incongruence


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incongruence

unequal loading across articular cartilage and/or epiphyseal plate (e.g. subluxation, predisposing bone remodelling and osteoarthrosis (see Table 1)
Table 1: Bone modelling
Type of modellingComment
Chondral modelling during bone growthRate of ossification of cartilaginous precursor of bone/articular cartilage/epiphyseal plates depends on imposed load during development
Joint incongruence within normal range: load inequality across articular cartilage causes remodelling and restoration of maximal congruence, via negative-feedback loop
Joint incongruence beyond normal range: load inequality across articular cartilage causes remodelling adapting to abnormal load, and loss of maximal congruence, via positive-feedback loop
Metaphyses and epiphysesWhere abduction and adduction forces about a joint (e.g. knee) are equal, resultant transverse force across the joint is of zero magnitude
Where adductor force > abductor force:
• Soft-tissue anomaly causes soft-tissue positional genu valgum and increases force on lateral articular surface/epiphyseal areas
• Rate of bone growth at lateral areas increases; that of medial areas remains normal
• Joint congruence is restored, and the horizontal force is restored to zero magnitude, but soft-tissue genu valgum deformity persists as bone deformity
Articular surfacesMinor incongruence between articular surfaces within a synovial joint causes large changes in forces acting at different parts of articular surface, e.g.
• Absent subtalar joint inversion/eversion causes trochlear talus to undergo reactive twist within ankle mortise, and compression at articular areas remaining in contact
• Excess loading at these sites reduces local bone growth; unloaded areas continue to grow at normal rate
• Shape of articular surface gradually changes, adapting to abnormal loading pattern, and maximum congruence is achieved, but trochlea becomes rounded (rather than pulley-shaped) and ankle joint forms ball-and-socket, rather than hinge, joint
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