Lateral Tibial Bone Research Articles

Curative Effect Observation of Ilizarov Lateral Tibial Bone Transfer Surgery for Diabetic Foot

Curative Effect Observation of Ilizarov Lateral Tibial Bone Transfer Surgery for Diabetic Foot

Modified transverse tibial bone transplantation and microcirculation reconstruction for the treatment of end-stage diabetic foot

To explore clinical effect of modified transverse tibial bone transfer microcirculation reconstruction in treating end-stage diabetic foot. From August 2016 to June 2018, 87 patients with diabetic foot treated with modified tibial transverse bone removal and microcirculation reconstruction, inclduing 54 males and 33 females;aged from 39 to 95 years old with an average of (68.9±11.3) years old;2 patients were grade 2, 37 patients were grade 3 and 50 patients were grade 4 according to Wagner's classification;the courses of diabetic were for 10 to 16 years with an average of (13.0±2.2) years;the courses of diabetic feet were for 21 to 48 days with an avergae of (34.2±8.6) days. Postoperative comlications were observed. Skin temperature, visual analogue scale(VAS) and ankle brachial index(ABI) and wound healing were recorded before and 3 months after operation. All patients were followed up for 4 to 19 months with an average of (12.6±2.8) months. Two patients occurred subcutaneous tissue liquefaction and seepage under needle passage during bone transfer, and scabed without special treatment. One patient was performed amputation above 5 cm of ankle joint because of severe infection, and 1 patient occurred re-ulceration at 1 year after wound healing, bone transfer was performed again at the same site, and was completely healed at 8 weeks after operation. The healing time of wound ranged from 3 to 24 weeks with an average of (11.9± 3.8) weeks. Foot skin temperature before operation was (28.9±0.91) ℃, and increased to (31.70±0.32)℃ at 3 months after operation(t=5.72 P=0.006);VAS score before opertaion was (7.80±0.72), and improved to (2.20±0.13) at 3 months after operation (t=25.38, P=0.000);ABI beforeoperation was(0.48±0.30), increased to(0.98±0.24) at 3 months after oeprtaion(t= 14.68, P=0.000). Modified lateral tibial bone transfer could effectively reconstruct microvascular network under lower leg, promote recovery of peripheral blood vessels, and promote wound healing of foot, reduce or avoid amputation. At the same time, the improved osteotomy is one of the effective methods for the treatment of diabetic foot which has advantags of less trauma, simple opertaion.

Patellar tendon enthesis abnormalities and their association with knee pain and structural abnormalities in older adults

Purpose: The patellar tendon works together with the quadriceps tendon to enable knee flexion. Its attachment site (enthesis) is at risk of micro damage and degeneration. Recent studies suggest that enthesis abnormalities are associated with development of osteoarthritis through the synovio-entheseal complex. However, no studies have assessed the presence of patellar enthesis abnormalities in older adults and its association with osteoarthritis outcomes. Therefore, we aimed to describe associations between presence of patellar tendon enthesis (PTE) abnormalities visible on magnetic resonance (MR) images at baseline and knee pain, physical function limitations, and osteoarthritic structural abnormalities both cross-sectionally and longitudinally over 10.7 years. Methods: Patellar tendon enthesis abnormalities, defined as presence of abnormal bone signal and/or bone erosion were measured on T2-weighted fat suppressed fast spin echo MR images at baseline in 961 community-dwelling older adults. Knee pain and physical function limitation score were assessed using WOMAC at baseline and 10.7 years. Tibial, femoral, and patella bone marrow lesions (BMLs), cartilage volume and cartilage defects were assessed at baseline and 10.7 years, tibial bone area at baseline and 2.7 years, and infrapatellar fat pad area at baseline using validated methods. Associations were assessed using hurdle, log binomial, linear, and mixed models, after adjusting for confounders. Results: 20% of participants had bone signal and/or erosion at PTE. Cross-sectionally, presence of PTE abnormalities were associated with greater intensity of pain while going up and down stairs (β = 0.22 (95% CI; 0.03, 0.41)), greater risk of having a femoral (RR = 1.46 (1.22, 1.90)) BML, greater lateral tibial bone area (β = 25.95 (1.00, 50.91)), smaller infrapatellar fat pad area (β = −0.26 (−0.46, −0.05)), and a worse tibial cartilage defect score (RR = 1.70 (1.16, 2.47), after adjustment for age, sex, BMI, and structural confounders. Longitudinally, presence of PTE abnormalities at baseline predicted an increased risk of deleterious changes in tibial BML size (RR = 1.52 (1.12, 2.05)) only over 10.7 years but not pain or other structural changes. Conclusions: Patellar tendon enthesis abnormalities are common in the elderly. The presence of cross-sectional but not longitudinal associations suggests they commonly co-exist with other knee structural abnormalities. This suggests they may not be a major player in symptom development or structural changes with the exception of tibial BMLs.

