Download PDF
J Knee Surg 2011; 24(1): 045-054
DOI: 10.1055/s-0031-1275401
ORIGINAL ARTICLE

© Thieme Medical Publishers

Biomechanical Evaluation of a High Tibial Osteotomy with a Meniscal Transplant

Geoffrey S. Van Thiel1 , Rachel M. Frank1 , Aman Gupta3 , Neil Ghodadra1 , Elizabeth F. Shewman3 , Vincent M. Wang2 , Bernard R. Bach1 , Nihkil N. Verma4 , Brian J. Cole1 , Matthew T. Provencher1
  • 1Division of Sports Medicine, Department of Orthopedics, University of Illinois, Chicago, Illinois
  • 2Sports Research Laboratory, Rush University Medical Center, Chicago, Illinois
  • 3Department of Biomechanics, University of Illinois, Chicago, Illinois
  • 4Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California
Further Information

Publication History

Publication Date:
25 March 2011 (online)

    Permissions and Reprints

ABSTRACT

This study determines the biomechanical advantage and the optimal configuration of a high tibial osteotomy (HTO) and meniscus transplantation performed concurrently. Six cadaver knees were placed in a spatial frame, and an HTO was completed. Loading points between a mechanical 6 degrees of varus and 8 degrees of valgus were loaded to 800 N for medial meniscal intact, meniscectomized, and transplanted states. Posterior slope was also increased by 3 degrees in these specimens. Contact data was recorded. Peak pressures significantly increased in the meniscectomized state in every degree of varus/valgus (p < 0.05). For both peak and total medial compartment pressures, there was a significant drop (p < 0.001) between neutral and 3 degrees of valgus. Lateral compartment pressures linearly increased from varus to valgus orientation. There was no significant change in the pressure profile of the knee with a 3-degree increase in posterior slope. This biomechanical study confirms the hypothesis that an HTO improves the peak pressures in the medial compartment at all degrees of varus/valgus alignment in the setting of meniscal transplantation. Furthermore, the largest decrease in medial pressures was between neutral and 3 degrees of valgus, suggesting that perhaps neutral aligned knees could benefit from an HTO.

