiography‐based navigation system for control of derotational osteotomies

Grünwald

Schröter

Windolf

et al. 2020

Journal Orthopaedic Research

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Malalignment of the femur is a frequently encountered problem in orthopaedics entailing manifold consequences for the affected patients. Corrective osteotomies, necessary to restore the physiological and anatomical relationships, face great challenges due to no existing reliable gold standard for intraoperative control of torsional malalignment. The aim of this study was to test a novel radiography-based navigation tool for control of derotational osteotomies in a clinical environment. In a first-and preliminary-casecontrolled study on 12 patients (level 3 of evidence), the achieved torsional correction measured with implementation of the navigation tool was compared with measurements from pre-and postoperative computed tomography (CT) scans. The navigation tool was able to acquire and process all relevant data and capture possible malrotation during surgery with only little deviations of 1.61°± 0.86°(mean ± standard deviation) from the measurements based on CT scans. Next, the system will be used to assist surgeons for more precise treatment avoiding maltorsion after derotational osteotomies.

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“…With the development of computer science and technology, finite element calculations have been gradually applied widely in the biomechanical research of orthopedics. Recent studies ( 6 – 8 ) suggest that the fusion of three-dimensional (3D) finite element models and biomechanical models based on images can simulate the stress state of joints more accurately. Brekelmans et al ( 9 ) used this method to preliminarily analyze the influence of vertebral body material properties and geometry on the stress distribution of intervertebral discs.…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis of Spinal Cord Stress in a Single Segment Cervical Spondylotic Myelopathy

Yang

Yuan

et al. 2022

Front. Surg.

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BackgroundSpinal cord ischemia is largely caused by cervical spondylotic myelopathy (CSM), which has a corresponding biomechanical basis. Finite element analysis of spinal cord stress in diseased segments of CSM was performed to provide a biomechanical basis for the pathogenesis of CSM.MethodsA single segment (C4-5) in a patient with CSM was selected for mechanical simulation of three-dimensional (3D) computed tomography scanning, and a 3D finite element model of the cervical vertebra was constructed. Based on the patient's age, sex, height, weight, and other parameters, a finite element analysis model of an individual with healthy cervical vertebrae in our hospital was selected as the control to compare the stress changes between the patient and control groups in the analysis of the cervical vertebrae under anterior flexion, posterior extension, lateral flexion, and rotating load in the diseased spinal cord segment.ResultsIn the CSM patient, the diseased segment was C4-5. Under loading conditions of forward flexion, posterior extension, left flexion, right flexion, left rotation, and right rotation, the maximum stress on the spinal cord in the control group was 0.0044, 0.0031, 0.00017, 0.00014, 0.0011, and 0.001 MPa, respectively, whereas those in the spinal cord in the CSM group were 0.039, 0.024, 0.02, 0.02, 0.0194, and 0.0196 MPa, respectively.ConclusionThe maximum stress on the diseased segments of the spinal cord in the CSM group was higher than that in the control group, which contributed to verifying the imaging parameters associated with spinal cord compression stress.

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Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study

Cited by 18 publications

References 18 publications

Three dimensional CT analysis of the change in rotational alignment in double level osteotomy after double level osteotomy performed for varus osteoarthritic knees

Three dimensional CT analysis of the change in rotational alignment in double level osteotomy after double level osteotomy performed for varus osteoarthritic knees

In vivo test of a radiography‐based navigation system for control of derotational osteotomies

Finite Element Analysis of Spinal Cord Stress in a Single Segment Cervical Spondylotic Myelopathy

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