femoral neck. (Fig. 2-B) is the angle that is formed by the head-neck line (C-N), which is viewed along the Y axis and the transverse functional axis (the Z axis)30.
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The anatomy and functional axes of the femur Y Yoshioka, D Siu and TD Cooke J Bone Joint Surg Am. 1987;69:873-880.
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Copyright
The BY
YUKI
YOSHIOKA,
Anatomy M.D.,
1987 by The Journal
DAVID
SIU,
M.SC.1,
AND
KINGSTON, the
and Joint
Clinical and
Mechanics
Group,
Mechanical
T.
DEREK
ONTARIO, Division
Engineering,
Linear and angular measurements were cadaveric femora with respect to the mechanical (functional) axes of the bone. The long axis was defined as a line from the center of the femoral head to the anterolateral attachment of the posterior cruciate ligament. The transverse axis was defined as a line through the posterior cruciate ligament parallel to the line connecting each epicondyle. The condylar width, the length of each interepicondylar line, correlated well with depth, but the projections of the condyles from the transverse plane revealed significant variations from specimen to specimen. Considerable variation also was found between femora in terms of angular dimensions (that is, the angle of anteversion and the neck-shaft angle proximally, and the valgus angle of the femoral shaft distally). Considerable interspecimen variation in the angles between the transcondylar plane and the femoral center, in accord with the valgus angle of the femoral shaft distally, was also noted. The mean transcondylar valgus angle (described as the tangent of the condyles to the perpendicular of the long axis) was 3.8 degrees. In contrast, little variation among specimens was noted for the angle made by the shaft and the long axis. CLINICAL RELEVANCE: These interspecimen van-
of the Femur*
V.
COOKE,
of Orthopaedics,
Departments
University,
Our
interest
sulted
in an
inward
varus angulation in the coronal
by osteotomy
or total
the
medial
femur
and
linear
measurements
of the
length
the bon&6-20’25’29. The anteroposterior dimensions era! and medial femoral condybes were found pendentby correlated with the width of the bone dybar
area
were
found
in eighty-three between
specimens’6. that
width
and
Similar the patient’s
correlation end of the
or breadth
femoral
also
bow-begged,
relationships height.
* No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject ofthis article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was the National Research Council of Canada. t Department of Orthopaedics, Kobe University Medical School, Kobe, Japan. : Clinical Mechanics Group, Division of Orthopaedics, Department of Surgery, Queen’s University, Kingston, Ontario K7L 3N6, Canada. Please address requests for reprints to Dr. Cooke.
VOL.
69-A,
NO.
6, JULY
1987
(valgus
condyle,
geometry
was
angulation
as compared
meant
observations
raised
about
of the
and
knee
axes
To study
questions
of motion
to the
features,
cruciate collateral
relationships,
were,
head and, (anterolateral
other
data
morphology and
of
of the ar-
were analyzed with that were chosen to at the knee. The proximally,
important
between the
the centhe fernposterior
of the medial and lateral and lateral epicondyles).
indicated
no correlation features
number These
longitudinal
distally, three points: aspect) of the
ligament and the origins ligaments (the medial and
of the
of the load-
measurements
or landmarks,
accumulated
that
of the bone.
ticular morphology of the hip and knee reference to certain anatomical features represent axes of flexion and extension selected
femur;
A smaller pattern5.
the articular
its relationships
these
with
medialization
and ankle. (lateralized)
transverse
of the
anteroposterior radiograph, was noa greater posterior projection of the viewed from the side5. Furthermore, who had inwardly slanted knees were
and this
interspecimen
those
variations
and
and
femorab
mor-
articular
phology. Materials
of
of the latto be indein the con-
of femoral
bearing line between the hip had a neutral or knock-knee
variations studies have documented a high anatomical features at the distal
tilt
lateral condyle on an tably associated with medial condyle when most of these patients
certain Numerous between some
study
of the tibia) to the knee’s articular surfaces plane5. The relative prominence distally of
The
deformities
F.R.C.S.(C)1,
of Surgery
in a further
to correct
arthritic
B.CHIR.,
generated by having seen arthritic patients with wide distal femoral valgus angles (more than 10 degrees) accompanied by significant tibia vara. These findings constitute a geometric malformation of the two bones at the knee that re-
ter of the femoral oral attachment
replacement.
