Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study

Abstract

Patella infera is a known complication of high tibial osteotomy (HTO) that can cause anterior knee pain due to excessive stresses associated with abnormal patellofemoral (PF) joint biomechanics. However, the translation of these abnormal biomechanics to native cartilage pressure has not been explored. The present study was designed to compare the PF contact pressures of three different HTOs in a human cadaveric model of valgus tibiofemoral correction. Nine fresh cadaveric knees underwent (1) medial opening wedge (OWHTO) with a proximal tuberosity osteotomy (PTO), (2) OWHTO with a distal tuberosity osteotomy (DTO), and (3) a lateral closing wedge (CWHTO). The specimens were mounted in a custom knee simulation rig, with muscle forces being simulated using a pulley system and weights. The PF contact pressure was recorded using an electronic pressure sensor at 15 degrees , 30 degrees , 60 degrees , 90 degrees , and 120 degrees of knee flexion, with results of the intact knees obtained as relative control. Compared to the intact knee, the DTO OWHTO and CWHTO did not significantly (P > 0.05) influence PF pressure at any flexion angle. On the other hand, PTO OWHTO lead to a significant elevation in PF cartilage pressure at 30 degrees (P < 0.05), 60 degrees (P < 0.005), and 90 degrees (P < 0.0005) knee flexion. We conclude from these results that DTO OWHTO maintains normal joint biomechanics and has no significant effect on PF cartilage pressure. In patients who complain of pre-existing anterior knee pain, DTO OWHTO or CWHTO should be considered.

Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review

“…Overcorrection of more than 6° was associated with progressive degeneration of the lateral compartment [44]. In addition, OWHTO above the tibial tubercle can have adverse effects on patellofemoral articulation [2, 45, 46]. Yim et al [17] compared OWHTO and UKA patients and reported that two cases of UKA showed patellofemoral joint OA compared to three cases of OWHTO.…”

The Effect of Medial Opening Wedge Proximal Tibial Osteotomy on Patellofemoral Contact

“…5,9,12,14,20,33 Increased contact pressures are thought to be an important factor in the degeneration of articular cartilage. 6,24,28 Recent research regarding the effects of HTO on the patellofemoral joint has shown an alteration of patellar height, 10,18,26,31,33 contact pressure, 30 and patellofemoral joint tracking. 11,15 Whereas some studies have suggested an increase in patellofemoral contact stresses with patella alta, 13,27,34 others have shown an increase, a decrease, and no change with patella infera.…”

Osteotomy at the distal third of tibial tuberosity with LCP L-buttress plate for correction of tibia vara

“…Stoffel et al [24] compared medial open wedge osteotomies that were either distal or proximal to the tuberosity and found that PF contact stress was significantly lower in the distal osteotomy group. The osteotomy site in the modified CWHTO procedure was distal to the tuberosity.…”