Wear patterns on tibial plateau from varus osteoarthritic knees

doi:10.1016/j.clinbiomech.2005.09.001

Clinical Biomechanics

Volume 21, Issue 2, February 2006, Pages 152-158

https://doi.org/10.1016/j.clinbiomech.2005.09.001 Get rights and content

Abstract

Background

The knowledge of cartilage wear patterns at the medial tibial plateau is important to understand the main causes of arthritis in varus knees. The most important factors influencing knee arthritis in fact seem to be the severity of the degenerative changes determined by the lower limb mechanical axis and the abnormal knee joint kinematics which frequently results from dysfunction of the anterior cruciate ligament.

Methods

We studied the wear patterns of cartilage damage in 70 medial tibial plateaus resected at operation during total knee arthroplasty indicated for varus osteoarthritic knee. Anterior cruciate ligament and medial meniscus integrity was assessed intra-operatively. Calibrated digital images were used to measure the wear patterns with a standard software tool. The medial compartment of the tibial plateau was divided into six zones, and the amount of cartilage and bone destruction in each zone was classified into two grades.

Findings

The wear pattern was found to be highly dependent upon knee varus deformity (Mann Whitney P < 0.001) and anterior cruciate ligament integrity (Friedman P < 0.0005). Anterior cruciate ligament was found intact in 35.7% of the cases. Wear patterns on intact anterior cruciate ligament knees occurred in the central to medial aspect of the tibial plateau. Anterior cruciate ligament deficient knees had significantly larger wear patterns anteriorly and posteriorly in the most medial region of the medial plateau.

Interpretation

These observations suggest altered joint mechanics exist in anterior cruciate ligament deficient varus knees, which would worsen cartilage degeneration and osteoarthritis progression.

Introduction

Knee osteoarthritis (OA) is a complex clinical scenario where many biological and mechanical factors influence the severity of the articular degenerative changes. Cartilage degenerative changes are due to genetic (collagen gen II, cytokinegene pro⧹anti-inflammatory, metabolism gene chondrocyte⧹bone, etc) (Borzi et al., 2004, Silvestri et al., 2005) and biomechanical (joint instability, trauma, overweight, daily living activities, etc.) factors, and age progression, which all lead to matrix degradation and abnormal chondrocyte metabolism. Surgical treatment (arthroscopy, tibial osteotomy, uni- or tri-compartmental arthroplasty) of OA knees is based on the knowledge of the causes, i.e. lower limb deformity and capsulo-ligamentous instability. The function of knee capsulo-ligamentous structures has been studied to understand the wear pattern of the joint cartilage (Dejour et al., 1987, Logan et al., 2004a, Logan et al., 2004b). Knee varus⧹valgus deformity, anterior cruciate ligament (ACL) and meniscus integrity are all factors that contribute to determining abnormal kinematics and excessive joint loading (Ahlback, 1968, Harman et al., 1998, Weidow et al., 2002, White et al., 1991). These few studies have focused on the correlation of ACL integrity, knee deformity, and cartilage wear, as these emerge in knees with end-stage OA, with contrasting results and limited conclusions. However, these studies have demonstrated that whatever mechanism occurs in varus knees can be much different from that in valgus knees. OA patients with valgus knees showed a lower incidence of ACL damage, and the cartilage wear pattern was dominated by a central erosion of the lateral tibial plateau, which determines a more constrained motion of the lateral condyle in the antero-posterior direction (Harman et al., 1998). In addition, it has been established by clinical and surgical experience that knee deformity is mainly due to lateral condyle displasia.

The objective of this prospective study was to enlarge our knowledge on the destructive mechanisms in varus OA knees, by possibly finding correlations between wear patterns of the cartilage at the tibial plateau and deformity or integrity of the other soft tissues. In order to do this, the mechanical axis of the lower limb, the degree of involvement of OA, as inferred from radiological analysis (Ahlback, 1968), the integrity of ACL and medial meniscus and the size and location of the cartilage wear pattern on the medial tibial plateau were observed in a large population of varus OA knees. The latter information was obtained on specimens after resection during total knee arthroplasty (TKA). It was hypothesized that knee varus deformity and ACL integrity significantly affect the cartilage wear pattern.

Section snippets

Methods

From July to December 2003, the mechanical axis of the lower limb in the frontal plane was measured from standard pre-operative weight-bearing antero-posterior X-rays in patients suffering of gonarthrosis and indicated for TKA. Inclusion criterion for the study was primary OA in varus knee, according to this measurement. In these patients, the posterior slope of the tibial plateau was also measured on the latero-lateral X-ray. Ahlback’s classification (1968) was also applied on the

Results

Measurements from pre-operative X-rays, intra-operative anatomical assessments and results of the image analysis are reported in Table 1 for all patients. Severe joint deformity (a median 10° varus) and only about one third of knees with intact ACL (36.3%) and intact meniscus (33.3%) were found in the patients analyzed. Large patterns of severe wear were observed in more than one fourth of the total articular surface medial plateau (median 26.7%), though limited mainly to its medial region

Discussion

The knowledge of cartilage wear patterns at the tibial plateau in varus knees is important to understand the main causes of knee arthritis. The most important factors influencing knee arthritis seem to be the severity of knee degenerative changes determined by the lower limb mechanical axis and the abnormal knee kinematics resulting from dysfunction of the ACL (Agneskirchner et al., 2002, Dejour et al., 1987, Georgoulis et al., 2003, Logan et al., 2004a, Logan et al., 2004b, Scarvell et al.,

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Wear patterns on tibial plateau from varus osteoarthritic knees

Abstract

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Methods

Results

Discussion

J. Arthroplasty

J. Orthop. Res.

J. Arthroplasty

Axis deviation, cartilage damage and cruciate ligament rupture–concomitant interventions in replacement of the anterior cruciate ligament

Unfallchirurg

Osteoarthrosis of the knee. A radiographic investigation

Acta Radiol. Diagn. (Stockh)

Risk factors for progressive cartilage loss in the knee: a longitudinal magnetic resonance imaging study in forty-three patients

Arthritis Rheum.

Chemokines in cartilage degradation

Clin. Orthop. Relat. Res.

Kinematics after tear in the anterior cruciate ligament: dynamic bilateral radiostereometric studies in 11 patients

Acta Orthop. Scand.

Arthrosis of the knee in chronic anterior laxity

Rev. Chir. Orthop. Reparatrice Appar. Mot.

In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis

Clin. Orthop. Relat Res.

In vivo knee kinematics derived using an inverse perspective technique

Clin. Orthop. Relat Res.