Effect of distal tibial varus and valgus deformity on joint contact_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAOHongmou ¹ ,  LIANGXiaojun ¹ , LIYi ¹ , NIUWenxin ² , ZHANGDongsheng ³

1. Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an Shaanxi, 710054, P. R. China;
2. Biomechanical Laboratory, Tongji University School of Medicine;
3. Mechanical Department of Shanghai University;

Corresponding author：

LIANGXiaojun, Email: liangjun33369@163.com

Keywords：

Ankle joint deformity; Supramalleolar osteotomy; Biomechanics

DOI：

10.7507/1002-1892.20160169

Video：

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Objective To study the effect of different degrees of distal tibial varus and valgus deformities on the tibiotalar joint contact, and to understand the role of fibular osteotomy. Methods Eight cadaveric lower legs were used for biomechanical study. Nine conditions were included: normal ankle joint (group A), 10° varus (group B), 5° varus (group C), 5° valgus (group D), 10° valgus (group E) with fibular preserved, and 10° varus (group F), 5° varus (group G), 5° valgus (group H), and 10° valgus (group I) after fibular osteotomy. The joint contact area, contact pressure, and peak pressure were tested; and the translation of contact force center was observed. Results The joint contact area, contact pressure, and peak pressure had no significant difference between group A and groups B to E (P>0.05). After fibular osteotomy, the contact area decreased significantly in groups F and I when compared with group A (P < 0.05); the contact pressure increased significantly in groups F, H, and I when compared with group A (P < 0.05); the peak pressure increased significantly in groups F and I when compared with group A (P < 0.05). There were two main anterior-lateral and anterior-medial contact centers in normal tibiotalar joint, respectively; and the force center was in anterior-lateral part, just near the center of tibiotalar joint. While the fibula was preserved, the force center transferred laterally with increased varus angles; and the force center transferred medially with increased valgus angles. However, the force center transferred oppositely to the medial part with increased varus angles, and laterally with increased valgus angles after fibular osteotomy. Conclusion Fibular osteotomy facilitates the tibiotalar contact pressure translation, and is helpful for ankle joint realignment in suitable cases.

Citation： ZHAOHongmou, LIANGXiaojun, LIYi, NIUWenxin, ZHANGDongsheng. Effect of distal tibial varus and valgus deformity on joint contact. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 826-829. doi: 10.7507/1002-1892.20160169 Copy

1.	Valderrabano V, Horisberger M, Russell I, et al. Etiology of ankle osteoarthritis. Clin Orthop Relat Res, 2009, 467(7): 1800-1806.
2.	Pagenstert G, Leumarm A, Hintermann B, et al. Sports and recreation activity of varus and valgus ankle osteoarthritis before and after realignment surgery. Foot Ankle Int, 2008, 29(10): 985-993.
3.	Haraguchi N, Ota K, Tsunoda N, et al. Weight bearing line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Am), 2015, 97(4): 333-339.
4.	Harstall R, Lehmann O, Krause F, et al. Supramalleolar lateral closing wedge osteotomy for the treatment of varus ankle arthrosis. Foot Ankle Int, 2007, 28(5): 542-548.
5.	Lee WC, Moon JS, Lee K, et al. Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg (Am), 2011, 93(13): 1243-1248.
6.	Ahn TK, Yi Y, Cho JH, et al. A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. J Bone Joint Surg (Am), 2015, 97(5): 381-388.
7.	Kim YS, Park EH, Koh YG, et al. Supramalleolar osteotomy with bone marrow stimulation for varus ankle osteoarthritis: clinical results and second-look arthroscopic evaluation. Am J Sports Med, 2014, 42(7): 1558-1566.
8.	Kobayashi H, Kageyama Y, Shido Y. Treatment of varus ankle osteoarthritis and Instability with a novel mortise-plasty osteotomy procedure. J Foot Ankle Surg, 2016, 55(1): 60-67.
9.	Mann HA, Filippi J, Myerson MS. Intra-articular opening medial tibial wedge osteotomy (plafond-plasty) for the treatment of intra-articular varus ankle arthritis and instability. Foot Ankle Int, 2012, 33(4): 255-261.
10.	赵宏谋, 梁晓军, 李毅, 等.踝上截骨治疗成人踝内翻畸形合并骨性关节炎的近期疗效.中华外科杂志, 2013, 51(9): 859-860.
11.	Colin F, Bolliger L, Horn Lang T, et al. Effect of supramalleolar osteotomy and total ankle replacement on talar position in the varus osteoarthritic ankle: a comparative study. Foot Ankle Int, 2014, 35(5): 445-452.
12.	徐向阳, 朱渊, 刘津浩, 等.踝关节周围截骨术治疗踝关节炎.中华骨科杂志, 2012, 32(5): 431-436.
13.	张松, 勘武生, 谢鸣, 等.踝上截骨术治疗踝关节二期创伤性关节炎的疗效观察.中华创伤骨科杂志, 2009, 11(12): 1110-1113.
14.	赵宏谋, 梁晓军, 李毅, 等.后踝骨折复位程度对胫距关节接触情况的影响.中华创伤杂志, 2014, 30(10): 1035-1039.
15.	Tanaka Y. The concept of ankle joint preserving surgery. Why does supramalleolar osteotomy work and how to decide when to do an osteotomy or joint replacement? Foot Ankle Clin, 2012, 17(4): 545-553.
16.	Stufkens SA, van Bergen CJ, Blankevoort L, et al. The role of the fibula in varus and valgus deformity of the tibia: a biomechanical study. J Bone Joint Surg (Br), 2011, 93(9): 1232-1239.
17.	Aurégan JC, Finidori G, Cadilhac C, et al. Children ankle valgus deformity treatment using a transphyseal medial malleolar screw. Orthop Traumatol Surg Res, 2011, 97(4): 406-409.
18.	Myerson MS, Zide JR. Management of varus ankle osteoarthritis with joint-preserving osteotomy. Foot Ankle Clin, 2013, 18(3): 471-480.
19.	Nüesch C, Huber C, Paul J, et al. Mid-to long-term clinical outcome and gait biomechanics after realignment surgery in asymmetric ankle osteoarthritis. Foot Ankle Int, 2015, 36(8): 908-918.
20.	Knupp M, Stufkens SA, Bolliger L, et al. Classification and treatment of supramalleolar deformities. Foot Ankle Int, 2011, 32(11): 1023-1031.