M.B.,
Kingston
ations in angular dimensions could possibly be involved in the genesis of osteoarthnitis at the knee and the patterns of associated deformities. They are of importance in the selection of the ideal surgical planes that are used knee
M.A.,
CANADA
Queen’s
on thirty-two
Incorporated
Axes
ABSTRACT:
made
Surgery,
and Functional
PH.D.t,
From
ofBone
and
Methods
Thirty-two embalmed normal femora were obtained from the Department of Anatomy, Queen’s University, Kingston, Ontario, Canada. Any specimen that showed a significant arthritic abnormality at the hip or knee was discarded.
Twenty-six
specimens
femora of the same cadaver pies (five right and one left). was
73.4
years
(men,
consisted
of the right
and left
while six were unilateral samThe average age of the subjects
75. 1 years;
women,
71 .6 years),
and
the range was sixty-one to eighty-nine years. Equal numbers of specimens from men and women were studied. After carefully marking the distal landmarks (the fernoral
attachment
epicondybes)
of the posterior with
small
pins
cruciate or dye,
ligament
or both,
and
all soft
both
tissues 873
874
YUKI
YOSHIOKA,
DAVID
SIU,
AND
T.
D.
V.
COOKE
Square
Y Scale
Scale-
guide FIG.
were removed. was left intact.
The articular cartilage at the knee and hip No major variation was noted in the thickness
of the cartilage in all of the specimens. We constructed an osteometry table,
coordinates
Two
of a
each
on the table.
mechanical
femur.
One
(functional)
axes
was a longitudinal
system.
head-neck line (C-N), which is viewed along the transverse functional axis (the Z axis)30. The
consisting
base plate, a pointer, two bone supports, and three mutually perpendicular scales (X, Y, and Z) (Fig. 1). This device allowed each sample of bone to be precisely positioned and held while each dimension was being measured against the fixed
1
of the osteometric
Diagram
were
functional
defined axis27,
for which
data
were
top computer land, Colorado)
all recorded
(Hewlett-Packard on which
extent of distal femoral rotation in flexion-extension knee and consisted of a line through the landmark
millimeter,
to the line connecting in the transverse plane. in a helicoid pattern of
instant centers’#{176}, around this Z axis. Our axis (as referenced to the transepicondylar portantly
from
other
documented
definition of this line) differs im-
assessments
of axes
flexion of the kne&3-’6’20-22’27, but it permits separate of the geometry of the hip and the condyles, which
the long
axis
lay parallel
on the
to the longitudinal
(Y scale)
and the transepicondylar
transverse
coordinate
(Z scale).
transverse
functional
obtained
automatically.
To determine
axes
the linear
osteornetry
head
usually
medial
the
As an example femoral neck
condyle
revealed
which
standard
was
small
were
set,
both the
and angular
distal
(point
deviations
enough
of a deskLoveanalysis
points on a coordinates
of less
for our
than
0.7
purposes.
Results The in Tables
linear and angular data according I and II. Certain of the dimensions
with regard confidence
to sex and level showed
sexes
in any
were
significant
side. The data no significant
of the angular
CONDYLAR
so
to sex are shown were compared at the 95 difference
measurements.
differences
between
LINEAR
coordinate
line lay parallel Once
and the most
This
of
Parametert
there
for the linear
I
MEASUREMENTS
Male
per cent between
However,
the sexes
(mm)’
Laterall
to the
Mediall
Female
Male
Female
the bong and the X coordinate
dimensions
was
point
Width
(HI, JK)
31 [2.3]
28 [1.8]
32 [3.1]
27 [3.1]
Depth
(AQ,
BR)
72 [4.0]
65 [3.7]
70 [4.3]
63 [4.5]
Anterior (AO,
projection BO)
43 [2.6]
38 [3.1]
36 [2.0]
31 [3.4]
Posterior (OQ,
projection OR)
29 [4.1]
57 [3.2]
34 [3.7]
31 [3.5]
15 [1.8]
13 [2.1]
12 [2.6]
10 [2.4]
of the
parameters to be measured, 21 points were chosen on the distal and proximal ends of each sample (Figs. 2-A, 2-B, and 3). As an example of one linear parameter, the femoral length was the distance between the most proximal point of
the femoral
six times.
analyses was not table
tape Calculator, statisticab
by measuring seven the three-dimensional
TABLE
possible with the other methods. Each femur was mounted that
we
9825A did our
of coordinates and angles were rounded to the nearest 0.5 millimeter and 1 .0 degree, respectively. Before the actual measurement, a validation for the technique was performed sample of bone against
posterior cruciate ligament parallel the medial and lateral epicondybes As the knee flexes the tibia rotates
on magnetic
and
(Student t tests). The reproducibility of readings in this system was less than one millimeter for linear measurements and 0.5 degree for angular readings. Finer measurements
was a line connecting the landmark on the posterior cruciate ligament to the center of the femoral head (Fig. 2-A). The other was the transverse functional axis, which reflected the at the on the
the Y axis
Distal
extent
(OS,
OU)
of the condyle,
U in Figs.