Lateral tibial bone mineral density around the level of the proximal tibiofibular joint

During open-wedge high tibial osteotomy, fracture occurring in the insufficient osteotomy before distraction of the osteotomy gap is an important complication. The objective of this study was to evaluate bone mineral density (BMD) around the proximal tibiofibular joint (PTFJ) and the osteotomy hinge. The hypotheses of this study were (1) BMD would be higher in the level of PTFJ, compared with that of above--or below--the level of PTFJ, (2) BMD of the posterolateral side of the hinge would be higher than that of the anterior or lateral side. Computed tomography was used to determine the BMD of the lateral aspect of the proximal tibia around the PTFJ and the osteotomy hinge. The means and standard deviations of the regions of interest were measured. To verify the first hypothesis, a coronal reconstructed image showing the beginning of the fibula head was used and an axial reconstructed image showing the beginning of the fibula head was used for verification of the second hypothesis. BMD of the lateral aspect of the proximal tibia at the level of the PTFJ was significantly higher, compared with that of above (P = 0.04)-or below (P < 0.01)--the level of the PTFJ in male patients. In addition, it was also significantly higher, compared with that of below the level of the PTFJ (P < 0.01). BMD of the posterolateral area of the proximal tibia was significantly higher than that of the anterior or lateral area in both male and female patients (P < 0.01). BMD of the level of the PTFJ was higher, compared with that of above-or below-the level of the PTFJ and that of the posterolateral area of the proximal tibia was significantly higher, compared with that of the anterior or lateral area.

A rare case of bilateral large osteolysis following cemented and cementless total knee arthroplasties

A 66-year old woman (BMI 36) presented for routine follow-up after undergoing total knee arthroplasty (TKA) in the right knee 12 years ago, and TKA in the left knee 4 years ago. The right TKA was a cementless cruciate-retaining prosthesis (Encore Medical Foundation Knee, femoral component porous coated CoCrMb alloy, tibial component Ti-alloy with 4 screws, PE insert 9 mm). The left TKA was a cemented cruciate-retaining prosthesis (Zimmer Natural Knee II, femoral component CoCrMb alloy, tibial baseplate component Ti-alloy, PE insert 9 mm). The patient reported only mild problems (knee score 88 points, function score 60 points). Radiographs and CT scans revealed extensive osteolysis at the proximal medial tibia of both knees (Figures 1 and ​and2).2). There was a mild varus malalignment (4°) of both legs. Rotational alignment measured on the CT scans showed a rotational mismatch between femoral and tibial components of 8° (femoral internal rotation) in the right knee and no mismatch (1° of femoral internal rotation) in the left knee. Figure 1. Anterioposterior and lateral radiograph and CT scans showing osteolysis of the distal right femur and the proximal tibia 12 years after implantation of a cemenless TKA. Figure 2. Anterioposterior and lateral radiograph and CT scans showing osteolysis of the distal left femur and the proximal tibia 4 years after implantation of a cemented TKA. Open biopsy was performed bilaterally to rule out a possible malignancy or infection. Microscopic histological examination revealed chronic inflammation and hisitocytic infiltrates in both knees. Polyethylene particles were observed within the cytoplasma of the histiocytes. There was no evidence of metal debris. All microbiological cultures were negative. During revision, both tibial baseplates were manually assessed as being well fixed to the lateral tibial bone stock, providing no evidence that baseplate loosening was the cause of the osteolysis. However, upon removal of the baseplates, the cortical bone at the proximal medial tibia was observed to be very thin and completely missing in some regions, as already revealed on the CT scans. Osteolytic defects were filled with autologous cancellous bone and augmented with bone cement, and both knees were implanted with a modular constrained TKA prosthesis.

