Establishment of finite element model of varus-type ankle arthritis and biomechanical analysis of different correction models for tibial anterior surface angle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Cheng ,  YANG Yunfeng , LI Bing , XIA Jiang , ZHAO Youguang , ZHU Hui , ZHOU Haichao , LI Yongqi , LI Zhendong , HE Wenbao , ZHANG Yi , HUANG Hui

Department of Orthopaedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092, P. R. China;

Corresponding author：

YANG Yunfeng, Email: yyfscn@163.com

Keywords：

Varus-type ankle arthritis; tibial anterior surface angle; supramalleolar osteotomy; finite element analysis

DOI：

10.7507/1002-1892.202302078

Video：

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Objective To establish the finite element model of varus-type ankle arthritis and to implement the finite element mechanical analysis of different correction models for tibial anterior surface angle (TAS) in supramalleolar osteotomy. Methods A female patient with left varus-type ankle arthritis (Takakura stage Ⅱ, TAS 78°) was taken as the study object. Based on the CT data, the three-dimensional model of varus-type ankle arthritis (TAS 78°) and different TAS correction models [normal (TAS 89°), 5° valgus (TAS 94°), and 10° valgus (TAS 99°)] were created by software Mimics 21.0, Geomagic Wrap 2021, Solidworks 2017, and Workbench 17.0. The 290 N vertical downward force was applied to the upper surface of the tibia and 60 N vertical downward force to the upper surface of the fibula. Von Mises stress distribution and stress peak were calculated. Results The finite element model of normal TAS was basically consistent with biomechanics of the foot. According to biomechanical analysis, the maximum stress of the varus model appeared in the medial tibiotalar joint surface and the medial part of the top tibiotalar joint surface. The stress distribution of talofibular joint surface and the lateral part of the top tibiotalar joint surface were uniform. In the normal model, the stress distributions of the talofibular joint surface and the tibiotalar joint surface were uniform, and no obvious stress concentration was observed. The maximum stress in the 5° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress distribution of medial tibiotalar joint surface was uniform. The maximum stress of the 10° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress on the medial tibiotalar joint surface increased. Conclusion With the increase of valgus, the stress of ankle joint gradually shift outwards, and the stress concentration tends to appear. There was no obvious obstruction of fibula with 10° TAS correction. However, when TAS correction exceeds 10° and continues to increase, the obstruction effect of fibula becomes increasingly significant.

Citation： CHEN Cheng, YANG Yunfeng, LI Bing, XIA Jiang, ZHAO Youguang, ZHU Hui, ZHOU Haichao, LI Yongqi, LI Zhendong, HE Wenbao, ZHANG Yi, HUANG Hui. Establishment of finite element model of varus-type ankle arthritis and biomechanical analysis of different correction models for tibial anterior surface angle. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(7): 796-801. doi: 10.7507/1002-1892.202302078 Copy

