Increased kinematic changes in ascending compared with descending biplanar cut in open wedge high tibial osteotomy—a multibody simulation
Knee Surgery and Related Research, vol. 36, pp. 35
Abstract
BACKGROUND: The ascending or descending extended biplanar tibial cut in open wedge high tibial osteotomy (owHTO) not only changes the lower limb anatomy in the coronal plane but also leads to different three-dimensional (3D) changes in the patellofemoral joint. This study aimed to perform a comprehensive analysis of the dynamic biomechanical changes in the knee joint using a multibody simulation model. METHODS: Thirteen 3D computer models derived from lower limb computer tomography scans were used for owHTO. Osteotomies with ascending or descending biplanar cut were simulated for each wedge height from 6 to 12 mm (in 1-mm intervals). Multibody simulation was used to analyze differences in patellar shift, patellar tilt, mediolateral patellar rotation, and tibiofemoral rotation during a squat simulation from 5° to 100° knee flexion. RESULTS: The main effects of an ascending compared with a descending extended biplanar cut in owHTO were characterized by an increase in lateralization of the patella and rotation, along with reduced tilt. Linear mixed models revealed statistically significant effects of both wedge height and cut variant on knee kinematics at 100° knee flexion, with the influence of the cut variant (ascending/descending) being higher on all analyzed kinematic parameters. CONCLUSIONS: Significant differences in the changes in patellofemoral shift, tilt, rotation, and tibiofemoral rotation were observed when performing owHTO with an ascending versus a descending biplanar cut. Apart from tibiofemoral rotation, the resulting kinematic changes were greater with an ascending cut.
Authors 8
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Maximilian Jörgens corresponding
LMU Klinikum · Garmisch-Partenkirchen Medical Center · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany. maximilian.joergens@med.uni-muenchen.de
Endogap, Joint Replacement Institute, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany. maximilian.joergens@med.uni-muenchen.de
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
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Affiliation as printed
Chair of Medical Engineering, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
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Berufsgenossenschaftliche Unfallklinik Murnau · Technical University of Munich
Affiliation as printed
Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
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Affiliation as printed
Chair of Medical Engineering, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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LMU Klinikum · Berufsgenossenschaftliche Unfallklinik Murnau · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
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