Knee cartilage defects in a sample of older adults: natural history, clinical significance and factors influencing change over 2.9 years

To describe the natural history of knee cartilage defects, and their relationship to cartilage volume loss and risk of knee replacement in a longitudinal study of older adults. 395 randomly selected older adults (mean age 62.7 years) had magnetic resonance imaging of their right knee at baseline and approximately 2.9 years later to determine cartilage defect grade (0-4), cartilage volume, medial and lateral tibial bone size, and presence of bone marrow lesions (BMLs). Height, weight, body mass index (BMI) and radiographic osteoarthritis were measured by standard protocols. At baseline higher grade cartilage defects (grade ≥2) were significantly associated with age, BMI, lateral tibial bone size, BMLs, and radiographic osteoarthritis. Over 2.9 years, the average defect score increased statistically significantly in all compartments; however, the majority of defects remained stable and regression of defects was rare. Baseline factors associated with increase in defect score over 2.9 years were radiographic osteoarthritis, tibial bone size, BMI and being female. In multivariate analysis, baseline cartilage defect grade predicted cartilage volume loss at the medial tibia, lateral tibia and patella over 2.9 years (β=-1.78% to-1.27% per annum per 1 grade increase, P<0.05 for all comparisons), and risk of knee replacement over 5 years (odds ratio (OR)=1.73 per 1 grade increase, P=0.001). Knee cartilage defects in older adults are common but less likely to regress than in younger life. They independently predict cartilage volume loss and risk of knee replacement, suggesting they are potential targets for intervention.

The patella and tibial condyle position after combined and after closing wedge high tibial osteotomy

High tibial osteotomy changes the patella and tibial condyle position, which makes the subsequent total knee replacement technically demanding. From 1 January 1993 to 31 December 2000, combined osteotomy [After the first osteotomy made 2 cm distally to the joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial condyle (half bone wedge). The distal part of the tibia is placed into the valgus position and the half bone wedge is placed into the gap opened medially.] was performed on 103 knees and closing wedge osteotomy was performed on 47 consecutive knees. Eighty combined (group A) and 41 closing wedge (group B) osteotomy were studied. All knees were assessed radiologically before surgery, in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (in group A-66.15 months, in group B-66.61 months). We examined the change of the femorotibial angle, of the patellar height according to the method of Insall and Salvati, of the tibial slope angle according to the method of Bonnin, of the tibial condylar offset according to the method of Yoshida and of the distance between the lateral tibial plateau and the top of the fibular head. In group A and B, the recurrence of the varus deformity was not noted and valgus alignment did not increase in any case. In group-A, the Insall-Salvati ratio remained unchanged in 65% of knees. The tibial slope angle decreased in both groups. There was correlation between the change of the tibial condylar offset and the angle of the correction in both groups. There was correlation between the change of the distance between the lateral tibial plateau and the top of the fibular head. After combined osteotomy, the transposition of the tibial condyle and the decrease of the distance between the lateral tibial plateau and the top of the fibular head was less than after closing wedge osteotomy, although the average angle of correction was more after combined osteotomy (11.835 degrees ), than after closing wedge osteotomy (9.465 degrees ). Theoretically, the recurrence of the varus deformity, the increase of the valgus alignment and (in majority of cases) the shortening of the patellar tendon do not compromise the likelihood of successful conversion to the subsequent total knee replacement, either after combined or after closing wedge osteotomy. The combined osteotomy does not lead to considerable transposition of the tibial condyle and to considerable lateral tibial bone loss; therefore, theoretically, the combined osteotomy does not impair the subsequent total knee replacement.

The genetic contribution to longitudinal changes in knee structure and muscle strength: A sibpair study

To estimate the heritability of longitudinal changes in knee cartilage volume, chondral defects, subchondral bone size, and lower limb muscle strength. A sibpair design was used. Longitudinal changes in lateral and medial tibial cartilage volume and bone size, as well as progression of chondral defects, were determined on serial magnetic resonance images. Radiographs were obtained and scored for individual features of radiographic osteoarthritis (OA) at baseline. Lower limb muscle strength was measured by dynamometry. Heritability was estimated using the SOLAR software package. A total of 115 subjects (55 men and 60 women, mean age 45 years) from 48 families representing 95 sibling pairs were successfully followed up for a mean of 2.4 years. The adjusted heritability estimates for changes in cartilage volume were 73% for the medial compartment (P < 0.01) and 40% for the lateral compartment (P = 0.10). The adjusted heritability estimates for changes in bone size were 62% for the lateral compartment (P = 0.03) and 20% for the medial compartment (P = 0.22). The adjusted heritability estimate for changes in muscle strength was 64% (P = 0.01). The adjusted heritability estimates for progression of chondral defects were 80% for the lateral compartment (P = 0.06) and 98% for the medial compartment (P = 0.03). These estimates changed little after adjusting for each other and for the predominantly mild radiographic OA, with the exception of progression of chondral defects in the lateral compartment. Early longitudinal changes in knee structures of relevance to later OA, such as changes in medial tibial cartilage volume, lateral tibial bone size, progression of chondral defects, and muscle strength, have high heritability, most likely reflecting a strong genetic component and suggesting their potential to be studied in quantitative trait linkage and association analysis.

