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Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage

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



The purpose of this study was to analyse the resultant stress induced by joint-line obliquity after HTO for varus knee deformity using a three-dimensional (3D) finite element model analysis.


The geometrical bone data used in this study were derived from commercially available human bone digital anatomy media. The 3D knee models were developed using 3D computer-aided design software. The articular surface was overlaid with a 2-mm-thick cartilage layer for both femoral and tibial condyles. Ligament structures were simulated based on properties reported in previous anatomical studies. Regarding the loading condition, isolated axial loads of 1200 N with lateral joint-line inclinations of 2.5°, 5°, 7.5°, and 10° in reference to the horizontal axis were applied to the femur to simulate the mechanical environment in a knee with joint-line obliquity.


A steep rise of shear stress in the medial compartment was noted in the model with obliquity of 5° or more. This laterally directed shear stress exhibited an incremental increase in accordance with the obliquity angle. The maximum shear stress value in the medial cartilage increased from 1.6 MPa for the normal knee to 3.3, 5.2, and 7.2 MPa in the joint-line obliquity models with 5°, 7.5°, and 10° of obliquity, respectively.


The effects of HTO for varus knee deformity on the amount/distribution of stresses in the articular cartilage were analysed using a 3D finite element model. It was shown that joint-line obliquity of more than 5° induced excessive shear stress in the tibial articular cartilage. A large amount of correction in OWHTO with a resultant joint-line obliquity of 5° or more may induce detrimental stress to the articular cartilage. Double-level osteotomy should be considered as a surgical option in this situation.

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Correspondence to Masaru Higa.

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The authors have no conflict of interest.


No funding was received for this study.

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The design of this study was approved by the Review Board of Hyogo College of Medicine (No. 2218).

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Nakayama, H., Schröter, S., Yamamoto, C. et al. Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthrosc 26, 1873–1878 (2018).

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