KEYWORDS

Meniscus - transplant - tibial - osteotomy - high

REFERENCES

  • 1 Paletta Jr G A, Manning T, Snell E, Parker R, Bergfeld J. The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee. A biomechanical study.  Am J Sports Med. 1997;  25 692-698
    CrossrefPubMedGoogle Scholar
  • 2 Fairbank T J. Knee joint changes after meniscectomy.  J Bone Joint Surg Br. 1948;  30 664-670
    PubMedGoogle Scholar
  • 3 Alford J W, Lewis P, Kang R W, Cole B J. Rapid progression of chondral disease in the lateral compartment of the knee following meniscectomy.  Arthroscopy. 2005;  21 1505-1509
    CrossrefPubMedGoogle Scholar
  • 4 De Boer H H, Koudstaal J. The fate of meniscus cartilage after transplantation of cryopreserved nontissue-antigen-matched allograft. A case report.  Clin Orthop Relat Res. 1991;  (266) 145-151
    PubMedGoogle Scholar
  • 5 Aagaard H, Jörgensen U, Bojsen-Möller F. Reduced degenerative articular cartilage changes after meniscal allograft transplantation in sheep.  Knee Surg Sports Traumatol Arthrosc. 1999;  7 184-191
    CrossrefPubMedGoogle Scholar
  • 6 Stollsteimer G T, Shelton W R, Dukes A, Bomboy A L. Meniscal allograft transplantation: A 1- to 5-year follow-up of 22 patients.  Arthroscopy. 2000;  16 343-347
    CrossrefPubMedGoogle Scholar
  • 7 Rodeo S A. Meniscal allografts—where do we stand?.  Am J Sports Med. 2001;  29 246-261
    PubMedGoogle Scholar
  • 8 Wirth C J, Peters G, Milachowski K A, Weismeier K G, Kohn D. Long-term results of meniscal allograft transplantation.  Am J Sports Med. 2002;  30 174-181
    CrossrefPubMedGoogle Scholar
  • 9 van Arkel E R, de Boer H H. Survival analysis of human meniscal transplantations.  J Bone Joint Surg Br. 2002;  84 227-231
    CrossrefPubMedGoogle Scholar
  • 10 Graf Jr K W, Sekiya J K, Wojtys E M. Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA . Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction: Minimum 8.5-year follow-up study.  Arthroscopy. 2004;  20 129-140
    PubMedGoogle Scholar
  • 11 Noyes F R, Barber-Westin S D. Meniscus transplantation: Indications, techniques, clinical outcomes.  Instr Course Lect. 2005;  54 341-353
    PubMedGoogle Scholar
  • 12 Rueff D, Nyland J, Kocabey Y, Chang H C, Caborn D N. Self-reported patient outcomes at a minimum of 5 years after allograft anterior cruciate ligament reconstruction with or without medial meniscus transplantation: An age-, sex-, and activity level-matched comparison in patients aged approximately 50 years.  Arthroscopy. 2006;  22 1053-1062
    CrossrefPubMedGoogle Scholar
  • 13 Verdonk R, Almqvist K F, Huysse W, Verdonk P C. Meniscal allografts: Indications and outcomes.  Sports Med Arthrosc. 2007;  15 121-125
    CrossrefPubMedGoogle Scholar
  • 14 Sekiya J K, West R V, Groff Y J, Irrgang J J, Fu F H, Harner C D. Clinical outcomes following isolated lateral meniscal allograft transplantation.  Arthroscopy. 2006;  22 771-780
    CrossrefPubMedGoogle Scholar
  • 15 Verdonk P C, Verstraete K L, Almqvist K F et al.. Meniscal allograft transplantation: Long-term clinical results with radiological and magnetic resonance imaging correlations.  Knee Surg Sports Traumatol Arthrosc. 2006;  14 694-706
    CrossrefPubMedGoogle Scholar
  • 16 Cole B J, Dennis M G, Lee S J et al.. Prospective evaluation of allograft meniscus transplantation: A minimum 2-year follow-up.  Am J Sports Med. 2006;  34 919-927
    CrossrefPubMedGoogle Scholar
  • 17 Hommen J P, Applegate G R, Del Pizzo W. Meniscus allograft transplantation: Ten-year results of cryopreserved allografts.  Arthroscopy. 2007;  23 388-393
    CrossrefPubMedGoogle Scholar
  • 18 Kim J M, Bin S I. Meniscal allograft transplantation after total meniscectomy of torn discoid lateral meniscus.  Arthroscopy. 2006;  22 1344-1350, e1
    CrossrefPubMedGoogle Scholar
  • 19 Lubowitz J H, Verdonk P C, Reid III J B, Verdonk R. Meniscus allograft transplantation: A current concepts review.  Knee Surg Sports Traumatol Arthrosc. 2007;  15 476-492
    CrossrefPubMedGoogle Scholar
  • 20 Rijk P C. Meniscal allograft transplantation—part I: Background, results, graft selection and preservation, and surgical considerations.  Arthroscopy. 2004;  20 728-743
