The effect of partial fibulectomy on contact pressure of the knee: a cadaveric study

Yazdi, Hamidreza; Mallakzadeh, Mohammadreza; Mohtajeb, Maryam; Farshidfar, Sara Sadat; Baghery, Abolfazl; Givehchian, Behrooz

doi:10.1007/s00590-013-1381-0

Cited by 32 publications

(21 citation statements)

References 5 publications

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“…Some cadaveric experiments have uncovered that PFO can reduce stresses in the medial compartment of the knee. Yazdi et al [23] have cut off the 20-mm long proximal fibulae in 6 cases and have found that the overall knee joint stress has been reduced, revealing a more significant decrease in the medial compartment stress with the maximum decrease of 21.6% and an increase in the lateral compartment stress with the maximum increase of 12.9%. In our finite element experiment, PFO changed the stress distribution in the knee joint and reduced the medial compartment stress especially in KOA patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: a finite element analysis

et al. 2020

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Background: Many previous studies lack sufficient quantitative evidences about changes in biomechanical properties of the knee in response to proximal fibular osteotomy (PFO). Therefore, the aim of this study was to compare the preoperative and postoperative effects of PFO on mechanical stresses in the knee joint and provide with a biomechanical basis for PFO in the treatment of mild knee osteoarthritis (KOA) with varus deformity. Methods: A total of 10 patients suffering mild KOA with varus deformity were enrolled in this study. Their image data from computerized tomography (CT) and magnetic resonance imaging (MRI) were used for finite element models, and PFO models were established. Static structural analysis was carried out using ABAQUS to compare the von Mises stress distribution and values of the maximal von Mises stress of femoral cartilage, meniscuses, tibial cartilages, and tibial plateau before and after surgery. Results: The stress distribution in the cortical bone of the tibial plateau showed that stresses were transferred from the anterior medial area to the posterior medial area after PFO. Values of the maximal von Mises stress in femoral cartilage, medial meniscus, medial tibial cartilage, and tibial plateau after surgery were significantly lower than the preoperative values, with statistically significant differences (P < 0.05). Postoperative values of the maximal von Mises stress of lateral meniscus and lateral tibial cartilage were significantly higher than the preoperative ones, with statistically significant differences (P < 0.05). Conclusion: PFO could reduce the stresses in the medial compartment of the knee joint with stress pathways transferring from the anterior medial area to the posterior medial area of the tibial plateau. Therefore, PFO is recommended for the treatment of mild KOA with varus deformity featuring favorably pain-relieving effects.

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Section: Discussionmentioning

confidence: 99%

Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: a finite element analysis

et al. 2020

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“…Partial fibulectomy is a procedure commonly used to harvest bone graft or to treat nonunion of tibial fractures or fibular fractures. One previous cadaveric study revealed that partial fibulectomy at 12 cm above the lateral malleolus resulted in decreased pressure in the medial compartment and increased pressure in the lateral compartment of the knee joint. However, this study was irrelevant to knee OA.…”

Section: Introductionmentioning

confidence: 94%

Anatomical Adaptation of Fibula and its Mechanism of Proximal Partial Fibulectomy Associated with Medial Compartment Knee Osteoarthritis

Juan

Chen

et al. 2019

Orthopaedic Surgery

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Objectives To reveal the anatomical adaptation of the fibula and its relations to age and settlement of the medial tibial plateau, and to explore the mechanism of proximal partial fibulectomy in treating medial compartment knee osteoarthritis (OA). Methods A retrospective study was performed in the Third Hospital of Hebei Medical University. Weight‐bearing full‐leg anteroposterior (AP) radiographs of 280 adults (560 knees) obtained from 1 January 2018 to 31 October 2018 were enrolled according to our inclusion and exclusion criteria, including 157 men and 123 women, with an average age of 50.3 ± 14.8 years (range, 19–80 years). Radiographic severity of knee OA was assessed using Kellgren and Lawrence (K–L) grading. The settlement of the medial tibial plateau was evaluated using the medial proximal tibial angle (MPTA). Curvatures of the tibia and the fibula were measured as proximal tibial curvature (PTC), distal tibial curvature (DTC), proximal fibular curvature (PFC), and distal fibular curvature (DFC). Two orthopaedic surgeons performed all the radiological measurements for 30 randomly selected patients, and repeated the measurements 1 week later. Based on the satisfactory intra‐observer and inter‐observer reliabilities (ICC > 0.9), each parameter was analyzed in this study. Multivariable linear regression models were used to examine relations between radiological measurements and age. Results The mean MPTA, PTC, DTC, PFC, and DFC were 85.4° ± 2.8°, 176.2° ± 1.9°, 176.8° ± 1.8°, 176.8° ± 1.9°, and 177.0° ± 2.0°, respectively. Ninety‐three knees of K–L grade I were categorized as non‐knee OA, and 467 knees of K–L grades II–IV were categorized as knee OA. The MPTA, PTC, and PFC of the knee OA group were significantly smaller than those of non‐knee OA group (P < 0.05). The K–L grade of knee OA significantly increased with age (χ 2 = 182.169, P < 0.01). The multivariate linear regression analysis indicated that the MPTA and fibular curvatures were negatively correlated with age (the regression equation is age = 561.165–0.945 MPTA‐0.937 PFC‐0.959 DFC, P < 0.05), and the MPTA was negatively correlated with PFC (the regression equation is MPTA = 7.827 + 0.099 DFC, P < 0.05). Conclusions The proximal curve of the fibula increased in patients with medial compartment knee OA, and this change was positively correlated with age and settlement of the medial tibial plateau. This anatomical adaptation of the fibula was associated with greater fibular axial load and the pulling from the peroneus longus. The proximal partial fibulectomy procedure effected a receptive foot pronation to reduce KAM and rebalance the biceps‐proximal fibula–peroneus longus complex, consequently achieving medial compartment unloading.

