Skip to main content

Advertisement

SpringerLink
Log in

Integrating various common indexes of bony alignment in femoral supracondyle

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

Indexes, which can optimally represent the bony alignment around the knee, are still controversial. Three common indexes, mechanical axis (MA), anatomic axis (AA), and anatomic lateral distal femoral angle (aLDFA), were integrated to simplify patient follow-up in the femoral supracondylar region.

Materials and methods

Eighty consecutive adult patients (40 men, 40 women; age range 19–40 years) were studied using a full-length standing scanogram. Thirteen indexes, including MA, AA, and aLDFA, were measured and integrated. The relationships among these indexes were analyzed.

Results

The MA of the lower extremity passed with an average of 6.6 mm (9.2 % of the tibial articular surface width) medial to the knee center. The supracondylar axis (SA) was an average of 2.0° more valgus than the AA in the femoral supracondyle. An average 1.1° deviation was noted in the AA, as measured by the femoral shaft axis or a line connecting the piriformis fossa to the knee center.

Conclusion

The femoral MA may be more favorable than the MA of the lower extremity in order to represent an ideal weight-bearing line. The AA and aLDFA may be measurable via the SA in the anteroposterior view of the plain knee radiograph. Thus, patient follow-up becomes much more convenient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Richards RR, Waddell JP, Sullivan TR, Ashworth MA, Rorabeck CH (1984) Infra-isthmal fractures of the femur: a review of 82 cases. J Trauma 24:735–741

    Article  CAS  PubMed  Google Scholar 

  2. Wu CC, Lee ZL (2004) One-stage lengthening using a locked nailing technique for distal femoral shaft nonunions associated with shortening. J Orthop Trauma 18:75–80

    Article  PubMed  Google Scholar 

  3. Leung KS, Shen WY, So WS, Mui LT, Grosse A (1991) Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the femur. J Bone Joint Surg Am 73:332–340

    CAS  PubMed  Google Scholar 

  4. Wu CC (2007) Femoral supracondylar malunions with varus medial condyle and shortening. Clin Orthop Relat Res 456:226–232

    Article  PubMed  Google Scholar 

  5. Davison BL (2003) Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Am J Orthop 32:27–30

    PubMed  Google Scholar 

  6. Collinge CA, Gardner MJ, Crist BD (2011) Pitfalls in the application of distal femur plates for fractures. J Orthop Trauma 25:695–706

    Article  PubMed  Google Scholar 

  7. Tew M, Waugh W (1985) Tibiofemoral alignment and the results of knee replacement. J Bone Joint Surg (Br) 67:551–556

    CAS  Google Scholar 

  8. Dingwall I (1994) Biomechanics of the knee. In: Barrett D (ed) Essential basic sciences for orthopedics. Butterworth-Heinemann, Oxford, pp 94–108

    Google Scholar 

  9. Latta LL (1991) Mechanics of normal and reconstructed limbs. Curr Orthop 5:33–41

    Article  Google Scholar 

  10. Coventry MB (1988) Proximal tibial osteotomy. Orthop Rev 17:456–458

    CAS  PubMed  Google Scholar 

  11. Hsu RW, Himeno S, Coventry MB, Chao EYS (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 255:215–227

    PubMed  Google Scholar 

  12. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286:188–195

    Article  CAS  PubMed  Google Scholar 

  13. Ogata K, Yoshii I, Kawamura H, Miura H, Arizono T, Sugioka Y (1991) Standing radiographs cannot determine the correction in high tibial osteotomy. J Bone Joint Surg (Br) 73:927–931

    CAS  Google Scholar 

  14. Kraus VB, Vail TP, Worrell T, McDaniel G (2005) A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arth Rheum 52:1730–1735

    Article  Google Scholar 

  15. Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P (1997) Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthr Cartil 5:39–47

    Article  CAS  PubMed  Google Scholar 

  16. Hendersen RC, Kemp GJ (1991) Assessment of the mechanical axis in adolescent tibia vara. Orthopedics 14:313–316

    Google Scholar 

  17. Johnson LJ, Cope MR, Shahrokhi S, Tamblyn P (2008) Measuring tip-apex distance using a picture archiving and communication system (PACS). Injury 39:786–790

    Article  PubMed  Google Scholar 

  18. Dabov GD (2008) Miscellaneous nontraumatic disorders. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopedics. Mosby, Philadelphia, pp 987–1060

    Chapter  Google Scholar 

  19. Foroughi N, Smith R, Vanwanseele B (2009) The association of external knee adduction moment with biomechanical variables in osteoarthritis: a systematic review. Knee 16:303–309

    Article  PubMed  Google Scholar 

  20. Chao EYS, Neluheni EVD, Hsu RWW, Paley D (1994) Biomechanics of malalignment. Orthop Clin North Am 25:379–386

    CAS  PubMed  Google Scholar 

  21. Colebatch AN, Hart DJ, Zhai G, Williams FM, Spector TD, Arden NK (2009) Effective measurement of knee alignment using AP knee radiographs. Knee 16:42–45