2-A
of one angular parameter, anteversion (Fig. 2-B) is the angle that is formed
and
3).
of the by the
Rounded t Letters Average *
to the nearest in parentheses with standard
THE
millimeter. refer to parameters defined deviation in brackets.
JOURNAL
OF BONE
in Figure
AND JOINT
3.
SURGERY
THE
parameters
of femoral
length
femorab head of the lateral
(t = 6.42), condyle (t
condybe
(t
4.42).
that
been
had
=
The
obtained
(t
higher from
2.73),
=
condylar = 5 .21),
ANATOMY
width (t and height
values
were
AND
diameter =
FUNCTIONAL
of the
6.80), height of the medial
in the specimens
men.
AXES
OF
THE
875
FEMUR
Similar t tests were done on the paired the thirteen cadavera (six male and seven which bilateral specimens had been obtained, vealed no significant differences cept for one measurement. anteversion
(t
3.01),
=
with
femora
between the two That difference the larger
from
female) from and they re-
side
sides was
averaging
exin 12.2
degrees (standard deviation, 7.6 degrees) and the smaller averaging 4.0 degrees (standard deviation, 6.3 degrees)30. With respect to condylar width and depth, seven femora showed
larger
the left.
measurements
An assessment
by measurements
on the
right
of condylar
of their
depths,
side
and
six,
proportions,
showed
that
on
revealed
they
averaged
within a few millimeters of each other (68.2 compared with 66. 1 millimeters), but considerable variation was found in
the extent projected
to which from
medial
condybe
limeters
farther
either
the medial
the transverse
projected than
or the lateral
functional
axis
posteriorly
the lateral
an average
condyle
did.
jections of both the medial and the lateral the widest variations (Table I). Comparative
(Table
Iv
relationships
I) were examined
the depths
were compared,
between
a strong
and medial
Posterior
paired
correlation
(r
=
parameters
tively
T S
FIG. 2-A
coefficients
(Fig. 4). Since abnormal
in a malformation
(r) were
functional
of the major
0.86
kinematics
articular
When
of the samples 0.92)
was
A lesser but still a good correlation was established the width and the depth of the lateral or medial the correlation
proshowed
analysis.
condyles
The
of 4.8 mil-
condyles
by linear regression
of the lateral
condyle
(Z axis).
and
condyle;
0.88,
may
parts,
found.
between respec-
be reflected
the same
condylar data were analyzed with reference to the transverse functional axis (Z axis). In contrast to the good correlations just mentioned, these dimensions showed considerably poorer correlations: the coefficients were 0.7 and 0.5 for the anterior and posterior projections of the lateral condybe,
XI
zi
FIG. 2-B Frontal view (Fig. 2-A) and axial view (Fig. 2-B) of the landmarks, reference lines, and angular projections. The osteometric axes are also shown. C = center of the hip, E and F = lateral and medial epicondyles, N = center of the neck, 0 = origin of the coordinate system that is, the attachment of the posterior cruciate ligament, Sc = subtrochanteric center, U and S = the distal ends of the medial and lateral condyles, a = neckshaft angle, 13 = hip center-femoral shaft angle, 8 = transcondylar angle (the tangent line of the condyles with respect to the Z axis), y = tilt angle of the transepicondylar line from the Z axis, 4 = anteversion of the neck, OC = longitudinal functional axis, and Z axis = transverse functional (flexion-extension) axis, which is parallel to the transepicondylar line and passes through point 0 in the transverse plane.
VOL.
69-A,
NO.
6, JULY
1987
876
YUKI
respectively, the
and
0.8
and
0.6
medial condyle, respectively. In general, assessment
showed greater linear dimensions
for of
the the
YOSHIOKA,
same angular
projections
erage center-shaft angle was 5.4 valgus angle showed considerable 3.8
averaged the
neck
degrees 7.4
SIU,
of
(±
degrees;
somewhat
2. 1 degrees). however,
to the rather
dimensions
differently
than
other
most
V.
