The Effect of Lateral Opening Wedge Distal Femoral Varus Osteotomy on Tibiofemoral Contact Mechanics Through Knee Flexion

Wylie, James D.; Scheiderer, Bastian; Obopilwe, Elifho; Baldino, Joshua B.; Pavano, Colin; Macken, Craig; Bell, Ryan; Mazzocca, Augustus D.; Arciero, Robert A.; Imhoff, Florian B.

doi:10.1177/0363546518799353

Cited by 28 publications

(23 citation statements)

References 18 publications

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“…After a mean follow-up of 40 months, the authors reported clinical improvement and accurate correction [ 51 ]. However, from a biomechanical point of view, it must be noted, that DFO decreases tibiofemoral contact pressure more effectively in extension compared with increasing angles of knee flexion [ 53 ]. Based on knowledge of total knee arthroplasty, HTO should decrease tibiofemoral contact pressure throughout flexion angles [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, from a biomechanical point of view, it must be noted, that DFO decreases tibiofemoral contact pressure more effectively in extension compared with increasing angles of knee flexion [ 53 ]. Based on knowledge of total knee arthroplasty, HTO should decrease tibiofemoral contact pressure throughout flexion angles [ 53 ]. Therefore, it remains unknown whether DFO is as effective as HTO.…”

Section: Discussionmentioning

confidence: 99%

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Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided

Feucht

Winkler

Mehl

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To perform a detailed deformity analysis of patients with varus alignment and to define the ideal osteotomy level (tibial vs. femoral vs. double level) to avoid an oblique joint line. Methods A total of 303 digital full-leg standing radiographs of patients aged 18-60 years and varus alignment [mechanical tibiofemoral varus angle (mFTA) ≥ 3°] were included. All legs were analyzed regarding mFTA, mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal femur angle (mLDFA), and joint line convergence angle. Based on mFTA, varus alignment was categorized as "mild" (3°-5°), "moderate" (6°-8°), or "severe" (≥ 9°). Deformity location was determined according to the malalignment test described by Paley. Two osteotomy simulations were performed with different upper limits for mMPTA: anatomic correction (mMPTA ≤ 90°, mLDFA ≥ 85°) and overcorrection (mMPTA ≤ 95°, mLDFA ≥ 85°). If a single osteotomy exceeded these limits at the intended mFTA of 2° valgus, a double-level osteotomy was simulated. If even a double-level osteotomy resulted in deviations from the defined limits, the leg was categorized as "uncorrectable". Results Mean mFTA was 6° ± 11° of varus (range 3°-15°). A tibial deformity was observed in 28%, a femoral deformity in 23%, a combined tibial and femoral deformity in 4%, and no bony deformity in 45%. The prevalence of a tibial deformity did not differ between varus severity groups, whereas a femoral and bifocal deformity was significantly more prevalent in knees with more distinct varus (p < 0.001). Osteotomy simulation revealed that isolated high tibial osteotomy (HTO) was appropriate in only 12% for anatomic correction, whereas a double-level osteotomy was necessary in 63%. If overcorrection of mMPTA was tolerated, the number of HTOs significantly increased to 57% (p < 0.001), whereas the number of doublelevel osteotomies significantly decreased to 33% (p < 0.001). Isolated DFO was considered ideal in 8% for both simulations. Significantly more knees were considered "uncorrectable" by simulating anatomic correction (18 vs. 2%; p < 0.001). A double-level osteotomy was significantly more often necessary in knees with "severe" varus (p < 0.001). Conclusion Less than one-third of patients (28%) with mechanical varus ≥ 3° have a tibial deformity. If anatomic correction (mMPTA ≤ 90°) is intended, only 12% of patients can be corrected via isolated HTO, whereas 63% of patients require a double-level osteotomy. If slight overcorrection is accepted (mMPTA ≤ 95°), 57% of patients can be corrected via isolated HTO, whereas 33% of patients would still require a double-level osteotomy. Level of evidence III, cross-sectional study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided

