Lower limb alignment, including its load-bearing axis (LBA), is best appraised by standardized radiography. Rotational orientation, including patellar alignment, is best measured by computed tomography (CT) or magnetic resonance imaging (MRI). Normal limb alignment may be defined as the means ± 1 SD of healthy adult parameters. Ideally, the knee is centered on the LBA (hip-knee-ankle (HKA) angle, zero deviation from linearity), and the quadriceps-patella-tendon (Q angle) is aligned at 11° laterally. A common deformity is varus (bow-legged) with the knee center lateral to LBA. This can cause knee instability and subluxation when the anterior cruciate ligament is lax. Subluxation is accentuated in the varus oblique knee in which the joint surfaces have an exaggerated inward tilt. Arthritic knee patterns relate to alignment through cause or effect or both. In osteoarthritis (OA), varus knee degradation is focused medially. Surveys of OA patients reveal that femoral deformity is more frequently responsible for the varus than tibial deformity. Valgus deformity (knock-knee) is uncommon in OA and linked to inflammatory arthritis, renal rickets, and various dysplasias. Thus, surgical realignment of deformed knees should be based on correction at its source—the femur, the tibia, or both. The frequent patellar malalignment in OA is probably attributable to torsional abnormalities which may call for CT or MRI assessments. Arthritis progression is optimally defined by standardized radiography in which assessments are made of the maximally involved compartment (joint space loss, osteophytes, erosion, and subluxation—which correlate with HKA). New developments include blood and urine analysis for breakdown products of cartilage and bone.
Operative Techniques in Sports Medicine – Elsevier
Published: Apr 1, 2000
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