Abstract
BackgroundExcessive hindfoot pronation, talotarsal joint (TTJ) instability, has been attributed to an increase in medial knee compartment pathology. Advocacy for hindfoot realignment has been the subject of research. An internal solution for TTJ instability, extra-osseous talotarsal stabilization (EOTTS), exists but its effect on knee forces is unknown. This is the first study to measure the in vivo forces acting within the medial knee compartment before and after EOTTS. We hypothesized that following EOTTS there should be a reduction of force acting on the medial knee compartment.Methods10 fresh frozen cadaver lower extremities exhibiting clinical and radiographic evidence of TTJ instability were evaluated. The proximal femur segment was mounted to a mechanical testing unit. Pressure sensors were placed within the medial knee compartment. A force of 1000 newtons was then applied, and the femur was internally rotated 10 degrees. Measurements were recorded before and after the insertion of a type II EOTTS stent.ResultsPre-EOTTS resulted in an average of 842 ± 247N acting within the medial knee joint compartment. These forces then decreased to an average of 565 ± 260N (<0.05) following EOTTS, representing an average reduction of force by 32.8%.ConclusionEOTTS has been shown to decrease the in vivo forces action within the medial knee compartment. This helps to further illustrate the importance of realigning and stabilizing the hindfoot for the prevention and treatment of chronic knee pain.
Highlights
Chronic knee pain has a negative impact to both an individual’s lifestyle and overall health
We hypothesized that following extra-osseous talotarsal stabilization (EOTTS) there should be a reduction of force acting on the medial knee compartment
Pre-EOTTS resulted in an average of 842 ± 247N acting within the medial knee joint compartment
Summary
Chronic knee pain has a negative impact to both an individual’s lifestyle and overall health. If the forces acting on the medial and lateral compartments of the knee joint are not balanced, this could result in accelerated cartilage degradation within one of the compartments. Scientific evidence suggests that altered lower extremity biomechanics lead to excessive loading of the medial knee compartment during weightbearing activities [5,6,7]. Talotarsal joint (TTJ) instability, has been attributed to an increase in medial knee compartment pathology. An internal solution for TTJ instability, extra-osseous talotarsal stabilization (EOTTS), exists but its effect on knee forces is unknown. This is the first study to measure the in vivo forces acting within the medial knee compartment before and after EOTTS. We hypothesized that following EOTTS there should be a reduction of force acting on the medial knee compartment
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