Purpose: The objective of this study was to quantify the effect of different loading axes
and of a valgus opening wedge high tibial osteotomy (HTO) on tibiofemoral cartilage
pressure. Methods: Six human knee specimens were tested with a load of 1000N in extension in a materials
testing machine using a specially designed fixture. Pressure in the medial and lateral
joint compartment was recorded using pressure-sensitive films. Different loading alignments
(varus, straight, and valgus) were simulated. A medial opening wedge HTO was performed
adjusting the loading axis to slight valgus. The first measurement was performed with
intact medial collateral ligament (MCL). Then the MCL was dissected gradually and
the cartilage pressure again analyzed. Results: There was a significant correlation of the load distribution with the position of
the loading axis. The medial compartment was predominantly loaded in the varus setting.
The more lateral the loading line intersected the knee, the more pressure was redistributed
laterally. The opening wedge HTO without the MCL release resulted in a significant
increase of the pressure medially (P = .002). Only after a complete release of the MCL was a significant decrease of pressure
medially observed after opening wedge HTO (P = .003). Conclusions: The position of the loading axis in the frontal plane has a strong effect on the
tibiofemoral cartilage pressure distribution of the knee. The medial compartment is
predominantly loaded in a varus knee; a neutral mechanical axis slightly loads the
lateral more than the medial compartment. In valgus alignment, the main load runs
through the lateral compartment. Clinical Relevance: A medial opening wedge HTO maintains high medial compartment pressure despite the
fact that the loading axis has been shifted into valgus. Only after complete release
of the distal fibers of the MCL does the opening wedge HTO produce a decompression
of the medial joint compartment.
Key Words
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Footnotes
Supported by a grant from the Robert Mathys Foundation.
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Copyright
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