Feucht

Winkler

Mehl

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“… 20 Realignment osteotomies are most commonly used in the treatment of osteoarthritis, to shift the weightbearing axis from a diseased articular surface to healthy areas. Osteotomies are also a good option to correct bony deformities and normalize biomechanical properties, such as reduction of locally elevated contact forces, of the knee in patients with congenital or postfracture deformity 1 , 39 or after ligament reconstruction, meniscal transplant, or chondral resurfacing surgery in adversely aligned lower limbs.…”

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confidence: 99%

Knee Joint Line Obliquity Causes Tibiofemoral Subluxation That Alters Contact Areas and Meniscal Loading

et al. 2021

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Background: Little scientific evidence is available regarding the effect of knee joint line obliquity (JLO) before and after coronal realignment osteotomy. Hypotheses: Higher JLO would lead to abnormal relative position of the femur on the tibia, a shift of the joint contact areas, and elevated joint contact pressures. Study Design: Descriptive laboratory study. Methods: 10 fresh-frozen human cadaveric knees (age, 59 ± 5 years) were axially loaded to 1500 N in a materials testing machine with the joint line tilted 0°, 4°, 8°, and 12° varus (“downhill” medially) and valgus, at 0° and 20° of knee flexion. The mechanical compression axis was aligned to the center of the tibial plateau. Contact pressure and contact area were recorded by pressure sensors inserted between the tibia and femur below the menisci. Changes in relative femoral and tibial position in the coronal plane were obtained by an optical tracking system. Results: Both medial and lateral JLO caused significant tibiofemoral subluxation and pressure distribution changes. Medial (varus) JLO caused the femur to subluxate medially down the coronal slope of the tibial plateau, and vice versa for lateral (valgus) downslopes ( P < .01), giving a 6-mm range of subluxation. The areas of peak pressure moved 12 mm and 8 mm across the medial and lateral condyles, onto the downhill meniscus and the “uphill” tibial spine. Changes in JLO had only small effects on maximum contact pressures. Conclusion: A 4° change of JLO during load bearing caused significant mediolateral tibiofemoral subluxation. The femur slid down the slope of the tibial plateau to abut the tibial eminence and also to rest on the downhill meniscus. This caused large movements of the tibiofemoral contact pressures across each compartment. Clinical Relevance: These results provide important information for understanding the consequences of creating coronal JLO and for clinical practice in terms of osteotomy planning regarding the effect on JLO. This information provides guidance regarding the choice of single- or double-level osteotomy. Excessive JLO alteration may cause abnormal tibiofemoral joint articulation and chondral or meniscal loading.

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“…A femoral-based osteotomy will preferentially affect joint contact forces in extension with less effect at higher knee flexion angles and no effect at 90 or beyond. 10 In these cases, as well as cases with a primary valgus deformity within the tibia, our preference is to perform a tibial based osteotomy. Other complications inherent to osteotomy procedures include nonunion, malunion, wound complications, infection, thromboembolism, stiffness, and painful hardware requiring reoperation.…”

Section: Discussionmentioning

confidence: 99%

Technique for Biplanar Lateral Opening Wedge Distal Femoral Osteotomy in the Valgus Knee

Duerr

Harangody

Magnussen

et al. 2020

Arthroscopy Techniques

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Valgus malalignment can be corrected with a biplanar lateral opening wedge distal femoral osteotomy (bLOWDFO) in patients with symptomatic lateral compartment disease. Advantages of a lateral opening wedge technique over the medial closing wedge technique include avoidance of vascular structures and theoretically better control of the amount of correction. The advantages of a bLOWDFO over a uniplanar osteotomy are that it creates a larger surface area for healing, and provides inherent stability to control the osteotomy intraoperatively. The purpose of this article is to present a reproducible technique for bLOWDFO and review the indications, preoperative planning, rationale, and clinical outcomes.

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The Effect of Lateral Opening Wedge Distal Femoral Varus Osteotomy on Tibiofemoral Contact Mechanics Through Knee Flexion

Cited by 28 publications

References 18 publications

Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided

Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided

Knee Joint Line Obliquity Causes Tibiofemoral Subluxation That Alters Contact Areas and Meniscal Loading

Technique for Biplanar Lateral Opening Wedge Distal Femoral Osteotomy in the Valgus Knee

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