1. Valderrabano V, Horisberger M, Russell I, et al. Etiology of ankle osteoarthritis. Clin Orthop Relat Res, 2009, 467(7): 1800-1806.
2. Pagenstert G, Leumarm A, Hintermann B, et al. Sports and recreation activity of varus and valgus ankle osteoarthritis before and after realignment surgery. Foot Ankle Int, 2008, 29(10): 985-993.
3. Haraguchi N, Ota K, Tsunoda N, et al. Weight bearing line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Am), 2015, 97(4): 333-339.
4. Harstall R, Lehmann O, Krause F, et al. Supramalleolar lateral closing wedge osteotomy for the treatment of varus ankle arthrosis. Foot Ankle Int, 2007, 28(5): 542-548.
5. Lee WC, Moon JS, Lee K, et al. Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg (Am), 2011, 93(13): 1243-1248.
6. Ahn TK, Yi Y, Cho JH, et al. A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. J Bone Joint Surg (Am), 2015, 97(5): 381-388.
7. Kim YS, Park EH, Koh YG, et al. Supramalleolar osteotomy with bone marrow stimulation for varus ankle osteoarthritis: clinical results and second-look arthroscopic evaluation. Am J Sports Med, 2014, 42(7): 1558-1566.
8. Kobayashi H, Kageyama Y, Shido Y. Treatment of varus ankle osteoarthritis and Instability with a novel mortise-plasty osteotomy procedure. J Foot Ankle Surg, 2016, 55(1): 60-67.
9. Mann HA, Filippi J, Myerson MS. Intra-articular opening medial tibial wedge osteotomy (plafond-plasty) for the treatment of intra-articular varus ankle arthritis and instability. Foot Ankle Int, 2012, 33(4): 255-261.
10. 赵宏谋, 梁晓军, 李毅, 等.踝上截骨治疗成人踝内翻畸形合并骨性关节炎的近期疗效.中华外科杂志, 2013, 51(9): 859-860.
11. Colin F, Bolliger L, Horn Lang T, et al. Effect of supramalleolar osteotomy and total ankle replacement on talar position in the varus osteoarthritic ankle: a comparative study. Foot Ankle Int, 2014, 35(5): 445-452.
12. 徐向阳, 朱渊, 刘津浩, 等.踝关节周围截骨术治疗踝关节炎.中华骨科杂志, 2012, 32(5): 431-436.
13. 张松, 勘武生, 谢鸣, 等.踝上截骨术治疗踝关节二期创伤性关节炎的疗效观察.中华创伤骨科杂志, 2009, 11(12): 1110-1113.
14. 赵宏谋, 梁晓军, 李毅, 等.后踝骨折复位程度对胫距关节接触情况的影响.中华创伤杂志, 2014, 30(10): 1035-1039.
15. Tanaka Y. The concept of ankle joint preserving surgery. Why does supramalleolar osteotomy work and how to decide when to do an osteotomy or joint replacement? Foot Ankle Clin, 2012, 17(4): 545-553.
16. Stufkens SA, van Bergen CJ, Blankevoort L, et al. The role of the fibula in varus and valgus deformity of the tibia: a biomechanical study. J Bone Joint Surg (Br), 2011, 93(9): 1232-1239.
17. Aurégan JC, Finidori G, Cadilhac C, et al. Children ankle valgus deformity treatment using a transphyseal medial malleolar screw. Orthop Traumatol Surg Res, 2011, 97(4): 406-409.
18. Myerson MS, Zide JR. Management of varus ankle osteoarthritis with joint-preserving osteotomy. Foot Ankle Clin, 2013, 18(3): 471-480.
19. Nüesch C, Huber C, Paul J, et al. Mid-to long-term clinical outcome and gait biomechanics after realignment surgery in asymmetric ankle osteoarthritis. Foot Ankle Int, 2015, 36(8): 908-918.
20. Knupp M, Stufkens SA, Bolliger L, et al. Classification and treatment of supramalleolar deformities. Foot Ankle Int, 2011, 32(11): 1023-1031.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of distal tibial varus and valgus deformity on joint contact

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