1.	Kimizuka M, Kurosawa H, Fukubayashi T. Load-bearing pattern of the ankle joint. Contact area and pressure distribution. Arch Orthop Trauma Surg (1978), 1980, 96(1): 45-49.
2.	Knupp M, Stufkens SA, van Bergen CJ, et al. Effect of supramalleolar varus and valgus deformities on the tibiotalar joint: a cadaveric study. Foot Ankle Int, 2011, 32(6): 609-615.
3.	Glazebrook M, Daniels T, Younger A, et al. Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. J Bone Joint Surg (Am), 2008, 90(3): 499-505.
4.	Valderrabano V, Horisberger M, Russell I, et al. Etiology of ankle osteoarthritis. Clin Orthop Relat Res, 2009, 467(7): 1800-1806.
5.	Hintermann B, Knupp M, Barg A. Supramalleolar osteotomies for the treatment of ankle arthritis. J Am Acad Orthop Surg, 2016, 24(7): 424-432.
6.	Butler JJ, Azam MT, Weiss MB, et al. Supramalleolar osteotomy for the treatment of ankle osteoarthritis leads to favourable outcomes and low complication rates at mid-term follow-up: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2023, 31(2): 701-715.
7.	Liang JQ, Wang JH, Zhang Y, et al. Fibular osteotomy is helpful for talar reduction in the treatment of varus ankle osteoarthritis with supramalleolar osteotomy. J Orthop Surg Res, 2021, 16(1): 575. doi: 10.1186/s13018-021-02732-8.
8.	Yang XQ, Zhang Y, Wang Q, et al. Supramalleolar osteotomy vs arthrodesis for the treatment of Takakura 3B ankle osteoarthritis. Foot Ankle Int, 2022, 43(9): 1185-1193.
9.	Beijk I, Burgerhof J, de Vries AJ, et al. Is there an optimal degree of correction for ankle varus deformity after supramalleolar osteotomy? A systematic review. Foot Ankle Surg, 2022, 28(8): 1139-1149.
10.	Zhu J, Forman J. A review of finite element models of ligaments in the foot and considerations for practical application. J Biomech Eng, 2022, 144(8): 080801. doi: 10.1115/1.4053401.
11.	Malakoutikhah H, Latt LD. Disease-specific finite element analysis of the foot and ankle. Foot Ankle Clin, 2023, 28(1): 155-172.
12.	杨志刚, 甘霖, 叶俊星. 胫骨远端骨折有限元模型的建立及稳定性分析. 中国组织工程研究, 2016, 20(17): 24500-24505.
13.	Lambert KL. The weight-bearing function of the fibula. A strain gauge study. J Bone Joint Surg (Am), 1971, 53(3): 507-513.
14.	Ahn TK, Yi Y, Cho JH, et al. A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. J Bone Joint Surg (Am), 2015, 97(5): 381-388.
15.	李兴军, 保超宇, 李骅, 等. 踝关节有限元模型的建立及其生物力学研究. 中华创伤杂志, 2018, 34(9): 827-832.
16.	Krähenbühl N, Zwicky L, Bolliger L, et al. Mid- to long-term results of supramalleolar osteotomy. Foot Ankle Int, 2017, 38(2): 124-132.
17.	Koo JW, Park SH, Kim KC, et al. The preliminary report about the modified supramalleolar tibial osteotomy for asymmetric ankle osteoarthritis. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499019829204. doi: 10.1177/1071100717709566.
18.	Tanaka Y, Takakura Y, Hayashi K, et al. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Br), 2006, 88(7): 909-913.
19.	Haraguchi N, Ota K, Tsunoda N, et al. Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Am), 2015, 97(4): 333-339.
20.	Choi GW, Lee SH, Nha KW, et al. Effect of combined fibular osteotomy on the pressure of the tibiotalar and talofibular joints in supramalleolar osteotomy of the ankle: A cadaveric study. J Foot Ankle Surg, 2017, 56(1): 59-64.
21.	Stufkens SA, van Bergen CJ, Blankevoort L, et al. The role of the fibula in varus and valgus deformity of the tibia: a biomechanical study. J Bone Joint Surg (Br), 2011, 93(9): 1232-1239.
22.	赵宏谋, 梁晓军, 李毅, 等. 胫骨远端内外翻畸形对胫距关节接触的影响. 中国修复重建外科杂志, 2016, 30(7): 826-829.
23.	Nha KW, Lee SH, Rhyu IJ, et al. Safe zone for medial open-wedge supramalleolar osteotomy of the ankle: A cadaveric study. Foot Ankle Int, 2016, 37(1): 102-108.

