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

Juan Wang, Hong-Zhi Lv, Wei Chen, Meng-Ke Fan, Ming Li, Ying-Ze Zhang
Orthopaedic Surgery 2019, 11 (2): 204-211

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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