    Article  PubMed  Google Scholar 

  22. Harrington IL (1983) Static and dynamic loading patterns in knee joints with deformities. J Bone Joint Surg (Am) 65:247–259

    CAS  Google Scholar 

  23. Block JA, Shakoor N (2010) Lower limb osteoarthritis: biomechanical alterations and implications for therapy. Curr Opin Rheumatol 22:544–550

    Article  PubMed  Google Scholar 

  24. Stuart MJ (1999) Arthroscopic management for degenerative arthritis of the knee. In: Zuckerman JD (ed) Instructional course lectures, 48th edn. AAOS, Rosemont, pp 135–141

    Google Scholar 

  25. Gold GE, Hargreaves BA, Stevens KJ, Beaulieu CF (2006) Advanced magnetic resonance imaging of articular cartilage. Orthop Clin North Am 37:331–347

    Article  PubMed  Google Scholar 

  26. McKellop HA, Sigholm G, Redfern FC, Doyle B, Sarmiento A, Luck JV (1991) The effect of simulated fracture-angulations of the tibia on cartilage pressures in the knee joint. J Bone Joint Surg (Am) 73:1382–1391

    CAS  Google Scholar 

  27. Gugenheim JJ, Probe RA, Brinker MR (2004) The effects of femoral shaft malrotation on lower extremity anatomy. J Orthop Trauma 18:658–664

    Article  PubMed  Google Scholar 

  28. Petersen TD, Rohr W Jr (1987) Improved assessment of lower extremity alignment using new roentgenographic techniques. Clin Orthop Relat Res 219:112–119

    PubMed  Google Scholar 

  29. Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs: preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. Clin Orthop Relat Res 280:65–71

    PubMed  Google Scholar 

  30. Gugerheim JJ, Brinker MR (2003) Bone realignment with use of temporary external fixation for distal femoral valgus and varus deformity. J Bone Joint Surg (Am) 85:1229–1237

    Google Scholar 

  31. Hall-Craggs ECB (1995) Anatomy as a basis for clinical medicine. Williams and Wilkins Waverly Europe, London

    Google Scholar 

  32. Snell RS (1995) Clinical anatomy for medical student. Little, Brown and Company, Boston

    Google Scholar 

  33. Lindsay DT (1996) Functional human anatomy. Mosby, St. Louis

    Google Scholar 

  34. Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs: preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 280:48–64

    PubMed  Google Scholar 

  35. Tetsworth KD, Paley D (1994) Accuracy of correction of complex lower-extremity deformities by the Ilizarov method. Clin Orthop Relat Res 301:102–110

    PubMed  Google Scholar 

  36. Hungerford DS, Hungerford MW (2005) Alignment of the normal knee; relationship to total knee replacement. In: Billemans J, Ries MD, Victor JMK (eds) Total knee arthroplasty: a guide to get better performance. Springer, Berlin, pp 25–31

    Chapter  Google Scholar 

  37. Paley D (1994) Corrective osteotomies for lower limb deformities. Curr Orthop 8:237–244

    Article  Google Scholar 

  38. Dearborn JT, Eakin CL, Skinner HB (1996) Medial compartment arthrosis of the knee. Am J Orthop 25:18–26

    CAS  PubMed  Google Scholar 

  39. Matsuda S, Miura H, Nagamine R, Mawatari T, Tokunaga M, Nabeyama R, Iwamoto Y (2004) Anatomic analysis of the femoral condyle in normal and osteoarthritic knees. J Orthop Res 22:104–109

    Article  PubMed  Google Scholar 

  40. Eckhoff DG (1994) Effect of limb malrotation on malalignment and osteoarthritis. Orthop Clin North Am 25:405–414

    CAS  PubMed  Google Scholar 

  41. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465

    CAS  PubMed  Google Scholar 

  42. Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg (Am) 69:745–749

    CAS  Google Scholar 

  43. Vanwanseele B, Parker D, Coolican M (2009) Frontal knee alignment: three-dimensional marker positions and clinical assessment. Clin Orthop Relat Res 467:504–509

    Article  PubMed Central  PubMed  Google Scholar 

  44. Lang JE, Scott RD, Lonner JH, Bono JV, Hunter DJ, Li L (2012) Magnitude of limb lengthening after primary total knee arthroplasty. J Arthroplast 27:341–346

    Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

    Chi-Chuan Wu

Authors
  1. Chi-Chuan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chi-Chuan Wu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wu, CC. Integrating various common indexes of bony alignment in femoral supracondyle. Eur J Orthop Surg Traumatol 24, 1271–1277 (2014). https://doi.org/10.1007/s00590-013-1373-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1373-0

Keywords

Search

Navigation