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This Article Full Text Full Text (PDF) All Versions of this Article: 34/9/1431    most recent 0363546506287297v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Rodner, C. M. Articles by Arciero, R. A. Search for Related Content PubMed PubMed Citation Articles by Rodner, C. M. Articles by Arciero, R. A. Related Collections Knee Operative

Medial Opening Wedge Tibial Osteotomy and the Sagittal Plane

The Effect of Increasing Tibial Slope on Tibiofemoral Contact Pressure

From the Department of Orthopaedics, University of Connecticut Health Center, Farmington, Connecticut

^* Address correspondence to Robert A. Arciero, MD, Department of Orthopaedics, Medical Arts and Research Building, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 (e-mail: arciero{at}nso.uchc.edu).

Background: Altering the tibial slope in an anterior cruciate ligament–deficient knee has been shown to affect anterior-posterior tibial translation. The effects on articular contact pressure of altering tibial slope during a high tibial osteotomy are unknown.

Hypotheses: Performing an opening wedge osteotomy anterior to the midaxial line will increase tibial slope. Increasing tibial slope with a high tibial osteotomy in an anterior cruciate ligament–deficient knee redistributes tibiofemoral joint contact pressures onto the posterior tibial plateau.

Study Design: Controlled laboratory study.

Methods: Medial opening wedge high tibial osteotomies were performed, and a plate fixation with a known diameter inset was placed along the medial tibia in an anterior position and a posterior position on 9 cadaveric knees. Medial and lateral tibiofemoral contact pressures were measured at the resulting 2 different tibial slopes in both ligament-intact and ligament-deficient states using thin electronic sensors.

Results: Anterior plate application resulted in an increase in posterior tibial slope by an average of 6.6° (P < .001) compared with posterior plate placement. After medial opening wedge high tibial osteotomy, the mean peak lateral tibiofemoral contact pressure (3.4 MPa) was significantly greater (P = .002) than was the mean peak medial pressure (2.6 MPa). In ligament-intact specimens, altering the tibial slope did not significantly shift peak contact pressures. However, in ligament-deficient knees, increasing tibial slope by an average of 5.5° significantly redistributed the location of peak intra-articular pressure, shifting it posteriorly by 24% (P = .003).

Conclusion: Increasing tibial slope in anterior cruciate ligament–deficient knees with a high tibial osteotomy redistributes pressure into the posterior tibial plateau.

Clinical Relevance: In knees with chronic anterior cruciate ligament deficiency, posteromedial compartment degeneration is observed. Inadvertent redistribution of contact pressure into this area may be a cause of pain and premature clinical failure after medial opening wedge tibial osteotomy.

Key Words: knee • high tibial osteotomy (HTO) • anterior cruciate ligament (ACL) • tibial slope

This article has been cited by other articles:

				J. R. Giffin, K. J. Stabile, T. Zantop, T. M. Vogrin, S. L-Y. Woo, and C. D. Harner Importance of Tibial Slope for Stability of the Posterior Cruciate Ligament Deficient Knee Am. J. Sports Med., September 1, 2007; 35(9): 1443 - 1449. [Abstract] [Full Text] [PDF]

				J. D. Agneskirchner, P. Lobenhoffer, R. A. Arciero, C. M. Rodner, and D. J. Adams Letters to the Editor * Authors' Response Am. J. Sports Med., March 1, 2007; 35(3): 494 - 496. [Full Text] [PDF]