COOKE
We referenced
1.12,19.20,23
transverse functional than to the tangent
roversion retroversion deviation
of the neck anteversion
D.
of
authors
the degree
of anteversion
axis (the Z axis in Fig. 2-B) line of the posterior condylar
-
degrees. The transcondylar variation, with the mean Anteversion
T.
surfaces (QR in Fig. 3). Our 10.8 to 22. 1 degrees. There retroversion in some specimens.
higher the av-
we defined
AND
have278’
interspecimen variations compared with (Tables I and II). The average neck-shaft
angle (Table II) was 1 3 1 degrees, which is slightly than the reported average of 125 degrees9-’#{176}’28,and
being
DAVID
measurements ranged from were significant degrees of Four specimens had ret-
of between zero and 5 degrees and two had of 6 and 10 degrees. The large standard of 8 .2 degrees is a measure of the wide variation -
-
-
in anteversion
that
ation been
the sides in detail
between discussed
was
found
in our
was also wide. elsewhere30.
specimens. These
The findings
vanhave
WI
FIG.
3
Diagrams of the distal part of the femur. Axial (top) and frontal (bottom) views are aligned on the horizontal axis HOK which is the same as the Z axis in Figs. 2-A and 2-B. A and B = the most anterior projections of the lateral and medial femoral condyles; E and F = the lateral and medial epicondyles; G = the anterior border of the intercondylar notch; 0 = the anterolateral attachment of the posterior cruciate ligament; H, I, J, and K = the distal cartilaginous borders of the lateral and medial condyles measured from Z parallel to the transepicondylar line at 0; M and P = the most lateral and medial points of the respective condyles; Q and R = the most posterior projections of the lateral and medial femoral condyles; S and U = the most distal projections of the lateral and medial femoral condyles; T = the distal margin of the intercondylar notch; and V = the base of the patellar trochlea. The linear and angular parameters that were studied are shown in Tables I and II.
THE
JOURNAL
OF BONE
AND
JOINT
SURGERY
THE
ANATOMY
AND
FUNCTIONAL
AXES
TABLE LINEAR
Linear
AND
52 [3.3]
45 [3.0]
Center-shaft
83 [3.9]
72 [4.7]
Transcondylar valgusangle(&)
90 [6.1]
80 [6.1]
Distal femoral-shaft valgusangle(3
Intercondylar width (U)
13 [3.1]
11 [4.0]
Tilt
Anterior condylar peak difference (AB)
38 [2.4]
32 [2.5]
Anteversion
Height of patellar trochlea (VO)
34 [2.4]
31 [3.6]
Condylar
Height of intercondylar notch (GO)
4 [1.8]
4 [2.0]
Distal projection intercondylar notch (TO)
6 [1.6]
4 [1.6]
of femoral
Condylar
width
head
(MP)
width
of
millimeter or nearest degree. deviation in brackets. refer to parameters defined in Figures
a direct
comparison
of our data
with
osteometry
anteversion with
table.
was
reported
With
1 3 1 degrees
values9’
10.1
this ,
.
technique,
a figure
the
2-A,
Neck-shaft
2-B,
those
Male
angle
(a)
angle
(3)
+ 8)
of transepicondylar line (-y)
and
(4) twist
(w)
ticular
the specifics
standardization
no
angle
between
No relationship tilt and anteversion
was and
5 [1.1]
3 [2.3]
4 [1.9]
9 [2.2]
10 [2.1]
1 [2.5]
1 [2.8]
7 [6.8]
8 [10.0]
5 [1.8]
6 [2.4]
in three reports
planes have
of the landmarks
have
made
not
been
specific
and
position
the references
during
defined.
reference
None
for
measurement of the
to the functional
cited inter-
well
twists
of
#{149}MALE
found
between
the neck-shaft
been many the geometry
oFEMALE
was found (Fig. 5). the
transII
angle.
75
w
Discussion There have 20.22.25.29 describing
5 [0.9]
mm
relationship
valgus
133 [6.6]
average
that compared
relationships
the hip-femoral shaft geometry. between the angle of condybar Similarily,
1 29 [7.3]
of the femoral
the femur proximally and distally, we examined the planar characteristics of the distal femoral articubar surfaces and
condylar
Female
3.
