Definition
Deformity causing alteration of mechanical axis from knee centre
Aims
1. Normal leg alignment
2. Equal leg lengths
3. Horizontal joint lines
Normal Anatomy
Mechanical Axes
A. Coronal Mechanical Axis of Lower Limb
Line from centre femoral head to centre of ankle
- passes medial to the centre of knee
- 10mm medial to the frontal plane centre
- medial tibial spine
- Llne of transmission of forces
Sagittal Plane
Centre of femoral head to centre of ankle
- just anterior to centre of knee joint
- aids in passive locking of knee joint in full extension
B. Femoral Mechanical Axis
- centre of femoral head to centre knee
C. Tibial Mechanical Axis
- same as tibial anatomic axis
- centre plateau to centre of talus / ankle
Anatomical Axis
Femoral - Tibial anatomic axis
- centre of femoral shaft to centre of knee, then centre of tibia
- 6o valgus
- increased in shorter femurs
- decreased in longer femurs
Femoral AA
- piriformis fossa to centre knee joint
- 6o from mechanical axis
- to knee joint is 81° on lateral side
Hip
Femoral Neck-shaft angle
- 125-131°
mLPFA (mechanical Lateral Proximal Femoral Angle)
- line tip GT to centre femoral head
- 90o to MA
Knee
Knee joint
- 3o valgus relative to MA
- 6o valgus distal femur
- 3o varus proximal tibia
Post Slope
- 9°
MPTA (medial proximal tibial angle)
- 87o or 3o varus
aLDFA (anatomical lateral distal femoral angle)
- 81o
mLDFA (mechanical lateral distal femoral angle)
- 87o
Mechanical Axis Deviation
Distance from centre of knee to MA in mm
Malalignment
Effect
Uncertain if malunion causes OA
- theoretical cartilage overload
- evidence in animals of cartilage changes
- evidence of increased forces in cadavers
Kristensen Acta Ortho Scand'89
- <15° Malunion = °OA
Known problems
Femoral Procurvatum
- MA passes posterior to knee joint
- prevents knee locking
Other joints stiff
- proximal tibial varus malunion
- can be compensated if mobile STJ
- if stiff subtalar joint, will notice abnormal gait
Ligamentous laxity of convex side of deformity
- increasing instability
- i.e. varus malunion with posterolateral instability
Chondral damage on overloaded side
Defining site of malunion
CORA
- centre of rotation of angulation
- lines of intra-medullary canals
- intersection is CORA
- site of deformity
- best site for correction
Indications for Surgery
Varus malalignment knee / ankle
- > 10o
Valgus malalignment knee / ankle
- > 15o
Mechanical axis deviation
- > 20 mm