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The effect of distal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Intraoperative fracture of the lateral cortex fractures of the tibia is a potential complication of high tibial osteotomy (HTO), which may result in inadequate rotational alignment of the distal tibia. Our aim was to determine how rotational malalignment of the distal tibial segment distal would affect intraarticular contact pressure distribution in the knee and ankle joints.

Methods

A medial, L-shaped opening-wedge HTO was performed on seven human lower body specimens. A stainless steel device with integrated load cell was used to axially load the leg. Pressure-sensitive sensors were used to measure intraarticular contact pressures. Intraoperative changes in alignment were monitored in real time using computer navigation. Measurements were performed in the native knee alignment, after 10° and 15° of alignment correction and with the distal tibia fixed at 15° of external rotation.

Results

Moderate-to-large alignment changes after medial opening-wedge HTO resulted in a shift in intraarticular contact pressures from the medial compartment of the knee towards the lateral compartment. However, fixation of the distal tibial segment at 15° of external rotation neutralized this intended beneficial effect. In the ankle, external rotation of the distal tibia also caused a reduction in contact pressures and tibiotalar contact area.

Conclusion

Malrotation of the distal tibial fragment negates the intended effect of offloading the diseased compartment of the knee, with the contact pressures remaining similar to those of the native knee. Furthermore, malrotation leads to abnormal ankle contact pressures. Care should be taken to ensure appropriate rotational alignment of the distal tibial segment during intraoperative fixation of HTO procedures.

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References

  1. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124(9):575–584

    Article  CAS  PubMed  Google Scholar 

  2. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23(8):852–861

    Article  PubMed  Google Scholar 

  3. Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20(3):586–593

    Article  CAS  PubMed  Google Scholar 

  4. Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):197–205

    Article  PubMed  Google Scholar 

  5. Fening SD, Kovacic J, Kambic H, McLean S, Scott J, Miniaci A (2008) The effects of modified posterior tibial slope on anterior cruciate ligament strain and knee kinematics: a human cadaveric study. J Knee Surg 21(3):205–211

    Article  PubMed  PubMed Central  Google Scholar 

  6. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21(1):170–180

    Article  PubMed  Google Scholar 

  7. Giffin JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD (2007) Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 35(9):1443–1449

    Article  PubMed  Google Scholar 

  8. Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382

    Article  PubMed  Google Scholar 

  9. Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW (2013) A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 21(1):90–95

    Article  CAS  PubMed  Google Scholar 

  10. Javidan P, Adamson GJ, Miller JR, Durand P Jr, Dawson PA, Pink MM, Lee TQ (2013) The effect of medial opening wedge proximal tibial osteotomy on patellofemoral contact. Am J Sports Med 41(1):80–86

    Article  PubMed  Google Scholar 

  11. Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, Krettek C, Hufner T (2008) Navigated lower limb axis measurements: influence of mechanical weight-bearing simulation. J Orthop Res 26(4):553–561

    Article  PubMed  Google Scholar 

  12. Liodakis E, Kenawey M, Liodaki E, Mommsen P, Krettek C, Hankemeier S (2010) The axis-board: an alternative to the cable technique for intraoperative assessment of lower limb alignment. Technol Health Care 18(3):165–171

    CAS  PubMed  Google Scholar 

  13. Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Der Orthopade 33(2):153–160

    Article  CAS  PubMed  Google Scholar 

  14. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138

    Article  PubMed  Google Scholar 

  15. Martin R, Birmingham TB, Willits K, Litchfield R, Lebel ME, Giffin JR (2014) Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Am J Sports Med 42(5):1118–1126

    Article  PubMed  Google Scholar 

  16. McKellop HA, Sigholm G, Redfern FC, Doyle B, Sarmiento A, Luck JV Sr (1991) The effect of simulated fracture-angulations of the tibia on cartilage pressures in the knee joint. J Bone Joint Surg Am 73(9):1382–1391

    Article  CAS  PubMed  Google Scholar 

  17. Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646

    Article  PubMed  Google Scholar 

  18. Mina C, Garrett WE Jr, Pietrobon R, Glisson R, Higgins L (2008) High tibial osteotomy for unloading osteochondral defects in the medial compartment of the knee. Am J Sports Med 36(5):949–955

    Article  PubMed  Google Scholar 

  19. Pape D, Duchow J, Rupp S, Seil R, Kohn D (2006) Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy. A human cadaver study evaluating medial joint opening by stress radiography. Knee Surg Sports Traumatol Arthrosc 14(2):141–148

    Article  PubMed  Google Scholar 

  20. Pape D, Kohn D, van Giffen N, Hoffmann A, Seil R, Lorbach O (2013) Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):82–89

    Article  CAS  PubMed  Google Scholar 

  21. Rodner CM, Adams DJ, Diaz-Doran V, Tate JP, Santangelo SA, Mazzocca AD, Arciero RA (2006) Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med 34(9):1431–1441

    Article  PubMed  Google Scholar 

  22. Stoffel K, Willers C, Korshid O, Kuster M (2007) Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 15(9):1094–1100

    Article  PubMed  Google Scholar 

  23. Suero EM, Sabbagh Y, Westphal R, Hawi N, Citak M, Wahl FM, Krettek C, Liodakis E (2014) Effect of medial opening wedge high tibial osteotomy on intraarticular knee and ankle contact pressures. J Orthop Res. doi:10.1002/jor.22793

    Google Scholar 

  24. Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94

    Article  PubMed  Google Scholar 

  25. Tarr RR, Resnick CT, Wagner KS, Sarmiento A (1985) Changes in tibiotalar joint contact areas following experimentally induced tibial angular deformities. Clin Orthop Relat Res 199:72–80

    Google Scholar 

  26. van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA (2008) Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop 79(4):508–514

    Article  PubMed  Google Scholar 

  27. Voos JE, Suero EM, Citak M, Petrigliano FP, Bosscher MR, Wickiewicz TL, Pearle AD (2012) Effect of tibial slope on the stability of the anterior cruciate ligament-deficient knee. Knee Surg Sports Traumatol Arthrosc 20(8):1626–1631

    Article  PubMed  Google Scholar 

  28. Yazdi H, Mallakzadeh M, Sadat Farshidfar S, Givehchian B, Daneshparvar H, Behensky H (2014) The effect of tibial rotation on knee medial and lateral compartment contact pressure. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3321-x

    PubMed  Google Scholar 

Download references

Acknowledgments

None of the authors have any professional or financial affiliations that could have biased this study. Funding awarded by the German Research Foundation (DFG) was used to construct the device used for axially loading the limb and the computer interface used to monitor changes in the knee joint during the experiments. Funding awarded by the Robert Mathys Foundation (RMS) was used for all materials required for performing the surgeries and for performing ankle measurements.

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Author notes

    Authors and Affiliations

    1. Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

      Eduardo M. Suero, Nael Hawi, Yaman Sabbagh, Musa Citak, Christian Krettek & Emmanouil Liodakis

    2. Institute for Robotics and Process Control, Braunschweig University of Technology, Brunswick, Germany

      Ralf Westphal & Friedrich M. Wahl

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    1. Eduardo M. Suero
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    2. Nael Hawi
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    8. Emmanouil Liodakis
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    Correspondence to Eduardo M. Suero.

    Additional information

    Eduardo M. Suero and Nael Hawi have contributed equally to this work.

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    Suero, E.M., Hawi, N., Westphal, R. et al. The effect of distal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints. Knee Surg Sports Traumatol Arthrosc 25, 299–305 (2017). https://doi.org/10.1007/s00167-015-3553-4

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