24.28
To book for functional
(Degrees)t
Parameterl
of others, the anteversion angle was also measured with each femur placed on a flat surface. Each specimen then had to be rotated externally as compared with its position on the
FEMUR*
Angular
442 [27.7]
to the nearest with standard in parentheses
To albow
THE
466 [22.8]
Epicondylar (EF)
1: Letters
OF
Female
Diameter
877
FEMUR
II
MEASUREMENTS
Male
Length
Rounded t Average
THE
(mm)t
Parameterl
*
ANGULAR
OF
quantitative reports37 of the human femur.
0.16.18-
In the
0
.
I LU .1 >-
main,
specific
all three,
data
have
reports
concerned
choice
of hip
the ranges suitable However,
on its shape,
form,
provided.
Recently,
been with naibs
for
surgical
considerations
fixation
of fernorab
in size and shape
in the design
relationships or distally.
have such
been as the
fractures26
ometry in relationship hip or knee have been
to functional scant7’8.
Previous descriptions” definitions as to the methodology -
NO. 6, JULY
1987
have been of femoral
mechanical
axes
00
z 0 0 -J
65
and
of anatomically
between articular parts ofthe The proximal angubar features
femur, in particular anteversion2”2”4”8’23, ied extensively. However, measurements
69-A,
there
or
prosthetic implants for total knee arthroplasty’6-25. none of these accounts gave information about
the angular proximally
VOL.
or development,
+
C.C.:
0.86
femur of the studgeat the
CONDYLAR
WIDTH
[w3J
FIG. 4
16. 19,20.25.27
have
of measurement;
lacked
strict in par-
Relationship between condylar articular height (L) shown as a linear regression. was found.
width (W) and lateral condylar A good correlation (r = 0.86)
878
YUKI
YOSHIOKA,
deg
DAVID
SIU,
AND
T.
D.
V.
COOKE
MALE FEMALE
. 0
11 0 0
Ui -J
9,
#{149}
0
z 4
0
I-
7
(I)
.
0
.
I-
coo
. #{149}0
5, 4
. . #{149} .
0
-J
.
0 0
>-
z
#{149}
0
3,
0
-l#{224}
c.c.=
0
‘
.
6
ANTEVERSION
relationships
between
between
the
anteversion
geometry
of the
of the hip
and
of motion at the knee. Walmsbey27 documented ometry and included data on the relationships condylar in regard author&
plane to the hip and the femoral to rotation he accepted (as the posterior
1.14.16.19.20.25)
as the reference unfortunately,
plane limited
Our attempt respect
the first study methodology to less 0.5
to examine
than
articular
sides
the geometry
using well defined yielding measurements
osseous that
millimeter
for
the
surfaces study
was,
of the femur
axes
one
the
His
may
with
therefore
be
landmarks and are reproducible
linear
dimensions
degree for the angular dimensions. The findings of our study have confirmed
much
condylar
twist
(w);
no correlation
was
found.
neck-shaft angles. Surprisingly, no correlations were found between the angular orientation of the femoral head and the distal part of the femur in the group as a whole or between
shaft. However, have most other
condylar
(functional)
distal
femoral geof the distal
for neutral rotation. to six specimens.
to its mechanical
5
and
the axis
I
OF NECK[
FIG.
(4)
neck
2’0Ieg
‘0
0.02
-
Relationship
0
ib
‘
sexes. In contrast
of what
to these samples,
differences,
except
variations
with
regard
between
to anteversion,
were quite small. Significant variations in anteversion in the population at large and between right and left sides in the same individual have been noted previously”26, and the reason for this finding is still unknown.
a
and
in our
The
specific
question
that
we had
asked
was
ticular asymmetry existed with respect to certain relationships that is, the transverse and longitudinal -
what
an-
angular func-
tionab axes of the bone as defined by the center of the femoral head and the ligamentous attachments at the distal end of
was already known namely, that there is a high level of symmetry between the femoral condyles’6’2529 and that there are significant differences between men and women with respect to femoral size, diameter of the femoral head, condylar width, and anteropostenor dimensions. However, to
femur. As already noted, the plane of the distal end of the femur showed a significant angular variation to either the hip (as indicated by the center of the femoral head) or the
our
neck-shaft
-
knowledge
angles
vary the
depicting
little angles
it has
not
been
the geometry
between the at the hip.
sexes
shown
previously
of the distal and
that
the
that
femoral same
the
condybes is true
for
shaft. sagittal
None of these plane showed angle.
