Opening wedge high tibial osteotomy: plate position and biomechanics of the medial tibial plateau |
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Authors: | Pilar Martinez de Albornoz Manuel Leyes Francisco Forriol Angelo Del Buono Nicola Maffulli |
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Institution: | 1. Hospital de Torrejón, C/Mateo Inurria s/n, 28850, Madrid, Spain 2. Clínica Cemtro, Madrid, Spain 3. School of Medicine, CEU San Pablo University, Madrid, Spain 4. Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy 5. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK 6. Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy
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Abstract: | Purpose To ascertain whether changing position and size of the spacer may modify the load and displacement of the tibial plateau when performing an opening wedge high tibial osteotomy. Methods Fifteen sawbones tibia models were used. In the axial plane, the anterior, medial, and posterior thirds of the tibial plateau were marked, and the medial and posterior thirds were called “point 1” and “point 2”, respectively. A 7.5-mm-stainless steel indenter was used to apply the load over these two points: the load applied to point 1 simulated the load to that site when the knee was extended, and the load to point 2 simulated the load to the same area when the knee was flexed. Maximum load (N) and displacement (mm) were calculated. Results The system was shown to withstand higher loads with less displacement when the plate was posterior than it could do with the plate in the middle position. Significant differences were also found when comparing the anterior and middle position of the plate with the greatest displacement when the plate was anterior. The differences were increased when comparing the anterior and posterior positions of the plate. No statistical differences (n.s.) were found when using different spacers. The maximum stiffness was achieved if the plate was posterior and in point 1 indenter position, in which the force vector stands on the points of the lateral and medial supports (Fμ = 198.8 ± 61.5 N). The lowest stiffness was observed when the plate was anterior, and the force was applied to point 2 (Fμ = 29.7 ± 5.1 N). Conclusions Application of the plate in a more posterior position provides greater stability. |
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