Bone marrow lesions in the knee are associated with increased local bone density

Bone marrow lesions are associated with pain and compartment-specific progression of joint space narrowing in patients with knee osteoarthritis (OA). Bone marrow lesions occur in regions under increased loading, and excess loading produces increased bone mineral density (BMD). The ratio of BMD in the medial tibial plateau compared with that in the lateral tibial plateau (M:L BMD ratio) reflects loading in the knee. Therefore, we hypothesized that a higher M:L BMD ratio would be associated with medial bone marrow lesions, and that lower ratios would be associated with lateral bone marrow lesions. Participants in the Framingham Osteoarthritis Study underwent magnetic resonance imaging (MRI), measurement of bone mineral density (BMD), and knee radiography between 2002 and 2004. MRI was used to define medial and lateral bone marrow lesions in the medial and lateral tibiofemoral compartments, respectively. We performed a logistic regression analysis with medial bone marrow lesions as the outcome, testing M:L BMD ratio groups as predictor variables. We adjusted for age, sex, body mass index, and systemic BMD, using generalized estimating equations to adjust for correlations between knees. An identical analysis evaluating lateral bone marrow lesions was performed. Medial bone marrow lesions were strongly associated with a high M:L BMD ratio. The odds ratios (ORs) for prevalent medial bone marrow lesions, for the lowest to the highest quartile of M:L BMD ratios, were 1.0 (referent), 1.3, 5.0, and infinity (P for trend < 0.0001). Lateral bone marrow lesions were strongly associated with low M:L BMD ratios (the ORs for prevalent lateral bone marrow lesions, for the highest to the lowest quartile, were 1.0 [referent], 3.0, 26.8, and 54.0 [P for trend < 0.0001]). Medial bone marrow lesions occur in knees with relatively higher local medial tibial bone density, and lateral bone marrow lesions occur in knees with relatively higher lateral tibial bone density, supporting the hypothesis that local BMD reflects loading within the knee. Our findings emphasize the importance of loading in the pathophysiology of OA.

The genetic contribution to muscle strength, knee pain, cartilage volume, bone size, and radiographic osteoarthritis: a sibpair study.

To estimate the heritability of muscle strength, knee pain, cartilage volume, bone size, and radiographic osteoarthritis (ROA), and to assess whether heritability of the knee structural components is independent of ROA. A sibpair design was utilized. Sagittal T1-weighted fat-suppressed magnetic resonance imaging (MRI) of the right knee was performed to determine cartilage volume and bone size. Standing semiflexed radiographs of the same knee were obtained to assess the presence of ROA. Knee pain was assessed by questionnaire and muscle strength by dynamometry. Heritability was estimated using the genetic analysis program SOLAR. A total of 128 subjects (61 men, 67 women; mean age 45 years) from 51 families representing 115 sibpairs were studied. Lower limb muscle strength had high heritability (42%; P = 0.02), as did knee pain (44%; P = 0.07). Heritability estimates for cartilage volume were 65% for medial tibial cartilage, 77% for lateral tibial cartilage, and 84% for patellar cartilage, and heritability estimates for bone size were 85% for medial tibial bone area, 57% for lateral tibial bone area, and 70% for patella bone volume (all P < or = 0.004). For ROA, heritability was 61% for presence (with a large standard error) (P = 0.16) and 61% for severity (P = 0.02). The estimates for tibial bone areas were the only ones markedly reduced after adjustment for body size, while all estimates with the exception of knee pain were independent of ROA. Cartilage and, to a lesser extent, bone sites investigated by MRI were largely under independent genetic control, with a lesser shared genetic component. With the exception of prevalent ROA, all knee modalities assessed had high heritability, most likely reflecting a strong genetic component. Cartilage volume, bone size, and muscle strength all have the potential to be studied in quantitative trait linkage analyses, but their exact relevance with regard to OA remains uncertain at this time.

The effect of the knee adduction moment on tibial cartilage volume and bone size in healthy women.