    PubMedGoogle Scholar
  • 21 Minas T. The role of cartilage repair techniques, including chondrocyte transplantation, in focal chondral knee damage.  Instr Course Lect. 1999;  48 629-643
    PubMedGoogle Scholar
  • 22 Minas T. Autologous chondrocyte implantation in the arthritic knee.  Orthopedics. 2003;  26 945-947
    PubMedGoogle Scholar
  • 23 Peters G, Wirth C J. The current state of meniscal allograft transplantation and replacement.  Knee. 2003;  10 19-31
    CrossrefPubMedGoogle Scholar
  • 24 Verdonk P C, Demurie A, Almqvist K F, Veys E M, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases.  J Bone Joint Surg Am. 2005;  87 715-724
    CrossrefPubMedGoogle Scholar
  • 25 Amendola A, Panarella L. High tibial osteotomy for the treatment of unicompartmental arthritis of the knee.  Orthop Clin North Am. 2005;  36 497-504
    CrossrefPubMedGoogle Scholar
  • 26 Coventry M B, Ilstrup D M, Wallrichs S L. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases.  J Bone Joint Surg Am. 1993;  75 196-201
    CrossrefPubMedGoogle Scholar
  • 27 Dowd G S, Somayaji H S, Uthukuri M. High tibial osteotomy for medial compartment osteoarthritis.  Knee. 2006;  13 87-92
    CrossrefPubMedGoogle Scholar
  • 28 Koshino T, Wada S, Ara Y, Saito T. Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee.  Knee. 2003;  10 229-236
    CrossrefPubMedGoogle Scholar
  • 29 Verma N N, Kolb E, Cole B J et al.. The effects of medial meniscal transplantation techniques on intra-articular contact pressures.  J Knee Surg. 2008;  21 20-26
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Wirth C J, Milachowski K A, Weismeier K. Meniscus refixation and transplantation.  Langenbecks Arch Chir. 1987;  372 269-271
    CrossrefPubMedGoogle Scholar
  • 31 Milachowski K A, Weismeier K, Wirth C J. Homologous meniscus transplantation. Experimental and clinical results.  Int Orthop. 1989;  13 1-11
    PubMedGoogle Scholar
  • 32 Coventry M B. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report.  J Bone Joint Surg Am. 1965;  47 984-990
    PubMedGoogle Scholar
  • 33 van Arkel E R, Goei R, de Ploeg I, de Boer H H. Meniscal allografts: Evaluation with magnetic resonance imaging and correlation with arthroscopy.  Arthroscopy. 2000;  16 517-521
    CrossrefPubMedGoogle Scholar
  • 34 van Arkel E R, de Boer H H. Human meniscal transplantation. Preliminary results at 2 to 5-year follow-up.  J Bone Joint Surg Br. 1995;  77 589-595
    PubMedGoogle Scholar
  • 35 de Boer H H, Koudstaal J. Failed meniscus transplantation. A report of three cases.  Clin Orthop Relat Res. 1994;  (306) 155-162
    PubMedGoogle Scholar
  • 36 Cameron J C, Saha S. Meniscal allograft transplantation for unicompartmental arthritis of the knee.  Clin Orthop Relat Res. 1997;  (337) 164-171
    PubMedGoogle Scholar
  • 37 El-Azab H, Halawa A, Anetzberger H, Imhoff A B, Hinterwimmer S. The effect of closed- and open-wedge high tibial osteotomy on tibial slope: A retrospective radiological review of 120 cases.  J Bone Joint Surg Br. 2008;  90 1193-1197
    CrossrefPubMedGoogle Scholar
  • 38 Marti C B, Gautier E, Wachtl S W, Jakob R P. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy.  Arthroscopy. 2004;  20 366-372
    CrossrefPubMedGoogle Scholar
  • 39 Agneskirchner J D, Hurschler C, Stukenborg-Colsman C, Imhoff A B, Lobenhoffer P. 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. 2004;  124 575-584
    CrossrefPubMedGoogle Scholar
  • 40 Rodner C M, Adams D J, Diaz-Doran V et al.. Medial opening wedge tibial osteotomy and the sagittal plane: The effect of increasing tibial slope on tibiofemoral contact pressure.  Am J Sports Med. 2006;  34 1431-1441
    CrossrefPubMedGoogle Scholar
  • 41 Mina C, Garrett Jr W E, Pietrobon R, Glisson R, Higgins L. High tibial osteotomy for unloading osteochondral defects in the medial compartment of the knee.  Am J Sports Med. 2008;  36 949-955
    CrossrefPubMedGoogle Scholar

Geoffrey S Van ThielM.D. M.B.A. 

Division of Sports Medicine, Department of Orthopedics, Rush University Medical Center

1611 W. Harrison Street, 2nd Floor, Chicago, IL 60612

Email: Geoffrey_vanthiel@rush.edu

      >