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“…Proximal fibular osteotomy indirectly initiates KOA and promotes its progression as it is based on the 'theory of differential settlement' [7]. Minimal trauma, few complications, definite effects and wide clinical applications are the characteristics of this treatment approach [8]. The available evidence on the benefits of proximal fibular osteotomy was analyxed by this study.…”

Section: Introductionmentioning

confidence: 88%

“…With increasing grade of OA of the knee, femoral neckshaft valgus angle decreases and lateral bowing of the femoral shaft increases, reducing the condylar shaft angle and shifting the mechanical axis medially, whereas on the tibial side, especially in the early stages of OA tibial plateau compression leads to a steepening of medial plateau more than bowing of tibia, [8].Progress of medial OA occurs more due to medial tibial compression rather than to bowing of the tibia [8]. The apparent density of trabeculae, trabecular architecture and the strength of the bone material are the determinants of compressive strength and stiffness of trabecular bone [9].…”

Section: Biomechanics Of Varus Knee Osteoarthritismentioning

confidence: 99%

Clinical and Functional Outcome of Proximal Fibular Osteotomy and Arthroscopic Debridement for Medial Compartment Osteoarthritis of Knee

Chaturvedi

Shinde

et al. 2020

PIJR

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OBJECTIVE: To explore the effects of proximal fibular osteotomy and Arthroscopic debridement for pain relief and improvement of medial joint space and function in patients with knee osteoarthritis. METHODS: From January 2018 to December 2019, 22 patients who underwent proximal fibular osteotomy and arthroscopic debridement for medial compartment osteoarthritis were retrospectively followed up. To analyse the alignment of the lower extremity and ratio of the knee joint space (medial/lateral compartment preoperative and postoperative weight-bearing and whole lower extremity radiographs were obtained. Preoperatively and postoperatively at 6wks, 3 months, 6 months and 1 yr using a visual analogue scale,knee pain was assessed and knee ambulation activities were evaluated using the American Knee Society score RESULTS: Medial pain relief was observed in 20/22 patients after this procedure. Most patients exhibited improved walking postoperatively. An average increase in the postoperative medial knee joint space was seen in weight-bearing lower extremity radiographs. Additionally, obvious correction of alignment was observed in the whole lower extremity radiographs in 2 of 22 patients. But 25 % of patients had common peroneal nerve neuro-praxia which got improved over the period of average 6 months.  CONCLUSIONS This study demonstrates that proximal fibular osteotomy and arthroscopic debridement in patients with medial compartment osteoarthritis effectively relieves pain and improves joint function at a mean of 15 months postoperative.

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The effect of partial fibulectomy on contact pressure of the knee: a cadaveric study

Abstract: The current study demonstrated partial fibulectomy at 12 cm above lateral malleolus results in decreasing pressure in knee medial compartment and increasing pressure in knee lateral compartment. Further studies are needed to evaluate the clinical importance of partial fibulectomy.

Cited by 32 publications

References 5 publications

Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: a finite element analysis

Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: a finite element analysis

Anatomical Adaptation of Fibula and its Mechanism of Proximal Partial Fibulectomy Associated with Medial Compartment Knee Osteoarthritis

Clinical and Functional Outcome of Proximal Fibular Osteotomy and Arthroscopic Debridement for Medial Compartment Osteoarthritis of Knee

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