Wear patterns on tibial plateau from varus osteoarthritic knees
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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