Condyle Tibial Plateau Research Articles

Asymmetries and relationships between muscle strength, proprioception, biomechanics, and postural stability in patients with unilateral knee osteoarthritis.

Background: The pathological mechanism of knee osteoarthritis (KOA) is unknown. KOA degeneration may be associated with changes in muscle strength, proprioception, biomechanics, and postural stability. Objective: This study aimed to assess asymmetries in muscle strength, proprioception, biomechanics, and postural stability of bilateral lower limbs in patients with unilateral KOA and healthy controls and analyze correlations between KOA and these parameters. Methods: A total of 50 patients with unilateral KOA (age range: 50-70) and 50 healthy subjects were recruited as study participants (age range: 50-70). Muscle strength, proprioception, femorotibial angle (FTA), femoral condylar–tibial plateau angle (FCTP), average trajectory error (ATE), and center of pressure (COP) sways areas were accessed in study participants, and the correlation between these variables was investigated. Results: In patients with unilateral KOA, lower limb muscle strength was significantly lower on the symptomatic side than on the asymptomatic side (p < 0.01), while the proprioception (degree error), FTA, FCTP, and ATE were substantially higher compared to the asymptomatic side (p < 0.01). However, no significant difference was observed in the healthy controls (p > 0.05). Patients with unilateral KOA had lower muscle strength than healthy controls (p < 0.05), but their proprioception (degree error: the difference between the target and reproduction angles), ATE, and COP sway areas were higher (p < 0.05). Muscle strength was found to be negatively correlated with ATE and COP sways areas (p < 0.05), whereas proprioception (degree error) was positively correlated with ATE and COP sways areas (p < 0.05) in all study participants. However, no correlation was found between FTA, FCTP, and ATE, COP sways areas in patients with unilateral KOA (p > 0.05). Conclusion: In patients with unilateral KOA, muscle strength, proprioception, biomechanics, and postural stability of bilateral limbs are asymmetrical in unilateral KOA patients. Muscle strength, proprioception, and postural stability are significantly associated variables, and changes in these variables should be considered in KOA prevention and rehabilitation.

Discussion on the classification and treatment strategies of the lateral condylar tibial plateau fractures

Objective To discuss on the ABC classification of the lateral condylar tibial plateau fractures, and to evaluate its clinical application. Methods From March 2013 to June 2015, 87 patients with lateral condylar tibial plateau fracture were treated in our hospital, including 49 males and 34 females with the mean age of 49.1 years (range, 25-76). A new classification system of the lateral condylar tibial plateau fracture, ABC Classification, was used for all the 83 patients. There were 51 patients for type B, 6 for type C, 9 for type AB, 13 for type BC, 4 for type ABC. Surgery approach and fixation method depended on the type of fracture. Anterior-lateral approach and anterolateral locking plate fixation were used to treat type B and AB, and additional marginal plate were used in type AB. Carlson approach and T-buttress plate fixation were used to treat type C. Frosch approach was used to treat type BC and ABC. The radiographic and clinical results were evaluated by using Rasmussen's radiological and HSS grading at 12 months postoperatively respectively. Results 83 patients underwent surgeries successfully, with average time of 121 mins (range, 90-160 mins). With a follow-up rate of 83.1%, 69 patients were followed up for 12-24 months, the mean follow-up time was 14.6 months. There was no significant difference in fracture healing time of different types. The average time for fracture union were 13.5 weeks (range, 12-16 weeks). The mean score of the Rasmussen's radiological grading was 16.9 (range, 13-18). All the results according to HSS grading are excellent and the mean score of the HSS grading was 94.1 (from 82-98). Conclusion CT-based ABC Classification is worthy of popularization and application in clinics, and it is more reliable and instructive in the treatment of lateral condylar tibial plateau fractures. Key words: Tibia fractures; Fracture fixation, internal; Diagnosis

Computed tomographic classification of posterior condylar tibial plateau fractures

To study the new computed tomographic (CT) classification, surgical approaches and clinical efficacy of posterior condylar tibial plateau fractures. From January 2006 to July 2009, a total of 39 patients of posterior condylar tibial plateau fractures were treated by posteromedial and posterolateral knee approaches. There were 23 males and 16 females. The mean age was 41.6 years old (range: 28 - 68). Among all patients, the causes were traffic accidents (n = 26), falls (n = 9) and other injuries (n = 4). By CT classification, there were type I with posteromedial condylar tibial plateau split fracture (n = 7), type II with posterolateral condylar tibial plateau split fracture (n = 5), type III with posterolateral condylar tibial plateau depression fracture (n = 11), type IV with posterolateral condylar tibial plateau split depression fracture (n = 2) and type V with posteromedial split and posterolateral condylar tibial plateau depression fracture (n = 14). The mean follow-up period was 18.1 months (range: 12 - 30). The radiographic bony union time was 11 - 16 weeks (mean: 15.2) and the full weight-bearing time 12 - 20 weeks (mean: 15.6). No infection, knee varus/valgus, nerve injury or screw loosening/breakage was found. Bony union was achieved in all cases. According to the Rasmussen functional scoring, the results were excellent in 20, good in 14 and fair in 5. And the excellent and good rate was 87.2%. The radiological results were graded with the Rasmussen score to evaluate the reduction of fracture. The outcome was excellent in 28, good in 8 and fair in 3. And the excellent and good rate was 92.3%. This new CT classification scheme of posterior condylar tibial plateau fractures can significantly improve the reliability, guide the clinicians to select appropriate treatment plans and design an ideal regimen of operative approach and internal fixation.

Knee alignment does not predict incident osteoarthritis: The Framingham osteoarthritis study

To examine the relationship of knee malalignment to the occurrence of knee osteoarthritis (OA) among subjects without radiographic OA at baseline to determine whether malalignment is a risk factor for incident disease or simply a marker of increasing disease severity. We selected 110 incident tibiofemoral (TF) OA case knees (76 subjects) and 356 random control knees (178 subjects) from among participants in the Framingham Osteoarthritis Study. Case knees did not have OA at baseline (1992-1994 examination) but had developed OA (Kellgren/Lawrence grade>or=2) at followup (2002-2005 examination) (mean of 8.75 years between examinations). Control knees did not have OA at baseline. Standardized digital radiographs of the fully extended knee with weight-bearing were read using a standard protocol and eFilm viewing software. We measured the anatomic axis, the condylar angle, the tibial plateau angle, and the condylar tibial plateau angle. The interobserver intraclass correlation coefficient (ICC) ranged from 0.93 to 0.96 and the intraobserver ICC from 0.94 to 0.97. In a knee-specific analysis, we examined the relationship of each alignment measurement to the risk of TF OA using generalized estimating equations, adjusting for age, sex, and body mass index (BMI). We used the same approach to assess the association between each alignment measurement and the risk of medial TF OA. Subjects in the case population were older and had a higher BMI than the controls. The alignment values were normally distributed and were not different between the cases and the controls. After adjustment for age, sex and BMI, there was no significant increase in incident OA in the highest quartile compared with the lowest quartile category for any of the alignment measures (P for trend for anatomic axis and condylar tibial plateau angle was 0.83 and 0.80, respectively). Similar results were also observed for medial compartment OA. We found that baseline knee alignment is not associated with either incident radiographic TF OA or medial TF OA. These results suggest that malalignment is not a risk factor for OA, but rather is a marker of disease severity and/or its progression.