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Effect Of High Tibial Flexion Osteotomy On Cartilage Pressure And Joint Kinematics: A Biomechanical Study In Human Cadaveric Knees

J. Agneskirchner, C. Hurschler, C. Stukenborg-Colsman, A. Imhoff, P. Lobenhoffer
Published 2004 · Medicine

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IntroductionValgus high tibial osteotomy is an established treatment for unicompartmental varus osteoarthritis. However, only little is known about the effect of osteotomy in the sagittal plane on biomechanical parameters such as cartilage pressure and joint kinematics. This study investigated the effects of high tibial flexion osteotomy in a human cadaver model.Materials and methodsSeven fresh human cadaveric knees underwent an opening wedge osteotomy of the proximal tibia in the sagittal plane. The osteotomy was opened anteriorly, and the tibial slope of the specimen was increased gradually. An isokinetic flexion-extension motion was simulated in a kinematic knee simulator. The contact pressure and topographic pressure distribution in the medial joint space was recorded using an electronic pressure-sensitive film. Simultaneously the motion of the tibial plateau was analyzed three-dimensionally by an ultrasonic tracking system. The traction force to the quadriceps tendon which was applied by the simulator for extension of the joint was continuously measured. The experiments were carried out with intact ligaments and then after successively cutting the posterior and anterior cruciate ligaments.ResultsThe results demonstrate that tibial flexion osteotomy leads to a significant alteration in pressure distribution on the tibial plateau. The tibiofemoral contact area and contact pressure was shifted anteriorly, which led to decompression of the posterior half of the plateau. Moreover, the increase in the slope resulted in a significant anterior and superior translation of the tibial plateau with respect to the femoral condyles. Posterior subluxation of the tibial head after cutting the posterior cruciate ligament was completely neutralized by the osteotomy. The increase in slope resulted in a significant higher quadriceps strength which was necessary for full knee extension.ConclusionsWe conclude from these results that changes in tibial slope have a strong effect on cartilage pressure and kinematics of the knee. Therapeutically a flexion osteotomy may be used for decompression of the degenerated cartilage in the posterior part of the plateau, for example, after arthroscopic partial posterior meniscectomy. If a valgus osteotomy is combined with a flexion component of the proximal tibia, complex knee pathologies consisting of posteromedial cartilage damage and posterior and posterolateral instability can be addressed in one procedure, which facilitates a quicker rehabilitation of these patients.
This paper references
[Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees].
J. C. Brazier (1996)
Proximal tibial osteotomy. A critical long-term study of eighty-seven cases.
M. Coventry (1993)
Proximal tibial osteotomy
M. Ritter (1988)
Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine.
B. Slocum (1993)
[Upper tibial osteotomy for gonarthrosis in genu varum. Apropos of a series of 193 cases reviewed 6 to 10 years later].
L. Lootvoet (1993)
Ostéotomie tibiale haute de valgisation pour gonarthrose sur genu varum. A propos d'une série de 193 cas revus après 6 à 10 ans de recul.
L. Lootvoet (1993)
Korrekturosteotomie bei Primary-Varus-, Double-Varus- und Triple-Varus-Knieinstabilität mit Kreuzbandersatz
A. Imhoff (2003)
Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results.
C. Mb (1979)
Posterior slope of tibial plateau in Chinese.
K. Y. Chiu (2000)
Improvements in surgical technique of valgus high tibial osteotomy
P. Lobenhoffer (2003)
Open - wedge high tibial osteotomy with special medial plate fixator
P Lobenhoffer (2004)
[The tibial slope. Proposal for a measurement method].
P. Génin (1993)
Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair.
B. Slocum (1984)
Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.
P. Hernigou (1987)
High tibial osteotomy and cruciate ligament reconstruction for primary varus , double varus , and triple varus knee instability
AB Imhoff (2004)
[Outcome at more than 10 years of 93 tibial osteotomies for internal arthritis in genu varum (or the predominant influence of the frontal angular correction)].
D. Goutallier (1986)
The effect of simulated fracture-angulations of the tibia on cartilage pressures in the knee joint.
H. Mckellop (1991)
Posterior tibial slope in the normal and varus knee.
S. Matsuda (1999)
Revision after osteotomy for gonarthrosis. A 10-19-year follow-up of 314 cases.
S. Odenbring (1990)
Effects of Increasing Tibial Slope on the Biomechanics of the Knee
J. Robert Giffin (2004)
Tibiofemoral contact stress after total knee arthroplasty: comparison of fixed and mobile-bearing inlay designs.
C. Stukenborg-Colsman (2002)
Die öffnende valgisierende Osteotomie der proximalen Tibia mit Fixation durch einen medialen Plattenfixateur
P. Lobenhoffer (2004)
Caudal slope of the tibia and its relationship to noncontact injuries to the ACL.
K. Meister (1998)

