Article

Malaligned knees are predisposed to the development and progression of
unicompartmental degenerations because of the excessive load placed on one side
of the knee. Therefore, guided growth in skeletally immature patients is
recommended. Indication for correction of varus/valgus deformities are based on
static weight bearing radiographs. However, the dynamic knee abduction moment
during walking showed only a weak correlation to malalignment determined by
static radiographs. Therefore, the aim of the study was to measure the effects of
guided growth on the normalization of frontal plane knee joint moments during
walking. 15 legs of 8 patients (11-15 years) with idiopathic axial varus or
valgus malalignment were analyzed. 16 typically developed peers served as
controls. Instrumented gait analysis and clinical assessment were performed the
day before implantation and explantation of eight-plates. Correlation between
static mechanical tibiofemoral axis angle (MAA) and dynamic frontal plane knee
joint moments and their change by guided growth were performed. The changes in
dynamic knee moment in the frontal plane following guided growth showed high and
significant correlation to the changes in static MAA (R=0.97, p<0.001). Contrary
to the correlation of the changes, there was no correlation between static and
dynamic measures in both sessions. In consequence two patients that had a natural
knee moment before treatment showed a more pathological one after treatment. In
conclusion, the changes in the dynamic load situation during walking can be
predicted from the changes in static alignment. If pre-surgical gait analysis
reveals a natural load situation, despite a static varus or valgus deformity, the
intervention must be critically discussed.
CI - Copyright (c) 2015 Elsevier B.V. All rights reserved.

Langue : ANGLAIS