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Related Concept Videos

Bones of the Lower Limb: Tibia and Fibula01:10

Bones of the Lower Limb: Tibia and Fibula

The tibia is the main weight-bearing bone of the lower leg. It is larger than the fibula with which it is paired. The tibia is also the second longest bone in the body and is located right below the skin. The proximal end of the tibia forms the medial and the lateral condyle, which articulates with the condyles of the femur to form the knee joint. Between the articulating surfaces is the irregular elevated area known as the intercondylar eminence that serves as the inferior attachment point for...
Knee Joint01:23

Knee Joint

The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris group...

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Related Experiment Video

Updated: Jun 18, 2026

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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High tibial osteotomy effectively redistributes compressive knee loads during walking.

Enrico De Pieri1,2, Corina Nüesch2,3,4,5, Geert Pagenstert5,6

  • 1Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
|June 22, 2022
PubMed
Summary

High tibial osteotomy (HTO) effectively unloads the medial knee compartment in osteoarthritis patients by shifting load to the lateral compartment, though gait function shows limited improvement. Knee adduction moment changes do not always reflect medial compartment unloading.

Keywords:
ambulatory loadjoint preserving surgeryknee osteoarthritismusculoskeletal modelingstatistical parametric mapping

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Area of Science:

  • Orthopedics
  • Biomechanics
  • Sports Medicine

Background:

  • Knee osteoarthritis (OA) significantly impacts quality of life, necessitating effective joint-preserving surgical interventions.
  • High tibial osteotomy (HTO) is a common surgical procedure for medial compartment knee OA aimed at correcting alignment and reducing joint load.

Purpose of the Study:

  • To estimate pre- and postoperative lower limb kinematics, kinetics, and knee intra-articular forces during gait in HTO patients using musculoskeletal modeling.
  • To compare these biomechanical parameters to asymptomatic controls.
  • To determine correlations between biomechanical changes and patient-reported outcomes (KOOS subscores) after HTO.

Main Methods:

  • Musculoskeletal modeling was employed to analyze gait data from 16 knee OA patients before and after HTO, and from 16 matched controls.
  • Evaluated lower limb joint moments and knee contact forces during gait.
  • Correlated biomechanical changes with Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores.

Main Results:

  • HTO resulted in significant redistribution of knee joint load, decreasing compressive force on the medial compartment and increasing it on the lateral compartment during specific gait phases.
  • Postoperative lateral shear force was significantly reduced.
  • Changes in external knee adduction moment (KAM) did not consistently correlate with medial compartment unloading.
  • No significant correlation was found between biomechanical changes and improvements in KOOS subscores.

Conclusions:

  • HTO effectively unloads the medial knee compartment by redistributing compressive forces to the lateral compartment during gait, with limited impact on overall gait function.
  • The KAM may not be a sufficient indicator of compartmental load magnitude or changes after interventions.
  • Additional biomechanical outcome measures are crucial for evaluating the effectiveness of joint-preserving surgeries like HTO.