This paper is referenced by
Sagittal Plane Corrections around the Knee
D. Dejour (2017)
Clinical Outcome of Medial Opening Wedge Osteotomy with T-Locking Plate : Two Years Follow-Up
W. Kongcharoensombat (2014)
Tibial Slope Strongly Influences Knee Stability After Posterior Cruciate Ligament Reconstruction: A Prospective 5- to 15-Year Follow-up
C. Gwinner (2017)
Open-wedge-Osteotomie: Konzept und erste Erfahrungen
J. Agneskirchner (2004)
Supervivencia y factores pronósticos de la osteotomía de valguización tibial en el tratamiento del genu varo artrósico
M. González-Panisello (2009)
Alterations in structure and properties of collagen network of osteoarthritic and repaired cartilage modify knee joint stresses
M. E. Mononen (2011)
Komplexes Kniegelenktrauma
Sam Aryee (2006)
The Menisci
R. LaPrade (2017)
Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases
Andrew S. Bernhardson (2019)
Revision nach VKB-Plastik beim Sportler
Andrea Achtnich (2018)
Stanley E Kim (2008)
The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study
E. Hohmann (2005)
Development of an Image-Free Navigation Tool for High Tibial Osteotomy
S. Lorenz (2007)
Knee osteotomy for unicompartmental knee arthritis
S. Pill (2009)
Increasing posterior tibial slope does not raise anterior cruciate ligament strain but decreases tibial rotation ability.
M. Nelitz (2013)
Outcomes of Surgery for Sagittal Instability
Stefano Pasqualotto (2020)
Effect of superficial collagen patterns and fibrillation of femoral articular cartilage on knee joint mechanics-a 3D finite element analysis.
M. E. Mononen (2012)
Computer Navigated Medial Opening Wedge High Tibial Osteotomy- Review of Literature
Kunal Dhurve (2018)
Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study
K. Stoffel (2007)
Medial Open-Wedge High Tibial Osteotomy
P. Lobenhoffer (2020)
Concepts in Managing the Patient with Post-meniscectomy Knee Pain
B. Bloch (2016)
Mid‐Term Clinical Outcome and Reconstruction of Posterior Tibial Slope after UKA
A. Franz (2019)
The Posterolateral Instability Score (PoLIS) of the knee joint: a guideline for standardized documentation, classification, and surgical decision-making
Andreas Weiler (2020)
Comparison between Closing‐Wedge and Opening‐Wedge High Tibial Osteotomy in Patients with Medial Knee Osteoarthritis: A Systematic Review and Meta‐analysis
Hao Sun (2017)
The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases.
H. El-Azab (2008)
Intercondylar Roof Inclination Angle: Is It a Risk Factor for ACL Tears or Tibial Spine Fractures?
W. Samora (2016)
On the influence of mechanical conditions on osteochondral healing
Z. Ritter (2006)
Decision making for concomitant high tibial osteotomy (HTO) in cartilage repair patients based on a nationwide cohort study of 4968 patients
S. Faber (2020)
[Update on Failure Analysis of Implants in ACL Surgery: Technical Failure or Fate?]
Lukas Münch (2019)
The role of high tibial osteotomy in the treatment of knee laxity: a comprehensive review
O. Cantin (2015)
One-Staged Open-Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction
E. Song (2009)
Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques
Kirk Kilgour (2013)
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