Knee joint reaction force during tibial diaphyseal lengthening: a study on a rabbit model.

The in vivo passive knee joint reaction force was measured in a rabbit model of tibial diaphyseal lengthening. This was based on the assumption that limb lengthening creates soft tissue tension that compresses the joint surface and generates the joint contact force. A measurement method was developed that involved the distraction of the joint and the determination of the distraction force that just separates the joint surfaces. Sixteen immature (mean+/-SD age=9+/-0.6 weeks) New Zealand White rabbits underwent 30% (left) tibial diaphyseal lengthening at a rate of two 0.4mm incremental lengthenings per day. The knee joint reaction force was measured at the end of lengthening (8 rabbits, mean+/-SD age=14+/-0.6 weeks) and five weeks after lengthening (8 rabbits, mean+/-SD age=19+/-0.7 weeks). An instrumented bilateral distractor and an extensometer were fixed cross the knee joint. The joint distraction force and distraction displacement were measured when the joint was distracted in steps and after the section of the Achilles tendon. The joint reaction force on the lengthened side was significantly higher than the control side at both time points (mean+/-SD 44.4+/-7.8 N v. 27.2+/-4.0 N at the end of lengthening, 44.3+/-S6.5 N v. 31.3+/-3.0 N at 5 weeks after lengthening). The contribution of the gastrocnemius to the joint reaction force on the lengthened side was also significantly higher than the control side at both time points (mean+/-SD 9.0+/-1.3N v. 2.8+/-0.8 N at the end of lengthening, 5.3+/-1.4N v. 2.7+/-0.5N at 5 weeks after lengthening). There were significant knee and ankle joint contractures at the end of lengthening, as evidenced by decreased range of motion (mean+/-SD 27+/-8 degrees and 36+/-13 degrees, respectively), which remained 5 weeks after lengthening (mean+/-SD 26+/-6 degrees and 35+/-8 degrees, respectively). The gastrocnemius contributed about 20% of the joint reaction force, indicating that changes in the other intra- and extra-articular structures due to joint contracture may be more important in generating the joint reaction force.