There is considerable evidence that an abnormally high knee adductor moment is a characteristic of the gait patterns in people with knee osteoarthritis (OA). The aim of this study was to examine the relationship between the peak knee adduction moment during the early and late stance phases of gait, and medial and lateral tibial bone size and cartilage volume in healthy women. Three-dimensional Vicon gait analyses and magnetic resonance imaging (MRI) were performed on 20 healthy women without knee OA. The external knee adduction moment was correlated with medial and lateral tibial bone size and cartilage volume for the dominant leg. The knee adduction moment significantly correlated with the bone size of the medial tibial plateau (r = 0.63, P < 0.005), but was not related to the bone size of the lateral plateau. No relationship was observed between the knee adduction moment and medial or lateral tibial cartilage volume. Although the knee adduction moment was positively associated with the bone size of the medial tibial plateau, it appeared to have little effect on cartilage volume in that compartment in healthy women. It may be that the effect of the knee adduction moment differs in healthy subjects compared with those with established knee OA.

Total Knee Arthroplasty After High Tibial Osteotomy

Background: The outcome of total knee replacement after high tibial osteotomy remains uncertain. We hypothesized that the results of total knee replacement with or without a previous high tibial osteotomy are similar. Methods: The results of a consecutive series of thirty-nine bilateral total knee arthroplasties performed with cement at an average of 8.7 years after unilateral high tibial osteotomy were reviewed. There were twenty-seven men and twelve women. Preoperatively, the knee scores according to the system of the Knee Society were similar for all of the knees; however, valgus alignment and patella infera were more common in the knees with a previous high tibial osteotomy. Bilateral total knee replacement was staged in seven patients and was simultaneous in thirty-two patients. The results of the total knee arthroplasties were retrospectively reviewed with respect to the knee and function scores according to the system of the Knee Society, the radiographic findings, and the complications. Results: Intraoperatively, no notable differences were identified in the number of medial, lateral, or lateral patellar releases required. However, less lateral tibial bone was resected in the group with a previous high tibial osteotomy (average, 3.3 millimeters) than in the group without a high tibial osteotomy (average, 7.5 millimeters). The average duration of follow-up was 7.5 years (range, three to sixteen years) in the group with a previous high tibial osteotomy and 6.8 years (range, two to ten years) in the group without a high tibial osteotomy. At the time of the final follow-up, the knee and function scores were similar for the two groups (89.0 and 81.0 points, respectively, for the group with a previous high tibial osteotomy, and 89.6 and 83.9 points, respectively, for the group without a high tibial osteotomy). Although more knees were free of pain in the group without a previous high tibial osteotomy (thirty-six) than in the group with a previous osteotomy (thirty-three), this difference was not found to be significant with the numbers available (p = 0.4810). Knee alignment and stability, femoral and tibial component alignment, and range of motion also were similar in both groups postoperatively. One all-polyethylene tibial component was revised in the high tibial osteotomy group. Two knees in each group required manipulation. There were no deep infections. Conclusions: While patients with a previous high tibial osteotomy may have important differences preoperatively, including valgus alignment, patella infera, and decreased bone stock in the proximal part of the tibia, the present study suggests that the clinical and radiographic results of primary total knee arthroplasty in knees with and without a previous high tibial osteotomy are not substantially different. In our relatively small group of patients, the previous high tibial osteotomy had no adverse effect on the outcome of the subsequent total knee replacement.

Dynamic knee loads during gait predict proximal tibial bone distribution

This study tested the validity of the prediction of dynamic knee loads based on gait measurements. The relationship between the predicted loads at the knee and the distribution of bone between the medial and lateral sides of the tibia was examined. The motion and external forces and moments at the knee were measured during gait and a statically determinate muscle model was used to predict the corresponding forces on the medial and lateral tibial plateaus. In particular, the relationship between the knee adduction moment during gait and the ratio or distribution of medial to lateral tibial bone mineral content was studied. Bone mineral content was measured with dual energy X-ray absorptiometry in four regions, two proximal regions 20 mm in height, one medial and one lateral and two distal regions 20 mm in height, one medial and one lateral. The best single predictor of the medial–lateral ratio of proximal bone mineral content (bone distribution) was the adduction moment ( R 2=0.31, p=0.003 ). Adding weight (negative coefficient, p=0.0004) and the ratio of the average predicted peak force on the medial plateau to the predicted peak force on the lateral plateau (positive coefficient, p=0.0033) to the regression model significantly increased the ability to predict the proximal medial–lateral bone distribution ( R 2=0.72, p=0.0001 ). Distally neither the subject characteristics nor the gait moments and predicted forces were significant predictors of the bone distribution. The lack of a correlation distally may be reflective of the forces being more evenly distributed further from the tibial plateau. While it has long been suggested that the adduction moment is the primary determinate of the distribution of load between the medial and lateral plateaus, this is the first evidence of its relationship to the underlying bone distribution.