interspecimen of the femoral
angles in either any correlation
In conjunction
asymmetry condybes
with
iations that were found in all angular dimensions except one. Among both men and women, the hip center-femoral shaft angle was remarkably constant (between 5 and 6 degrees). Significant variations were noted between the transcondylar
the lateral
long axis comparable
striking
valgus
feature
angles
of our
both
or to the femoral with the variations
findings
as measured shaft. that
was
the wide
in relation
var-
to the
These variations were were noted between the
condyle
in the angular of the femorab
this
coronal or the anteversion or was
a significant
between the posterior projection with respect to the transverse func-
tional axis and the origin of the essence, these features represent sional deformity of the distal part ativeby greater variations in projection compared with the lateral condyle. the distal projection of the medial
The
the with
collateral ligaments. In varying degrees of torof the femur due to rebof the medial condyle Thus, the variations in condybe with respect to
in an anteroposterior
variations in vabgus head (or shaft). THE JOURNAL
radiograph orientation
OF BONE
AND
resulted
to the center
JOINT
SURGERY
THE
We also tried in the
frontal
more
valgus
to define
plane
and
that
angle
FUNCTIONAL
valgus
it had
than a right
the mean
AND
the transcondylar
found
orientation
Interestingly,
ANATOMY
angle
line
was
The dybes
posterior
had
no apparent
In other slight
words,
vabgus
a smaller
slim
of the femorab with
woman
transcondybar with
a short
valgus femur
transcondylar
valgus
not necessarily
bone distally. radiographic
geometric rotational femur is a notable
is commonly
matching
deformity
tibia,
of proximal
femoral
formations
geometry5.
of adjacent
an
articular
not
associated with
It appears parts
may
with
differing then
that
compensate
mabfor
each other, perhaps such that the influence on load-bearing is minimized’7. These data have important surgical implications. Our findings suggest that in total knee arthropbasty the femoral component is centered
should be placed along a longitudinal in the knee that is, on the attachment -
axis
that of the
being
of the rather
component than to the
unreliable
teoarthritis aberrations head and rations, geometric acterized predispose
data
femur
femoral
guides
early
valgus
be-
angulation)
osteoarthritic
assessments
of the distal to quantify
abnormality
The
angles
with
of
features
that
re-
reference
the
end of the femur to the hip; accurately the extent of distal
(valgus
geon to correct accurately and tibia as needed. of the
a
distal
knees
femoral
varus
Rotation epicondybes
latter
radiographic
more
disproportion of the feature5. Dysplasia of
end of the femur
the
careful
articular planes these are needed
much credence to the who have dysplasia of
the distal
of the
have
(anteversion) by an inward twist to the
accompanied
condyles,
angulation;
Furthermore,
ligament. to the
Dysplastic
quire
part of the femur
These findings lend observations in patients
the knee in whom distal part of the
and
879
FEMUR
inward tilt (excessive the dyspbastic knee5.
have a barger degree
angulation.
twist to the proximal
and
THE
cause of local variations”4’21. With respect to coronal tilt of the knee joint, Cooke and Pichora have already noted the relationship of arthritis of the medial compartment with
angle.
a bong femur
at the hip did not necessarily
of distal
a
con-
to the neck-shaft man
of the hip did not necessarily
of distal was
tall,
orientation the
angulation
asymmetry
relationship
the
degree
conversely,
outward
and distal
posterior
at a right
angle to the bong axis. With the knee flexed to 90 degrees, we found that the transepicondylar line comes to make right angie to the long axis of the tibia as well3’.
OF
posterior cruciate should be referenced
3 to 4 degrees
to the bong axis.
transepicondybar
AXES
angubation)
angular
depicting
angular
may
have
implications
at the
knee.
It is well
and
allow
deformity
variations
the sur-
in the femur of the distal
in the
genesis
accepted
that
end of os-
geometric
in the load-bearing orientation of the femoral acetabulum, exemplified by dyspbastic configupredispose variations
to osteoarthritis. of the
distal
We suggest end
of the
by twists in an outward (valgus) to subluxation and osteoarthnitis.
that
certain
femur,
char-
plane, may also A preliminary
analysis of 220 unselected osteoarthritic knees has revealed a valgus orientation of the distal part of the femur to the bong axis of more than 3 degrees in more than 80 per cent of them6, which bends credence to this idea. NOTE: The authors wish to acknowledge the viIal support provided by the Department of the technical advice and help of other members of the Clinical Mechanics Group at Queen’s University. and the skilled preparation ofthe manuscript by Mrs. C. Grant. Ms. F. Pelletier. and Mrs. P. Brennan.
Anatomy.
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