1. Kimizuka M, Kurosawa H, Fukubayashi T. Load-bearing pattern of the ankle joint. Contact area and pressure distribution. Arch Orthop Trauma Surg (1978), 1980, 96(1): 45-49.
2. Knupp M, Stufkens SA, van Bergen CJ, et al. Effect of supramalleolar varus and valgus deformities on the tibiotalar joint: a cadaveric study. Foot Ankle Int, 2011, 32(6): 609-615.
3. Glazebrook M, Daniels T, Younger A, et al. Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. J Bone Joint Surg (Am), 2008, 90(3): 499-505.
4. Valderrabano V, Horisberger M, Russell I, et al. Etiology of ankle osteoarthritis. Clin Orthop Relat Res, 2009, 467(7): 1800-1806.
5. Hintermann B, Knupp M, Barg A. Supramalleolar osteotomies for the treatment of ankle arthritis. J Am Acad Orthop Surg, 2016, 24(7): 424-432.
6. Butler JJ, Azam MT, Weiss MB, et al. Supramalleolar osteotomy for the treatment of ankle osteoarthritis leads to favourable outcomes and low complication rates at mid-term follow-up: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2023, 31(2): 701-715.
7. Liang JQ, Wang JH, Zhang Y, et al. Fibular osteotomy is helpful for talar reduction in the treatment of varus ankle osteoarthritis with supramalleolar osteotomy. J Orthop Surg Res, 2021, 16(1): 575. doi: 10.1186/s13018-021-02732-8.
8. Yang XQ, Zhang Y, Wang Q, et al. Supramalleolar osteotomy vs arthrodesis for the treatment of Takakura 3B ankle osteoarthritis. Foot Ankle Int, 2022, 43(9): 1185-1193.
9. Beijk I, Burgerhof J, de Vries AJ, et al. Is there an optimal degree of correction for ankle varus deformity after supramalleolar osteotomy? A systematic review. Foot Ankle Surg, 2022, 28(8): 1139-1149.
10. Zhu J, Forman J. A review of finite element models of ligaments in the foot and considerations for practical application. J Biomech Eng, 2022, 144(8): 080801. doi: 10.1115/1.4053401.
11. Malakoutikhah H, Latt LD. Disease-specific finite element analysis of the foot and ankle. Foot Ankle Clin, 2023, 28(1): 155-172.
12. 杨志刚, 甘霖, 叶俊星. 胫骨远端骨折有限元模型的建立及稳定性分析. 中国组织工程研究, 2016, 20(17): 24500-24505.
13. Lambert KL. The weight-bearing function of the fibula. A strain gauge study. J Bone Joint Surg (Am), 1971, 53(3): 507-513.
14. Ahn TK, Yi Y, Cho JH, et al. A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. J Bone Joint Surg (Am), 2015, 97(5): 381-388.
15. 李兴军, 保超宇, 李骅, 等. 踝关节有限元模型的建立及其生物力学研究. 中华创伤杂志, 2018, 34(9): 827-832.
16. Krähenbühl N, Zwicky L, Bolliger L, et al. Mid- to long-term results of supramalleolar osteotomy. Foot Ankle Int, 2017, 38(2): 124-132.
17. Koo JW, Park SH, Kim KC, et al. The preliminary report about the modified supramalleolar tibial osteotomy for asymmetric ankle osteoarthritis. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499019829204. doi: 10.1177/1071100717709566.
18. Tanaka Y, Takakura Y, Hayashi K, et al. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Br), 2006, 88(7): 909-913.
19. Haraguchi N, Ota K, Tsunoda N, et al. Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Am), 2015, 97(4): 333-339.
20. Choi GW, Lee SH, Nha KW, et al. Effect of combined fibular osteotomy on the pressure of the tibiotalar and talofibular joints in supramalleolar osteotomy of the ankle: A cadaveric study. J Foot Ankle Surg, 2017, 56(1): 59-64.
21. Stufkens SA, van Bergen CJ, Blankevoort L, et al. The role of the fibula in varus and valgus deformity of the tibia: a biomechanical study. J Bone Joint Surg (Br), 2011, 93(9): 1232-1239.
22. 赵宏谋, 梁晓军, 李毅, 等. 胫骨远端内外翻畸形对胫距关节接触的影响. 中国修复重建外科杂志, 2016, 30(7): 826-829.
23. Nha KW, Lee SH, Rhyu IJ, et al. Safe zone for medial open-wedge supramalleolar osteotomy of the ankle: A cadaveric study. Foot Ankle Int, 2016, 37(1): 102-108.

Chinese Journal of Reparative and Reconstructive Surgery

Establishment of finite element model of varus-type ankle arthritis and biomechanical analysis of different correction models for tibial anterior surface angle

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