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Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study

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

Abstract

Patella infera is a known complication of high tibial osteotomy (HTO) that can cause anterior knee pain due to excessive stresses associated with abnormal patellofemoral (PF) joint biomechanics. However, the translation of these abnormal biomechanics to native cartilage pressure has not been explored. The present study was designed to compare the PF contact pressures of three different HTOs in a human cadaveric model of valgus tibiofemoral correction. Nine fresh cadaveric knees underwent (1) medial opening wedge (OWHTO) with a proximal tuberosity osteotomy (PTO), (2) OWHTO with a distal tuberosity osteotomy (DTO), and (3) a lateral closing wedge (CWHTO). The specimens were mounted in a custom knee simulation rig, with muscle forces being simulated using a pulley system and weights. The PF contact pressure was recorded using an electronic pressure sensor at 15°, 30°, 60°, 90°, and 120° of knee flexion, with results of the intact knees obtained as relative control. Compared to the intact knee, the DTO OWHTO and CWHTO did not significantly (P > 0.05) influence PF pressure at any flexion angle. On the other hand, PTO OWHTO lead to a significant elevation in PF cartilage pressure at 30° (P < 0.05), 60° (P < 0.005), and 90° (P < 0.0005) knee flexion. We conclude from these results that DTO OWHTO maintains normal joint biomechanics and has no significant effect on PF cartilage pressure. In patients who complain of pre-existing anterior knee pain, DTO OWHTO or CWHTO should be considered.

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Authors and Affiliations

  1. Fremantle Orthopaedic Department, University of Western Australia, Fremantle Hospital, Alma Street, B Block, Level 6, Fremantle, WA, 6160, Australia

    Karl Stoffel, Omar Korshid & Markus Kuster

  2. Department of Orthopaedic Surgery, School of Surgery and Pathology, University of Western Australia, QE2 Medical Centre, Nedlands, WA, 6009, Australia

    Craig Willers

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  1. Karl Stoffel
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  2. Craig Willers
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  3. Omar Korshid
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Correspondence to Karl Stoffel.

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Stoffel, K., Willers, C., Korshid, O. et al. Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthr 15, 1094–1100 (2007). https://doi.org/10.1007/s00167-007-0297-9

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